Abnormal Left Ventricular Geometry Research Articles

Effect of Overweight and Obesity on Cardiovascular Events in Asymptomatic Aortic Stenosis: A SEAS Substudy (Simvastatin Ezetimibe in Aortic Stenosis)

This study investigated whether overweight and obesity impacted outcome in patients with aortic valve stenosis (AS). Increased body mass index (BMI) is a strong predictor of higher cardiovascular (CV) morbidity and mortality in the general population but not among patients undergoing heart surgery. Cardiovascular events in 1,664 patients with initially asymptomatic AS were recorded during a mean of 4.3 years of follow-up in the SEAS (Simvastatin Ezetimibe in Aortic Stenosis) study. Patients were grouped according to baseline BMI class. Overweight (n = 737) and obese patients (n = 334) had higher prevalence of hypertension, more abnormal left ventricular geometry, and lower stress-corrected midwall shortening throughout the study compared with normal weight patients (all p < 0.01). The AS progression rate did not differ between BMI classes. In univariate Cox regression, overweight was associated with a 17% to 22% lower rate of AS-related (p = 0.04) and ischemic CV events (p = 0.05). In multivariate analyses, adjusting for AS severity and differences in baseline characteristics, overweight had no significant influence on the rate of ischemic CV or AS-related events, whereas overweight and obesity had 46% and 67% higher rate of total mortality and 42% and 69% higher rate of combined hospital stay for heart failure and death from any cause, respectively, compared with normal weight patients (all p < 0.05). In patients with initially asymptomatic AS participating in the SEAS study, overweight and obesity did not influence AS progression or rate of AS-related or ischemic CV events but were both associated with increased mortality.

Prevalence and covariates of abnormal left ventricular geometry in never-treated hypertensive patients in Tanzania

Aim. To assess prevalence, type and covariates of abnormal left ventricular (LV) geometry in untreated native Tanzanian patients with hypertension in relation to normotensive controls. Methods. Echocardiography was performed in 161 untreated hypertensive outpatients and 80 normotensive controls at a tertiary hospital in Tanzania. Hypertensive heart disease was defined as presence of increased LV mass or relative wall thickness (RWT). Results. The prevalence of hypertensive heart disease increased with the severity of hypertension and was on average 62.1% among patients and 12.5% in controls. In multivariate analyses, higher LV mass index was associated with higher systolic blood pressure (β = 0.28), body mass index (β = 0.20), peak early transmitral to medial mitral annulus velocity ratio (β = 0.16), and with lower stress-corrected midwall shortening (scMWS) (β = − 0.44) and estimated glomerular filtration rate (β = − 0.16), all p < 0.05. Higher RWT was associated with higher systolic blood pressure (β = 0.16), longer E-wave deceleration time (β = 0.23) and lower scMWS (β = − 0.66), irrespective of LV mass (all p < 0.05). Conclusion. Subclinical hypertensive heart disease is highly prevalent in untreated native hypertensive Tanzanians and associated with both systolic and diastolic LV dysfunction. Management of hypertension in Africans should include high focus on subclinical hypertensive heart disease.

Effects of obesity and race on left ventricular geometry in hypertensive children

Like left ventricular hypertrophy (LVH), abnormal left ventricular (LV) geometry increases cardiovascular risk, but little data utilizing age and sex-specific norms are currently available on LV geometry in hypertensive children. This was a cross-sectional study of 141 hypertensive children aimed at determining the prevalence of LVH and abnormal LV geometry in the patient population and whether clinical characteristics associated with these findings differ by race. LVH was defined as an LV mass index of ≥95th percentile or cardiologist diagnosis. Abnormal geometry was defined as the presence of LVH or a relative wall thickness of >0.41. The prevalence of LVH was 35 % overall. According to race, LVH prevalence was 49 % among African-Americans (AA) versus 30 % among non-AA (p < 0.05). Overweight/obesity was also highly prevalent among AA compared to non-AA (87 vs. 71 %, respectively; p = 0.03). After multivariable adjustment, the body mass index (BMI) z-score and 95 % diastolic blood pressure (BP) index were the sole independent predictors of LVH. Of the 141 hypertensive children, 40 % had abnormal LV geometry; 63 % among AA vs. 32 % among non-AA (p = 0.001). Multivariable analyses revealed a 3.8-fold increased odds of abnormal geometry among AA (p = 0.002). While LVH, abnormal geometry and overweight/obesity are more prevalent among AA hypertensive children, after multivariable adjustment, BMI and race were independently associated with LVH and abnormal geometry, respectively. This result suggests that both race and obesity have important roles in the development of end-organ damage among children with primary hypertension.

