Reported physical symptoms during screening echocardiography are not associated with presence of suspected hypertrophic cardiomyopathy.

BACKGROUND: The prevalence of hypertrophic cardiomyopathy (HCM) can be silent and can present with sudden death as the first manifestation of this disease. The goal of this study was to evaluate any association between reported physical symptoms with the presence of suspected HCM. METHOD: The Anthony Bates Foundation has been performing screening echocardiography across the United States for the prevention of sudden death since 2001. A total of 4,120 subjects between the ages of 6 and 79 underwent echocardiographic screening. We evaluated any association between any symptoms and suspected HCM defined as any left ventricular wall thickness ³ 15 mm. RESULTS: The total prevalence of suspected HCM in the entire study population was 1.1%. The presence of physical symptoms was not associated with HCM (chest pain in 4.3% of participants with HCM vs. 9.9% of the control, p=0.19, palpitation in 4.3% of participants with HCM vs. 7.3% of the control., p=0.41, shortness of breath in 6.4% of participant with HCM vs. 11.7% of the control., p=0.26, lightheadedness in 4.3% of participant with HCM vs. 13.1% of the control., p=0.07, ankle swelling in 2.1% of participant with HCM vs. 4.0% of the control., p=0.52, dizziness in 8.5% of participant with HCM vs. 12.2% of the control., p=0.44). CONCLUSION: Echocardiographic presence of suspected HCM is not associated with a higher prevalence of physical symptoms in the participants undergoing screening echocardiography.

The Majority of Participants With Suspected Hypertrophic Cardiomyopathy Documented During Screening Echocardiography Have a Normal Electrocardiogram.

BACKGROUND: Patients with hypertrophic cardiomyopathy (HCM) usually have abnormal electrocardiograms consistent with left ventricular hypertrophy (LVH). The goal of this study was to evaluate the prevalence of abnormal ECG findings (LVH, T wave inversion, left bundle branch block, and left atrial enlargement) in participants with suspected HCM detected during screening echocardiography. METHOD: The Anthony Bates Foundation has been performing screening echocardiography across the United States for the prevention of sudden death since 2001. A total of 682 subjects between the ages of 8 and 71 underwent echocardiographic screening together with ECG documentation. We evaluated the prevalence of abnormal ECG in participants with suspected HCM defined as any left ventricular wall thickness ≥15 mm. RESULTS: The prevalence of LVH and T wave inversion were higher in HCM subjects as expected [HCM occurred in 23.5% (4/17) vs. 5.6% (37/665), P = 0.002, T wave inversion occurred in 17.6% (3/17) vs. 4.1% (27/664), P = 0.007]. However, despite adding these 2 common ECG abnormalities in this population, the presence of detected abnormal ECG remained less than 25% (23.5% of HCM subjects had LVH or T wave inversion on ECG vs. 8.7% of control, P = 0.036). Left bundle branch block or abnormal left atrium on ECG were not found in any participants with suspected HCM. CONCLUSIONS: The prevalence of abnormal ECG in the participants with suspected HCM detected during screening echocardiography is less than 25%. This suggests that ECG alone is not a sensitive marker for the detection of HCM.

Overweight (BMI of 25-30) Is Independently Associated With Significantly Higher Prevalence of Systolic and Diastolic Hypertension in Adults.

OBJECTIVE: Hypertension (HTN) is a major risk factor for cardiovascular disease. Obesity has been found to be associated with HTN. However, there are not many studies available to evaluate any association between overweight alone and HTN. METHODS: A database from the Anthony Bates Foundation that performs preventive cardiovascular examinations including measurement of body mass index (BMI) and blood pressure across the United States was used for our study. Using recorded measurements, we evaluated any association between being overweight defined as a BMI of 25 to 30 and the occurrence of systolic and diastolic HTN in adults over the age of 18 years. RESULTS: A total of 1558 participants with documented BMI and blood pressure over the age of 18 years were studied. Among them, 758 participants had a normal BMI, and 800 had a BMI in overweight category. The prevalence of systolic and diastolic HTN was significantly higher in participants in the overweight versus normal weight cohort. Systolic HTN was present in 36% of participants in the overweight versus 14% of the normal weight group ( P < 0.00.1). Diastolic HTN was present in 43% of participants with overweight versus 21% of normal weight cohort ( P < 0.001). After adjusting for age and gender, high systolic blood pressure (SBP) and diastolic blood pressure (DBP) remained independently associated with overweight (SBP prevalence OR, 2.8; CI, 2.1-3.6; P < 0.001; DBP prevalence OR, 2.1; CI, 1.7-2.7; P < 0.001). CONCLUSIONS: Our study found that increased BMI in the overweight category alone is independently associated with SBP and DBP in adults undergoing screening warranting further investigation.

