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Richard J Rodeheffer

Publications and source records attributed to Richard J Rodeheffer.

At least 37 records · Page 2Linked to original sources
PubMed2004

Measuring plasma B-type natriuretic peptide in heart failure: good to go in 2004?

Elevated plasma brain natriuretic (BNP) concentrations correlate with increased cardiac filling pressures. Therefore, increased BNP has been proposed as a marker for asymptomatic ventricular dysfunction, as an aid in the diagnosis of cardiac dyspnea, as an end point to assess the efficacy of heart failure therapy, and as a prognostic marker in heart failure. An understanding of the utility of BNP requires an appreciation of the sensitivity, specificity, and diagnostic accuracy of BNP in each of these clinical situations. At this time, there is strong evidence for the value of BNP in the evaluation of dyspnea of uncertain cause. Further population studies will need to be performed to refine the application of BNP to community cohorts and to determine its clinical value and cost-effectiveness as a screening tool in the early diagnosis of ventricular dysfunction. To make optimal use of BNP for the assessment of heart failure therapy and prognosis in individual patients, physicians will require additional information on the biological variability of BNP. Studies comparing the sensitivity, specificity, and predictive value of the available BNP and N-terminal pro-BNP assays need to be conducted in each of these clinical settings.

Biomarkers↗
PubMed2004

Plasma brain natriuretic peptide to detect preclinical ventricular systolic or diastolic dysfunction: a community-based study.

BACKGROUND: Preclinical systolic or diastolic dysfunction is associated with increased morbidity and mortality. We postulated that plasma brain natriuretic peptide (BNP) might serve as a biomarker for preclinical ventricular dysfunction (PCVD) but that the discriminatory values for BNP may vary with age and sex. METHODS AND RESULTS: We measured BNP, systolic and diastolic ventricular function, and clinical parameters in 2042 randomly selected residents of Olmsted County, Minn, aged 45 years or older. For preclinical systolic dysfunction, the areas under the receiver operating characteristics curve were higher for those with more severe (0.82 to 0.92) than any (0.51 to 0.74) systolic dysfunction and were similar in men and women and in younger and older persons. For preclinical diastolic dysfunction, the areas under the receiver operating characteristics curve were higher for those with moderate-to-severe (0.74 to 0.79) than any (0.52 to 0.68) diastolic dysfunction and were similar regardless of age or sex. Optimal discriminatory values of BNP varied with age and sex. Considering the prevalence of preclinical systolic or diastolic dysfunction and the predictive characteristics observed, using BNP to screen for PCVD would necessitate echo in 10% to 40% of those screened, with most confirmatory echocardiograms being negative, and would miss 10% to 60% of those affected. CONCLUSIONS: BNP is a suboptimal screening test for PCVD in the population.

Age Factors↗
PubMed2004

Relationship of myocardial perfusion imaging findings to outcome of patients with heart failure and suspected ischemic heart disease.

BACKGROUND: We retrospectively identified heart failure patients with suspected ischemic heart disease who underwent myocardial perfusion imaging (MPI) to examine the relationship of MPI findings to subsequent patient outcomes. METHODS: The study group consisted of 336 patients with heart failure, left ventricular ejection fraction <45%, and suspected ischemic heart disease who underwent MPI during the period of January 1991 to December 31, 1997. Patients were divided in 3 subgroups: group A (n = 137), large fixed perfusion defects; group B (n = 77), large reversible perfusion defects; and group C (n=122), absence of a large reversible or fixed perfusion defect. RESULTS: Overall, the 5-year mortality rate was high at 49.2% +/- 3.1%. Mortality was significantly different (P =.009) among the 3 subgroups. Groups A and B had a similar 5-year mortality rates >50%. Group C had a relatively better, but still substantial 5-year mortality rate of 40%. The overall revascularization rate was low (9.7% in 5 years). CONCLUSION: These results indicate a high 5-year mortality rate in patients with large myocardial perfusion defects (fixed or reversible) and presumably an ischemic etiology for their heart failure. Patients with no large or absent perfusion defects had more favorable survival outcomes.

Aged↗
PubMed2004

Defining unrecognized myocardial infarction: a call for standardized electrocardiographic diagnostic criteria.