Echocardiographic Assessment of Left Ventricular Geometric Patterns in Hypertensive Patients in Nigeria

Left ventricular (LV) hypertrophy is an important predictor of morbidity and mortality in hypertensive patients, and its geometric pattern is a useful determinant of severity and prognosis of heart disease. Studies on LV geometric pattern involving large number of Nigerian hypertensive patients are limited. We examined the LV geometric pattern in hypertensive patients seen in our echocardiographic laboratory. A two-dimensional, pulsed, continuous and color flow Doppler echocardiographic evaluation of 1020 consecutive hypertensive patients aged between 18 and 91 years was conducted over an 8-year period. LV geometric patterns were determined using the relationship between the relative wall thickness and LV mass index. Four patterns of LV geometry were found: 237 (23.2%) patients had concentric hypertrophy, 109 (10.7%) had eccentric hypertrophy, 488 (47.8%) had concentric remodeling, and 186 (18.2%) had normal geometry. Patients with concentric hypertrophy were significantly older in age, and had significantly higher systolic blood pressure (BP), diastolic BP, and pulse pressure than those with normal geometry. Systolic function index in patients with eccentric hypertrophy was significantly lower than in other geometric patterns. Doppler echocardiographic parameters showed some diastolic dysfunction in hypertensive patients with abnormal LV geometry. Concentric remodeling was the most common LV geometric pattern observed in our hypertensive patients, followed by concentric hypertrophy and eccentric hypertrophy. Patients with concentric hypertrophy were older than those with other geometric patterns. LV systolic function was significantly lower in patients with eccentric hypertrophy and some degree of diastolic dysfunction were present in patients with abnormal LV geometry.

Persistent organic pollutants and abnormal geometry of the left ventricle in the elderly

Established risk factors for left ventricular hypertrophy (LVH) are hypertension, diabetes, and obesity. However, as these risk factors explain only part of the variation in left ventricular mass, we investigated whether persistent organic pollutants (POPs) might also play a role in LVH, because exposure to polychlorinated biphenyl 126 induced cardiac growth in rats. In the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS), left ventricular mass index (LVMI), relative wall thickness (RWT), and geometric groups of LVH, were determined by echocardiography and 21 POPs were measured by high-resolution chromatography coupled to high-resolution mass spectrometry (HRGC/HRMS) in 1016 individuals aged 70 years. All individuals with a history of myocardial infarction were excluded from analysis (n = 72). Several of the POPs were related to abnormal left ventricular geometry before adjustment for established risk factors, but lost in significance following adjustment. However, the pesticide hexachlorobenzene (HCB) levels were significantly related to RWT, and concentric left ventricular remodeling, also following adjustment for sex, blood pressure, antihypertensive treatment, diabetes, and BMI (P <0.0001). In this cross-sectional study, circulating levels of HCB were related to increased wall thickness of the left ventricle and concentric left ventricular remodeling, independently of LVH risk factors, suggesting a role of this environmental contaminant in abnormal growth of the left ventricle.