Higher Heart Rate Is Independently Associated With Abnormal Body Mass Index in a J Shape Pattern.

BACKGROUND: High heart rate (HR) is independently associated with higher cardiovascular mortality and usually occurs in sedentary persons. Inactivity can also lead to obesity. The purpose of this study was to evaluate the associations between body mass index as an independent marker of high HR. METHOD: Data generated from screening echocardiography, for the prevention of sudden death at the Anthony Bates Foundation, was used. Data from 1340 subjects, with documented HR and body mass index, between the ages 19-79 years with a mean age of 32 years, were studied. We correlated the presence of a high HR >90 beats per minute (bpm) with different body mass index (BMI) categories. RESULTS: High HR was significantly associated with higher BMI categories and underweight subjects in adults suggesting a J shape association. A total of 22.7% of participants with an HR of more than 90 bpm had BMI >40 kg/m 2 , versus 19.0% of patients with BMI of 35-40 kg/m 2 versus 13.5% of subjects with BMI of 30-35 kg/m 2 versus 12.2% of subjects with BMI of 25-30 kg/m 2 -29.9 kg/m 2 , versus in 10.3% of subjects with BMI between 18.5 and 25 kg/m 2 , P < 0.01) Furthermore, increased HR was also more prevalent in underweight patient (17.4% in subjects with BMI < 18.5 kg/m 2 ). CONCLUSION: High HR is strongly associated with obesity and underweight suggesting that maintaining a normal weight is associated with most positive effect on the cardiovascular system.

Early repolarization is independently associated with African-American race, younger age, higher BMI and lower heart rate.

Background: Early repolarization (ER) is commonly seen in young adults. The goal of this study was to evaluate predictors of ER. Method: The authors used ECGs, available from 636 subjects, performed on healthy students for screening purposes. Results: The prevalence of ER was 13.5%. The prevalence of ER was higher in African-American subjects (48.0% vs 10.8%; odds ratio: 5.9; CI: 3.5-9.7; p < 0.0001), those with a BMI >25 (18.6% vs 11.7%; p = 0.02), those age <30 (16.4% vs 2.0%; p < 0.0001), male subjects (17.1% vs 8.3%; p = 0.001) and those with heart rate <70 (18.2% vs 9.2%; p = 0.001). With multivariate analysis, except gender, all other parameters remained significantly correlating with ER. Conclusion: The authors found younger age, African-American race, higher BMI and lower heart rate to be predictors of ER.

A finding in an ECG called early repolarization is very common and usually is a benign condition except in some genetic disorders. The authors studied the rate of this occurrence in a young population and found that it is very common in African­Americans. Furthermore, it is more common in individuals with obesity, those with a slow heart rate and higher BMI.

Presence of physical symptoms in healthy adolescence found to be associated with female gender, obesity, tachycardia, diastolic hypertension and smoking.

BACKGROUND: The goal of this study was to evaluate any association between physical symptoms and abnormal clinical history in adolescence undergoing screening echocardiography performed by Anthony Bates Foundation. METHOD: The Anthony Bates Foundation has been performing screening echocardiography across the United States for the prevention of sudden death since 2001. We performed uni- and multivariate analysis to evaluate any association between physical symptoms with gender, smoking, obesity, heart rate, and hypertension. RESULTS: We found a strong association between symptoms and the female gender (33% vs. 17.5% of males, P < 0.001). Furthermore, obesity (46.5% vs. 22.5%, P < 0.001), smoking (46.2% vs. 22.5%, P = 0.04), heart rate > 90 (34.8 vs. 22.8%, P = 0.001), and diastolic blood pressure > 90 (34.9% vs. 23.4%, P = 0.03) were all associated with symptoms. Increased systolic pressure was not associated with physical symptoms (24.3% vs. 21.9%, P = 0.4). Using multivariate analysis, female gender, diastolic blood pressure and obesity remained independently associated with physical symptoms. (Female gender: OR: 2.2, CI: 1.7-2.9, P < 0.001, obesity: OR: 2.5, CI 1.2-5.05, P = 0.009, and high diastolic blood pressure: OR: 2.08, CI 1.1-3.7, P = 0.01). CONCLUSION: Physical symptoms are associated with smoking, female gender, obesity, tachycardia, and high diastolic blood pressure but not systolic pressure in adolescence undergoing routine screening echocardiography.