BACKGROUND: Unrecognized myocardial infarctions (UMI) are detected by surveillance electrocardiograms (ECGs). In epidemiologic studies, different sets of ECG criteria have been used to define myocardial infarction, possibly contributing to significant differences in prevalence estimates and risk factor associations. We sought to summarize the rationale behind the various UMI-ECG definitions and to suggest an approach to develop uniform criteria. METHODS: A comprehensive review of relevant publications from 1966 to 2002 was conducted. RESULTS: Out of 14 major studies, the occurrence of UMI as a proportion of all infarctions varied from 4% to 44%, with markedly varying ECG criteria. No study directly addressed the rationale behind selection of ECG criteria. Computerized ECG analysis appears superior to visual reading due to better reliability, speed and cost while maintaining a similar predictive validity. Criteria requiring only major Q waves have the highest specificity for ECG-MI and for prediction validity for future coronary heart disease in middle-aged white men. The addition of minor Q waves and ST-T abnormalities improves predictive validity in middle-aged women and elderly men. Minor Q waves can have their diagnostic accuracy improved by several strategies, including use of ST-T wave changes, Washington Code, vector cardiogram, chronic obstructive pulmonary disease-ECG criteria, and serial ECG analysis. CONCLUSION: Currently the most cost-effective and valid method for detecting UMI in epidemiologic studies appears to be computerized ECG analysis using major Q waves in middle-aged white men. Issues needing further research include morphologic validation of ECG-UMI criteria and the influence of age, sex, and race on ECG-MI criteria.

Adult↗
PubMed2004

Participation bias in a population-based echocardiography study.

PURPOSE: To compare the characteristics of participants and non-participants in a population-based study of cardiac ventricular function. METHODS: Subjects aged 45 years and older on January 1, 1997 were recruited from a sampling frame of Olmsted County residents from the Rochester Epidemiology Project. Subjects were asked to complete a 17-page questionnaire and participate in a 4-hour clinical examination that included a brief physical examination, echocardiography, spirometry, and an electrocardiogram. With specific IRB approval, the community medical records of participants and non-participants from the first wave of recruitment were examined by trained nurse abstractors to elicit details of past medical history. RESULTS: Of the first 963 persons invited to participate in the study, 488 (51%) completed all phases of the examination. Participation rates were similar among men and women (53% vs. 49%, respectively). By age, participation rates were lowest among persons aged 75 years and older (44.7% and 34.9%) and 45 to 54 years (45.4% and 44.3%) for men and women. Participation rates were not different according to past history of coronary heart disease, congestive heart failure, or other cardiovascular disease. Persons with a history of chronic obstructive pulmonary disease were less likely to participate (19.4% vs. 51%; odds ratio, 0.36; 95% confidence interval, 0.18, 0.76) after adjustment for age, sex, and comorbid conditions. CONCLUSIONS: These results provide some reassurance that participation bias in this study may have little influence on its overall findings, although this cannot be conclusive.

Adult↗
PubMed2004

Agreement between self-report questionnaires and medical record data was substantial for diabetes, hypertension, myocardial infarction and stroke but not for heart failure.

OBJECTIVES: Questionnaires are used to estimate disease burden. Agreement between questionnaire responses and a criterion standard is important for optimal disease prevalence estimates. We measured the agreement between self-reported disease and medical record diagnosis of disease. STUDY DESIGN AND SETTING: A total of 2,037 Olmsted County, Minnesota residents > or =45 years of age were randomly selected. Questionnaires asked if subjects had ever had heart failure, diabetes, hypertension, myocardial infarction (MI), or stroke. Medical records were abstracted. RESULTS: Self-report of disease showed >90% specificity for all these diseases, but sensitivity was low for heart failure (69%) and diabetes (66%). Agreement between self-report and medical record was substantial (kappa 0.71-0.80) for diabetes, hypertension, MI, and stroke but not for heart failure (kappa 0.46). Factors associated with high total agreement by multivariate analysis were age <65 years, female sex, education >12 years, and zero Charlson Index score (P < .05). CONCLUSION: Questionnaire data are of greatest value in life-threatening, acute-onset diseases (e.g., MI and stroke) and chronic disorders requiring ongoing management (e.g.,diabetes and hypertension). They are more accurate in young women and better-educated subjects.

Age Factors↗
PubMed2003

Incidence of heart failure after myocardial infarction: is it changing over time?