Global left ventricular load in asymptomatic aortic stenosis: covariates and prognostic implication (the SEAS trial)

IntroductionValvuloarterial impedance (Zva) is a measure of global (combined valvular and arterial) load opposing left ventricular (LV) ejection in aortic stenosis (AS). The present study identified covariates and tested the prognostic significance of global LV load in patients with asymptomatic AS.Methods1418 patients with mild-moderate, asymptomatic AS in the Simvastatin Ezetimibe in Aortic Stenosis (SEAS) study were followed for a mean of 43±14 months during randomized, placebo-controlled treatment with combined simvastatin 40 mg and ezetimibe 10 mg daily. High global LV load was defined as Zva >5 mm Hg/ml/m2. The impact of baseline global LV load on rate of major cardiovascular (CV) events, aortic valve events and total mortality was assessed in Cox regression models reporting hazard ratio (HR) and 95% Confidence Intervals (CI).ResultsHigh global LV load was found in 18% (n=252) of patients and associated with female gender, higher age, hypertension, more severe AS and lower ejection fraction (all p<0.05). A total of 476 major CV events, 444 aortic valve events and 132 deaths occurred during follow-up. In multivariate Cox regression analyses, high global LV load predicted higher rate of major CV events (HR 1.35 [95% CI 1.08-1.71], P=0.010) and aortic valve events (HR 1.41 [95% CI 1.12-1.79], P=0.004) independent of hypertension, LV ejection fraction, female gender, age, abnormal LV geometry and AS severity, but failed to predict mortality.ConclusionIn asymptomatic AS, assessment of global LV load adds complementary information on prognosis to that provided by hypertension or established prognosticators like AS severity and LV ejection fraction.

Hypertension in Aortic Stenosis

The impact of hypertension on left ventricular structure and outcome during progression of aortic valve stenosis has not been reported from a large prospective study. Data from 1616 patients with asymptomatic aortic stenosis randomized to placebo-controlled treatment with combined simvastatin and ezetimibe in the Simvastatin Ezetimibe in Aortic Stenosis Study were used. The primary study end point included combined cardiovascular death, aortic valve events, and ischemic cardiovascular events. Hypertension was defined as history of hypertension or elevated baseline blood pressure. Left ventricular hypertrophy was defined as left ventricular mass/height 2.7 ≥46.7 g/m 2.7 in women and ≥49.2 g/m 2.7 in men and concentric geometry as relative wall thickness ≥0.43. Baseline peak aortic jet velocity and aortic stenosis progression rate did not differ between hypertensive (n=1340) and normotensive (n=276) patients. During 4.3 years of follow-up, the prevalence of concentric left ventricular hypertrophy increased 3 times in both groups. Hypertension predicted 51% higher incidence of abnormal LV geometry at final study visit independent of other confounders ( P &lt;0.01). In time-varying Cox regression, hypertension did not predict increased rate of the primary study end point. However, hypertension was associated with a 56% higher rate of ischemic cardiovascular events and a 2-fold increased mortality (both P &lt;0.01), independent of aortic stenosis severity, abnormal left ventricular geometry, in-treatment systolic blood pressure, and randomized study treatment. No impact on aortic valve replacement was found. In conclusion, among patients with initial asymptomatic mild-to-moderate aortic stenosis, hypertension was associated with more abnormal left ventricular structure and increased cardiovascular morbidity and mortality.

Inflammatory markers are associated with left ventricular hypertrophy and diastolic dysfunction in a population-based sample of elderly men and women

Markers of inflammation have previously been related to left ventricular (LV) hypertrophy (LVH) in uremic and hypertensive patients. The present study investigated inflammatory markers in relation to LV geometry and diastolic function in a population of elderly persons. In the population-based Prospective Study of the Vasculature in Uppsala Seniors (PIVUS) study (1016 men and women 70 years of age), echocardiograms to determine relative wall thickness (RWT), LV mass index (LVMI) and the E/A-ratio were obtained. Based on RWT and LVMI, four geometric subgroups were defined; normal, concentric remodeling, eccentric and concentric LVH. In all, 10 circulating inflammatory markers were measured. Higher levels of high sensitive C-reactive protein (hsCRP) and E-selectin were seen in the three abnormal geometry groups than in the normal group adjusting for gender, body mass index, systolic and diastolic blood pressure and use of antihypertensive medication. Higher level of inter-cellular adhesion molecule 1 (ICAM-1), vascular cell adhesion protein 1 (VCAM-1) and P-selectin were only seen in concentric LVH. Levels of tumor necrosis factor-alpha, interleukin-6, l-selectin, monocyte chemotactic protein-1 and leukocyte count did not differ between the LV groups. l-selectin and hsCRP were related to the E/A-ratio. The adhesion molecules; E-selectin, ICAM-1, VCAM-1, P-selectin and hsCRP were elevated in elderly persons with abnormal LV geometry, especially in concentric LVH, after adjusting for hypertension and obesity. l-selectin and hsCRP were related to LV diastolic function. Further studies are motivated to investigate a pathogenetic role of inflammation for abnormal LV geometry and function.