Higher Prevalence of Abnormal Electrocardigrams (ECG) in African Americans Undergoing Screening ECG and Echocardiography.

BACKGROUND: African American (AA) has higher prevalence of abnormal electrocardigrams (ECG) in general population. However, the degree of these abnormalities in a healthy population undergoing screening echocardiography is not known. The goal of this study was to evaluate the prevalence of ECG abnormalities reported during screening echocardiography based on race. METHOD: The Anthony Bates Foundation has been performing screening across the United States for the prevention of sudden death since 2001. We evaluated a total of 633 participants with documented race and ECG for the presence of any abnormalities. RESULTS: The age of the study population ranged between 6 and 75 years old. The prevalence of abnormal ECG in AA participant was 20.7% (12/58) versus 6.6% (38/578) in other races [odds ratio (OR), 3.70; confidence interval (CI), 1.8-7.58; P < 0.001]. Using multivariate analysis adjusting for age, sex, body mass index, left ventricular hypertrophy, and hypertension (systolic blood pressure >140 and diastolic blood pressure of >90), AA race remained independently associated with abnormal ECG (OR, 2.58; CI, 1.12-5.97; P = 0.02). Limiting our study only to teenagers (age, 13-19 years), AA race remained significantly associated with higher prevalence of ECG abnormalities [23.1% (12/58) of teenage AA had abnormal ECG vs. 7.5% (24/321) of other teenage races; OR, 3.71; CI, 1.36-10.11; P = 0.006]. After excluding benign ECG abnormalities such as sinus bradycardia and early repolarization, AA race remained significantly associated with higher prevalence of abnormal ECG (16.7% vs. 7.3%; OR, 2.52; CI, 0.998-6.39; P = 0.054). CONCLUSIONS: The prevalence of abnormal ECG is higher in AA race independent of echocardiographic abnormalities or demographics. However, some of these abnormalities appear to be related to sinus bradycardia and early repolarization.

Obesity in adolescence is associated with left ventricular hypertrophy and hypertension.

BACKGROUND: Obesity is a risk factor for hypertension (HTN) and left ventricular hypertrophy (LVH). However, the association between obesity, HTN or LVH in adolescents has not been studied in a large population. METHOD: Utilizing a database of screening echocardiograms, we assessed for the presence of LVH and HTN (defined as systolic blood pressure (SBP) > 140 mmHg or diastolic blood pressure (DBP) > 90 mmHg) in obese adolescents (BMI > 30) using univariate and multivariate analysis. RESULTS: A total of 2072 subjects were identified between the ages of 13-19 years. LVH was significantly more prevalent in obese subjects (47/166 [28.3%] vs. nonobese subjects (99/1612 [6.1%]) with a P-value of <0.001. Using multivariate analysis adjusting for age, gender and blood pressure, obesity remained strongly associated with the presence of LVH (OR 4.51, CI: 2.83-7.19, P < 0.001). Elevated SBP and DBP were also strongly associated with obesity. SBP > 140 was present in 38% of obese subjects (54/142) versus 12.7% of nonobese subjects (172/1, 353). DBP > 90 was present in 10.6% of obese subjects (15/141) of versus 3.1% of nonobese subjects (42/1352). After adjustment for age, gender and LVH, obesity remained independently associated with HTN (for SBP > 140, OR 2.24, CI: 1.46-3.45, P < 0.001, and for DBP > 90, OR 2.10, CI: 1.063-4.17, P = 0.03). CONCLUSION: Obese adolescents have a significantly higher prevalence of HTN and LVH. Our analysis suggests a direct negative effect of obesity on cardiovascular function starting early in teenage years. (Echocardiography 2011;28:150-153).

The reporting of gastric band slip and related complications; a review of the literature.

Laparoscopic adjustable gastric banding is a safe and effective treatment for morbid obesity. Long-term complications include band slippage, gastric pouch dilatation and gastric erosion. Rates of band slippage reported in the literature range from less than 1% to over 20%. The aim of this review was to explore whether differences in the reporting of this complication contributed to the variability in this outcome measure. A full literature search was undertaken using EMBASE and MEDLINE search engines. Forty studies were selected for analysis based on inclusion and exclusion criteria. Each was scrutinised for outcome reporting methods and related fields. Accurate definitions for relevant terms were derived from the best available evidence. Considerable variations in device deployed, operative approach, band fixation technique, and outcome reporting mechanisms were seen between the studies. The explanation and definition of terms used within manuscripts were also seen to vary between studies. A consensus needs to be reached on how best to report complications such as gastric band slippage. We suggest which information should be included by authors to allow for accurate and reproducible reporting of such outcomes in the future.