Improved survival after myocardial infarction (MI) could result in MI survivors' contributing to the US heart failure epidemic. Conversely, since the severity of MI is declining over time, a decline in post-MI heart failure might also be anticipated. This study tested the hypothesis that the incidence of post-MI heart failure was declining over time in a geographically defined MI incidence cohort. Between 1979 and 1994, 1,537 patients with incident MI and no prior history of heart failure were hospitalized in Olmsted County, Minnesota. Framingham Heart Study criteria were used to ascertain the incidence of inpatient and outpatient heart failure over a mean follow-up period of 7.6 years (standard deviation 5.5). Overall, 36% of patients experienced heart failure. After adjustment for factors related to post-MI heart failure (age, hypertension, smoking, and biomarkers), the incidence of heart failure declined by 2% per year (relative risk = 0.98, 95% confidence interval: 0.96, 0.99; p = 0.01). The relative risk of developing heart failure among persons with MIs occurring in 1994 versus 1979 was 0.72 (95% confidence interval: 0.55, 0.93), indicating a 28% reduction in the incidence of heart failure. Administration of reperfusion therapy within 24 hours after MI was associated with lower risk of post-MI heart failure and accounted for most of the temporal decline in heart failure. This suggests that improved survival after MI is unlikely to be a major contributor to the heart failure epidemic.

Adult↗
PubMed2003

Left atrial volume as an index of left atrial size: a population-based study.

OBJECTIVES: We studied left atrial volume (LAV) as an index of atrial size. BACKGROUND: Increased left atrial dimension (LAD) measured by M-mode echocardiography is a risk factor for atrial fibrillation, stroke, and death. METHODS: A random sample of residents of Olmsted County, Minnesota, age > or =45 years (n = 2,042) underwent Doppler echocardiography with assessment of LAD and LAV. A subgroup of the population (n = 767) with no cardiovascular disease and normal systolic and diastolic function was used to develop reference ranges for LAD and LAV. In the total population, the prevalence of left atrial enlargement and the association between cardiovascular disease and left atrial size as determined by both indexes were assessed. RESULTS: In the normal subgroup, both indexes were associated with gender and body size, thus models controlling for body size were used to determine gender-specific reference ranges for LAD and LAV. In the total population, left atrial enlargement was common, with a prevalence of 18% (men) and 12% (women) using LAD/body surface area (BSA) and of 16% (men and women) using LAV/BSA. The agreement between the indexes was only fair (kappa = 0.53). Adjusting for age and gender, LAV/BSA was more strongly associated with the presence of cardiovascular diseases than LAD/BSA. CONCLUSIONS: We described a simple technique of measuring LAV, examined methods for indexing LAV, and described its normal range in a large, healthy reference cohort. Further, we find that in the community, left atrial enlargement is common and reflects the burden of cardiovascular disease.

Age Factors↗
PubMed2003

Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic.

CONTEXT: Approximately half of patients with overt congestive heart failure (CHF) have diastolic dysfunction without reduced ejection fraction (EF). Yet, the prevalence of diastolic dysfunction and its relation to systolic dysfunction and CHF in the community remain undefined. OBJECTIVES: To determine the prevalence of CHF and preclinical diastolic dysfunction and systolic dysfunction in the community and determine if diastolic dysfunction is predictive of all-cause mortality. DESIGN, SETTING, PARTICIPANTS: Cross-sectional survey of 2042 randomly selected residents of Olmsted County, Minnesota, aged 45 years or older from June 1997 through September 2000. MAIN OUTCOME MEASURES: Doppler echocardiographic assessment of systolic and diastolic function. Presence of CHF diagnosis by review of medical records with designation as validated CHF if Framingham criteria are satisfied. Subjects without a CHF diagnosis but with diastolic or systolic dysfunction were considered as having either preclinical diastolic or preclinical systolic dysfunction. RESULTS: The prevalence of validated CHF was 2.2% (95% confidence interval [CI], 1.6%-2.8%) with 44% having an EF higher than 50%. Overall, 20.8% (95% CI, 19.0%-22.7%) of the population had mild diastolic dysfunction, 6.6% (95% CI, 5.5%-7.8%) had moderate diastolic dysfunction, and 0.7% (95% CI, 0.3%-1.1%) had severe diastolic dysfunction with 5.6% (95% CI, 4.5%-6.7%) of the population having moderate or severe diastolic dysfunction with normal EF. The prevalence of any systolic dysfunction (EF < or =50%) was 6.0% (95% CI, 5.0%-7.1%) with moderate or severe systolic dysfunction (EF < or =40%) being present in 2.0% (95% CI, 1.4%-2.5%). CHF was much more common among those with systolic or diastolic dysfunction than in those with normal ventricular function. However, even among those with moderate or severe diastolic or systolic dysfunction, less than half had recognized CHF. In multivariate analysis, controlling for age, sex, and EF, mild diastolic dysfunction (hazard ratio, 8.31 [95% CI, 3.00-23.1], P<.001) and moderate or severe diastolic dysfunction (hazard ratio, 10.17 [95% CI, 3.28-31.0], P<.001) were predictive of all-cause mortality. CONCLUSIONS: In the community, systolic dysfunction is frequently present in individuals without recognized CHF. Furthermore, diastolic dysfunction as rigorously defined by comprehensive Doppler techniques is common, often not accompanied by recognized CHF, and associated with marked increases in all-cause mortality.