The "Obesity Paradox" in Nigerians with heart failure

Previous studies have suggested that a high body mass index (BMI) was associated with improved outcome in congestive heart failure (CHF). The aim of this study was to examine the relationship between BMI and echocardiographic variables of cardiac function in stable outpatients with heart failure. This is a cross-sectional study in which the cardiology clinic out-patients of Obafemi Awolowo University Teaching Hospital with heart failure were recruited. Patients were categorized using baseline BMI as normal weight BMI = 18.5-24.9 kg/m(2) and overweight/obese (BMI > 25.0 kg/m(2)). Risks associated with BMI groups were evaluated and the data were analyzed with the aid of SPSS 15.0 software. Patients with higher BMI have higher left ventricular ejection fraction and fractional shortening and lesser tendency to have an abnormal left ventricular geometry and better functional (New York Heart Association) class of heart failure at presentation. Overweight and obese patients had less severe degree of heart failure than normal weight patients and efforts should be made to prevent excessive weight loss in patients with heart failure.

Effects of Nasal Continuous Positive Airway Pressure on Left Ventricular Concentric Hypertrophy in Obstructive Sleep Apnea Syndrome

Abnormal left ventricular (LV) geometry, especially concentric hypertrophy, is associated with cardiovascular morbidity and mortality. The aim of this study was to evaluate the impact of obstructive sleep apnea syndrome (OSAS) and the effects of nasal continuous positive airway pressure (CPAP) on the LV geometric patterns. The LV morphological parameters, including the LV mass index (LVMI) and the relative wall thickness (RWT), were evaluated using echocardiography in 37 patients with OSAS diagnosed on polysomnography and 34 control subjects. Based on the values of LVMI and RWT, the LV geometry was classified as normal, concentric remodeling, concentric hypertrophy or eccentric hypertrophy. The echocardiographic parameters were reassessed after three months of CPAP treatment. Compared with the controls, the OSAS patients had a higher proportion of concentric hypertrophy patterns (54% vs. 0%, p<0.001) and a lower proportion of normal geometric patterns (5% vs. 62%, p<0.001). A univariate logistic regression analysis showed the apnea-hypopnea index, lowest oxygen saturation, hypoxemia index and body mass index to each be significantly associated with the presence of concentric hypertrophy. In a multivariate analysis of these factors, the apnea-hypopnea index was found to be a significant independent factor associated with the presence of concentric hypertrophy (odds ratio: 1.06, p=0.008). Three months of CPAP treatment resulted in significant decreases in LVMI and the proportion of cases with concentric hypertrophy (both p=0.025). In our limited study population, OSAS patients were found to be associated with a high prevalence of concentric LV hypertrophy patterns that were able to be reversed with three months of CPAP treatment.