Prevalence of suspected hypertrophic cardiomyopathy or left ventricular hypertrophy based on race and gender in teenagers using screening echocardiography.

BACKGROUND: The goal of this study was to evaluate the prevalence of suspected hypertrophic cardiomyopathy (HCM) in a population of teenagers undergoing screening echocardiography for the detection of HCM. METHOD: The Anthony Bates Foundation performs screening echocardiography for the prevention of sudden death. A total of 2,066 students were studied between the ages of 13 to 19 years. Suspected HCM was defined as any wall thickness ≥ 15 mm. LVH was defined as wall thickness ≥ 13 mm RESULTS: Prevalence of suspected HCM was 0.7% (14/2066). After adjusting for hypertension (HTN), the total prevalence was 0.5% (8/1457). In a subgroup analysis, 551 teenagers with documented race and LV wall thickness were identified between the ages of 13-19 years. African American teenagers [6% (3/50)] had higher prevalence of suspected HCM [0.8% (4/501), OR 7.93, CI 1.72-36.49, p = 0.002]. After multivariate adjustment for age, gender, BMI and HTN (systolic BP >140 and diastolic BP of > 90), African American race remained independently associated with suspected HCM (OR 4.89, CI 1.24-39.62, p = 0.02). CONCLUSION: The prevalence of suspected HCM in young teenagers is approximately 0.2%. This prevalence appears to be higher in African Americans. However, due to small number of African Americans in our population, our result needs to be confirmed in larger trials.

Prevalence of mitral valve prolapse and associated valvular regurgitations in healthy teenagers undergoing screening echocardiography.

BACKGROUND: The true prevalence of mitral valve prolapse (MVP) in the population has been controversial. OBJECTIVE: To evaluate the prevalence of MVP and associated valvular abnormalities in healthy teenage students. METHODS: The Anthony Bates Foundation performed screening echocardiography in high schools across the United States. A total of 2072 students between 13 and 19 years of age were identified for the present study. RESULTS: Total prevalence of MVP was 0.7%. The prevalence of MVP was significantly higher among female teenagers (nine of 690 female teenagers [1.3%] versus five of 1382 male teenagers [0.4%], P=0.01, OR 3.6, CI 1.21 to 10.70). The prevalence of mitral regurgitation (MR) and tricuspid regurgitation (TR) was higher in teenagers with MVP. MR occurred in five of 14 teenagers (35.7%) with MVP versus 15 of 2058 controls (0.7%) (P<0.001, OR 75.6, CI 22.6 to 252.5). TR occurred in one of 14 teenagers (7.1%) with MVP versus nine of 2058 controls (0.4%) (P<0.001, OR 17.5, CI 2.0 to 148.3). CONCLUSION: The prevalence of MVP in this cohort of healthy teenage students was less than 1%. Furthermore, the prevalence of MVP was higher in female teenagers and was associated with a higher prevalence of MR and TR.

Fixation of the access-port is not required in gastric banding.

BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) is increasingly performed in patients with morbid obesity. Suturing of the access-port in LAGB can be difficult and time consuming but is felt necessary by many surgeons to prevent migration and facilitate band adjustments. METHODS: Between 2003 and 2006, 226 patients underwent LAGB with the MIDband. All surgery was performed by the pars flaccida approach. The access-port was positioned in a subcutaneous pouch adjacent to the left hypochondrial port site and was not secured. Regular follow-up and band fills were offered. All band or port-related complications were duly recorded. A patient satisfaction survey was also conducted among 50 randomly selected post-banding patients. RESULTS: Mean age was 41.65 years (range 18-73 years) and mean BMI was 45.85 kg/m2 (range 34.0-74.93 kg/m2). The access-port was inaccessible at first attempt in 5 (2%) patients. 4 of these required radiological imaging to identify the port orientation and 1 required multiple attempts at port puncture with subsequent re-operation due to tube puncture. 91% of patients reported no significant trouble other than mild discomfort and prominence of the port. CONCLUSION: This study shows non-fixation of the access-port to be safe and effective with good patient acceptability. In addition, it avoids the need for regular X-ray localization of the port.