Aged↗
PubMed2003

The new epidemiology of heart failure.

In the past 5 years there has been a significant shift in the focus of heart failure epidemiology research. In the 1960 to 1995 era, persons with overt clinical heart failure were identified by assessment of typical symptoms and signs of heart failure. Recent work has gone beyond symptoms and signs, to include objective echocardiographic measurement of ventricular function. This approach has revealed that most cases of ventricular dysfunction are asymptomatic. It has also underscored the high prevalence of diastolic ventricular dysfunction in the very elderly. Nevertheless, recent data suggest that advances in heart failure therapy may be resulting in improved survival for heart failure patients in the community. Future efforts need to be directed toward early detection of ventricular dysfunction and prevention of symptomatic heart failure.

Diastole↗
PubMed2003

Prognostic implications of ejection fraction from linear echocardiographic dimensions: the Strong Heart Study.

BACKGROUND: Although echocardiography is commonly used to assess left ventricular (LV) systolic function, few data are available concerning the prognostic significance of LV ejection fraction (EF) calculated from linear echocardiographic measurements or 2-dimensional (2-D) wall motion scores in population-based samples. METHODS: Echocardiography was used in the second Strong Heart Study (SHS) examination to calculate LV EF in 2948 American Indians without prevalent coronary heart disease; 2923 had 2-D wall motion scores. RESULTS: Mildly and severely reduced LV EF occurred in 10% and 2% of participants, was associated with older age, male sex, higher systolic pressure, heart rate and markers of renal disease and inflammation. During 37 +/- 9 months follow-up, cardiovascular death occurred in 2%, 5% and 12% of participants with normal, mildly reduced and severely reduced EF; all cause mortality rates were 6%, 10% and 32% (both P <.001). In Cox proportional hazards analyses, adjusting for covariates, cardiovascular death was higher with mildly reduced EF (risk ratio [RR] 2.9, 95% CI 1.6-5.4, P =.0007) and especially with severely reduced EF (RR 6.9, 95% CI 3.0-15.9, P <.0001); all-cause mortality was increased with severe LV dysfunction (RR 4.8, 95% CI 2.8-8.1, P <.001) and marginally with mildly reduced EF (odds ratio 1.4, 95% CI 0.95-2.15, P =.08). Segmental LV dysfunction and mildly and severely reduced EF from 2-D wall motion scores were associated with 3.3-fold (95% CI 1.1-9.4, P =.02), 3.5-fold (95% CI 2.1-5.8) and 3.8-fold (95% CI 1.9-7.6) (all P <.001) increased rates of cardiovascular death. CONCLUSIONS: LV EF from linear echocardiographic measurements as well as segmental LV dysfunction and EF from 2-D wall motion scores strongly and independently predict cardiovascular mortality. Reduced EF by simple echocardiographic method has estimated population-attributable risks of about 35% for cardiovascular death and 12% for all-cause mortality in a population-based sample of middle-aged to elderly adults.

Aged↗
PubMed2003

Association of newer diastolic function parameters with age in healthy subjects: a population-based study.