Association of Left Ventricular Geometry With Left Atrial Enlargement in Patients With Preserved Ejection Fraction

Left ventricular (LV) hypertrophy (LVH) is a known independent determinant of left atrial (LA) size; however, there is controversy regarding whether the LV geometric patterns are associated with LA enlargement (LAE), a major indicator of diastolic heart failure. The authors evaluated 47,865 patients with preserved ejection fraction to determine the relationship of LV geometry on LAE as determined by LA volume index (LAVi) 29 mL⁄m². Abnormal LV geometry was identified in 48% and LAE was indentified in 43% with associated higher prevalence of abnormal LV geometry(59% vs 41%, P<.0001). Both LV mass index and relative wall thickness (RWT) were independent determinants of LAE (P<.0001). LAVi and prevalence of LAE differ significantly by LV geometric patterns (P<.0001). In multivariate analysis, abnormal LV geometry patterns, especially eccentric and concentric LVH, were independently associated with LAE. In conclusion, LAE assessed as increased LAVi is strongly associated not only with LV mass index but also with RWT. Furthermore, LAE was independently associated with abnormalities in LV geometry.

Left Atrial Volume Index Predictive of Mortality Independent of Left Ventricular Geometry in a Large Clinical Cohort With Preserved Ejection Fraction

OBJECTIVE To determine the effect on mortality of the left atrial volume index (LAVI) and left ventricular (LV) geometry (normal, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy). PATIENTS AND METHODS From January 1, 2004, through December 31, 2006, we evaluated 36,561 patients with preserved ejection fraction with an average follow-up of 1.7±1.0 years. The LAVI was categorized as normal (≤28 mL/m 2) or increased (mild, 29-33 mL/m 2; moderate, 34-39 mL/m 2; severe, ≥40 mL/m 2). RESULTS Progressive increases in LAVI and mortality were noted with abnormal LV geometry. Similarly, abnormal LV geometry and mortality were significantly higher in patients with increased LAVI. In patients who died vs surviving patients, the LAVI ± SD was significantly higher (33.0±14.8 vs 28.1±10.8 mL/m 2; P<.001) and abnormal LV geometry was significantly more prevalent (62% vs 44%; P<.001). Compared with those with a normal LAVI, patients with a severe LAVI had a 42% increased risk of mortality. In patients with normal LV geometry or concentric remodeling, a severe LAVI was a significant independent predictor of mortality, with an increased risk of 28% and 46%, respectively. Similarly, in patients with eccentric hypertrophy and concentric hypertrophy, the mortality risk in patients with a severe LAVI was twice that of patients with a normal LAVI. Comparison of area under the curve (0.565 [without LAVI] vs 0.596 [with LAVI]; P<.001] and predictive models with and without LAVI for mortality prediction were significant, indicating increased mortality prediction by the addition of LAVI to other independent predictors. CONCLUSION THE LAVI significantly predicts mortality risk, independent of LV geometry, and adds to the overall mortality prediction in a large cohort of patients with preserved systolic function.

The Mitral Valve in Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy (HCM) has evoked both fascination and controversy since its first modern description >50 years ago.1 Originally described as “functional aortic subvalvar stenosis” by Brock, the majority of articles about HCM in the ensuing first decade emanated from observations made in the operating room or in the cardiac catheterization laboratory.1 The actual cause of left ventricular outflow tract (LVOT) obstruction in patients with this condition had not yet been clarified. Ironically, the mechanisms of LVOT obstruction in HCM were only elucidated several years after surgery was first performed in these patients. In fact, an early report by Morrow described the septal myotomy procedure as surgical treatment for HCM and proposed that the myotomy interfered with the sphincter-like muscular contraction ring in the LVOT.1 Article see p 40 Noninvasive cardiovascular imaging studies have greatly advanced our knowledge about HCM.2 Hypertrophic cardiomyopathy is now felt to have tremendous genetic,3 clinical, morphological, and hemodynamic heterogeneity.1 Nevertheless, the presence of LVOT obstruction in patients with HCM has continued to inspire interest. The often contentious debates surrounding LVOT obstruction have centered on its very existence, its causes, its clinical impact and prognosis, and its optimal management.1 These issues have inextricably included the mitral valve, which has long been felt to play a pivotal role in the pathophysiology of LVOT obstruction in patients with HCM. In the present issue of Circulation , Maron et al use cardiovascular magnetic resonance (CMR) imaging to characterize mitral valve leaflets in patients with HCM.4 This study assessed the lengths of the anterior mitral leaflet (AML) and posterior mitral leaflet in 172 consecutive patients with HCM. Their findings were compared with 172 normal control subjects matched for age, sex, and body surface area. In addition, the study included a small cohort of …