OBJECTIVES: We sought to determine if newer Doppler diastolic function parameters are associated with age and to define age-stratified reference ranges for these parameters in a population-based setting. BACKGROUND: Although newer Doppler parameters aid in the evaluation of diastolic function and filling pressures, age-specific reference ranges are poorly described. METHODS: Randomly selected residents of Olmsted County, Minn, age >/= 45 years were studied (n = 2042) prospectively. Those without a history of cardiovascular disease or abnormal 2-dimensional echocardiograms were selected. Measured parameters included the transmitral early (E) and late (A) filling velocities at rest and with Valsalva, A duration, pulmonary venous atrial reversal duration, lateral and septal early diastolic mitral annular velocities, E/lateral early diastolic mitral annular velocity, E/septal early diastolic mitral annular velocity, and the index of left ventricular myocardial performance. RESULTS: A total of 1012 subjects met the inclusion criteria. Both A duration (r = 0.18, P <.001) and pulmonary venous atrial reversal duration (r = 0.28, P <.001) were longer in older subjects, whereas their difference showed a marginal correlation with age (r = 0.07, P =.036). The E/A ratio at peak Valsalva correlated with age (r = -0.54, P <.001) whereas the change in E/A with Valsalva (corrected for E-A fusion) showed a marginal correlation with age (r = 0.08, P =.032). Both E/lateral early diastolic mitral annular velocity (r = 0.39, P <.001) and E/septal early diastolic mitral annular velocity (r = 0.27, P <.001) increased with age. Left ventricular myocardial performance showed a marginal correlation with age (r = 0.08, P =.014). Age specific reference ranges (median, 5th and 95th percentiles) for all parameters are provided. CONCLUSIONS: All newer Doppler diastolic function parameters showed a variable but significant correlation with age. Age-specific reference values will aid in the interpretation of diastolic function parameters.

Age Factors↗
PubMed2003

Clinical predictors of exercise capacity 1 year after cardiac transplantation.

BACKGROUND: The exercise capacity of cardiac transplant recipients is reduced compared with normal controls. However, clinical variables predictive of post-transplant exercise capacity have not been well defined. The objective of the present study was to identify clinical features predictive of post-transplant exercise capacity. METHODS: Ninety-five cardiac transplant recipients underwent cardiopulmonary testing at 1 year after transplant. The exercise parameters were compared with both pre-transplant values and normal subjects. The relationships between exercise parameters and clinical characteristics were analyzed. RESULTS: Mean peak oxygen consumption (VO(2)) and exercise test duration at 1-year post-transplant improved significantly from 16.4 to 19.9 ml/kg/min and 5.5 to 7.6 minutes, respectively (p < 0.001), but were significantly lower than for normal controls (peak VO(2) 34.0 ml/kg/min; exercise duration 11.2 minutes; p < 0.001). Age- and gender-adjusted VO(2) was 54% of predicted. Pre-operative body weight correlated strongly with post-transplant weight (r = 0.80, p < 0.001). Significant recipient predictors of 1-year post-transplant peak VO(2) identified by multivariate regression analysis were age, male gender, body mass index, exercise peak heart rate and duration of post-operative intensive care. Donor variables did not contribute significantly to post-transplant peak VO(2). CONCLUSIONS: Peak VO(2) improved after cardiac transplantation but remained significantly impaired compared with normal subjects. In estimating the impact of cardiac transplantation on exercise capacity the most important pre-transplant factors to consider are age, gender and height and weight (or, alternatively, body mass index).

Body Mass Index↗
PubMed2002

Plasma brain natriuretic peptide concentration: impact of age and gender.