Ambulatory blood pressure profile and left ventricular geometry in Nigerian hypertensives

Background:Left ventricular hypertrophy (LVH) is an independent cardiac risk factor in hypertensives and the structural classification of left ventricular (LV) geometry provides additional prognostic information. Ambulatory blood pressure (ABP) monitoring has been shown to be superior to office blood pressure (BP) in relation to hypertension LVH. We investigated ambulatory BP variables in relation to LV geometric patterns in Nigerian hypertensives.Materials and Methods:A total of 130 patients (males = 96, females = 34) with hypertension had their 24-hours ambulatory BP and trans-thoracic 2D/M- mode echocardiography. Data were analyzed with SPSS 13.0. P < 0.05 was considered statistically significant.Results:The mean age of the patients was 54.08±11.88 years. The prevalence rate of abnormal LV geometry was 48.4%. Mean ambulatory Systolic BP (day time, night time and 24-hour-average) was significantly higher in patients with LVH compared with those without LVH. Day-night systolic and diastolic BP decay (i.e. percentage nocturnal decline in BP) was also significantly lower in LVH group than in the group without LVH. Patients with eccentric LVH had abnormal day time mean ambulatory systolic BP, night time mean ambulatory systolic BP, elevated day time and night time systolic BP loads, as well as non-dipping diastolic BP pattern. Significant correlates of LV mass index in this study population were mean ambulatory systolic BP (day time: r = 0.355, P = 0.004; night time: r = 0.343, P = 0.005; 24- hour average: r = 0.358, P = 0.004) and day-night decay (systolic: r = -0.388, P = 0.007; diastolic: r = -0.290, P = 0.022) as well as 24-hour systolic BP variability.Conclusion:The presence of LVH in hypertension was associated with higher mean ambulatory systolic BP and lower percentage nocturnal decline in systolic and diastolic BP than its absence which appeared to be worse in patients with eccentric LV geometry when compared with other geometric patterns.

Increased relative wall thickness is a marker of subclinical cardiac target-organ damage in African diabetic patients : cardiovascular topic

To assess the prevalence and covariates of abnormal left ventricular (LV) geometry in diabetic outpatients attending Muhimbili National Hospital in Dar es Salaam, Tanzania. Echocardiography was performed in 61 type 1 and 123 type 2 diabetes patients. LV hypertrophy was taken as LV mass/height(2.7) > 49.2 g/m(2.7) in men and > 46.7 g/m(2.7) in women. Relative wall thickness (RWT) was calculated as the ratio of LV posterior wall thickness to end-diastolic radius and considered increased if ≥ 0.43. LV geometry was defined from LV mass index and RWT in combination. The most common abnormal LV geometries were concentric remodelling in type 1 (30%) and concentric hypertrophy in type 2 (36.7%) diabetes patients. Overall, increased RWT was present in 58% of the patients. In multivariate analyses, higher RWT was independently associated with hypertension, longer isovolumic relaxation time, lower stress-corrected midwall shortening and circumferential end-systolic stress, both in type 1 (multiple R(2) = 0.73) and type 2 diabetes patients (multiple R(2) = 0.66), both p < 0.001. These associations were independent of gender, LV hypertrophy or renal dysfunction. Increased RWT is common among diabetic sub-Saharan Africans and is associated with hypertension and LV dysfunction.