OBJECTIVES: We wished to examine the effects of age and gender on plasma brain natriuretic peptide (BNP) concentration in a population-based study. BACKGROUND: Measurement of BNP concentration is approved for use in the diagnosis of heart failure and may aid in the detection of left ventricular dysfunction. Although BNP is approved for clinical use, there are few data regarding the range of BNP observed in persons without cardiovascular disease or cardiac dysfunction. These data are essential for the interpretation of BNP. METHODS: In 2,042 randomly selected residents of Olmsted County, Minnesota, >44 years old, BNP (Shionogi and Biosite assays), Doppler echocardiography, and medical record review were performed. A normal subset of subjects (n = 767) in sinus rhythm without cardiovascular, renal, or pulmonary disease or diabetes; on no cardiovascular medications; and with normal systolic, diastolic, and valvular function was identified. RESULTS: Within the normal subset, the distribution of BNP differed by age, gender, and assay system. With both assays, BNP increased significantly with age and was significantly higher in women than men, leading to age-, gender-, and assay-specific reference ranges. Receiver operating characteristic analysis for the ability of BNP to detect an ejection fraction < or = 40% was performed in each age/gender stratum in the entire cohort (n = 2,042) and confirmed that discriminatory values for BNP for detection of reduced ejection fraction were higher in women and older persons and were different between the two assays. CONCLUSIONS: Interpretation of BNP should include consideration of age-, gender-, and assay-specific partition values.

Age Factors↗
PubMed2002

Heart failure after myocardial infarction: a review.

PURPOSE: The effects of survival after myocardial infarction on the prevalence of chronic heart failure have not been well characterized. We reviewed studies of the incidence, mortality, and predictors of heart failure after myocardial infarction, and suggest directions for further research. METHODS AND RESULTS: We conducted a review of the literature from 1978 to 2000. Of 33 identified articles, 18 (55%) included heart failure as a primary endpoint. The mean in-hospital incidence of heart failure after myocardial infarction differed significantly by study design; it was highest in population-based studies and lowest in clinical trials (37% vs. 18%, P <0.01). Only 10 studies reported the incidence of subsequent heart failure. One-year mortality ranged from 16% to 39% and showed no improvement with time. Patients with in-hospital heart failure after myocardial infarction had a two- to sixfold greater in-hospital mortality and up to a fivefold increased 1-year mortality compared with patients without heart failure. The most consistent risk factors for the development of heart failure after myocardial infarction were advanced age, female sex, diabetes, and an increased heart rate at the time of admission. CONCLUSIONS: The reported incidence of, and mortality from, heart failure after myocardial infarction varies by study design. Additional research on the etiology and prognosis of late heart failure after myocardial infarction is needed.

Epidemiologic Studies↗
PubMed2002

Hemodynamic and plasma atrial natriuretic peptide responses to acute digitalis therapy in patients with normal and impaired left ventricular function.

BACKGROUND: Digitalis has a long history in the treatment of heart failure but its effects on cardiac hemodynamics and neurohormonal modulation are not well characterized. AIMS: The purpose of this study was to evaluate the relationship between atrial natriuretic peptide (ANP) and the hemodynamic responses to acute digitalis administration in patients with normal and impaired left ventricular function (LVD). METHODS AND RESULTS: Thirty patients were enrolled in the study, 20 with LVD (LVEF=22+/-8%) and 10 control subjects (LVEF=77+/-10%). Hemodynamics and plasma ANP concentrations were measured supine and with leg elevation before and after digitalis. In patients with normal ventricular function, the hemodynamic stress of leg elevation in the pre-digitalis state resulted in significant (P<0.05) increases in PAWP and MPAP. Digitalis administration in the supine position produced reductions in heart rate, PAWP, MPAP and CI; SVR was increased. In LVD patients leg elevation further increased PAWP, RAP and MPAP. Digitalis in the supine position, however, reduced RAP, MPAP and PAWP and increased CI. These improved hemodynamics were preserved during the stress of leg elevation. Leg elevation following digitalis resulted in increased ANP concentrations despite decreased cardiac filling pressures. CONCLUSIONS: Acute digitalis administration results in hemodynamic improvement in LVD patients which may in part result from digitalis stimulated release of myocardial ANP under conditions of hemodynamic stress.

Adult↗
PubMed2002

Epidemiology and screening of asymptomatic left ventricular dysfunction.

The traditional approach to estimating heart failure prevalence has been based on signs and symptoms of heart failure; such prevalence estimates have been in the range of 2% of persons <or= 75 years of age. Newer approaches have focused on objective (echocardiographic) evaluation of systolic and diastolic function as well as on signs and symptoms. It is estimated that 4-5% of the population has depressed systolic function and approximately 5% has moderate to severe diastolic dysfunction. Since over half of these persons are asymptomatic, efforts are underway to determine whether simple techniques, such as measurement of plasma brain natriuretic peptide, will aid in early diagnosis of ventricular dysfunction.

Aged↗