A comparison of retrospectively self-gated magnetic resonance imaging and high-frequency echocardiography for characterization of left ventricular function in mice

Non-invasive imaging methods like echocardiography and magnetic resonance imaging (MRI) are very valuable in longitudinal follow-up studies of cardiac function in small animals. To be able to compare results from studies using different methods, and explain possible differences, it is important to know the agreement between these methods. As both self-gated high-field MRI and high-frequency echocardiography (hf-echo) M-mode are potential methods for evaluation of left ventricular (LV) function in healthy mice, our aim was to assess the agreement between these two methods. Fifteen healthy female C57BL/6J mice underwent both self-gated MRI and hf-echo during the same session of light isoflurane anaesthesia. LV dimensions were estimated offline, and agreement between the methods and reproducibility for the two methods assessed using Bland-Altman methods. In summary, hf-echo M-mode had better inter-observer repeatability than self-gated MRI for all measured parameters. Compared with hf-echo, systolic posterior wall thicknesses were significantly higher when measured by MRI, while diastolic anterior wall thicknesses were found to be significantly smaller. MRI measurements of diastolic LV diameter were also higher using MRI, resulting in larger fractional shortening values compared with the values obtained by hf-echo. In conclusion, hf-echo M-mode is easy to apply, has high temporal and spatial resolution, and good reproducibility. Self-gated MRI might be advantageous in cases of abnormal LV geometry and heterogeneous regional myocardial function, especially with improvements in spatial resolution. The moderate agreement between the methods must be taken into account when comparing studies using the two modalities.

Familial Aggregation of Left Ventricular Geometry and Association With Parental Heart Failure

Background— Data regarding the familial aggregation of left ventricular (LV) geometry and its relations to parental heart failure (HF) are limited. Methods and Results— We evaluated concordance of LV geometry within 1093 nuclear families in 5758 participants of the original (parents) (n=2351) and offspring (n=3407) cohorts of the Framingham Heart Study undergoing routine echocardiography in mid- to late adulthood. LV geometry was categorized based on cohort- and sex-specific 80th percentile cutoffs of LV mass and relative wall thickness (RWT) into normal (both &lt;80th percentile), concentric remodeling (LV mass &lt;80th percentile; RWT &gt;80th percentile), concentric hypertrophy (both &gt;80th percentile), and eccentric hypertrophy (LV mass &gt;80th percentile; RWT &lt;80th percentile). Within nuclear families, LV geometry was concordant among related pairs (parent-child, sibling-sibling) ( P =0.0015) but not among unrelated spousal pairs ( P =0.60), a finding that remained unchanged after adjusting for clinical covariates known to influence LV remodeling (age, systolic blood pressure, body mass index), excluding individuals with prevalent HF and myocardial infarction, and varying the thresholds for defining LV geometry. The prevalence of abnormal LV geometry was higher in family members of affected individuals, with recurrence risks of 1.4 for concentric remodeling (95% CI, 1.2 to 1.7) and eccentric hypertrophy (95% CI, 1.1 to 1.8) and 3.9 (95% CI, 3.2 to 4.6) for concentric hypertrophy. In a subset of 1497 offspring, we observed an association between parental HF (n=458) and eccentric hypertrophy in offspring ( P &lt;0.0001). Conclusions— Our investigation of a 2-generational community-based sample demonstrates familial aggregation of LV geometry, with the greatest recurrence risk for concentric LV geometry, and establishes an association between eccentric LV geometry and parental HF.

INCREASED RELATIVE WALL THICKNESS – A FREQUENT MARKER OF SUBCLINICAL CARDIAC TARGET ORGAN DAMAGE IN AFRICAN DIABETIC PATIENTS: PP.22.370

Introduction: Diabetes and hypertension is associated with increased prevalence of abnormal left ventricular (LV) geometry in African-Americans. However, limited data is available on subclinical cardiac target organ damage in African diabetic patients living in Sub-Saharan Africa. Aim: To assess prevalence and covariates of abnormal LV geometry in type1 and type 2 diabetic out-patients attending Muhimbili National Hospital in Dar Es Salaam, Tanzania. Methods: Cardiovascular risk assessment and echocardiography was performed in 96 patients, 45 type 1 and 51 type 2 diabetics, mean age 38 years, 59% women. LV hypertrophy was taken as LV mass index >116 g/m2 in men and >104 g/m2 in women. Relative wall thickness (RWT) was calculated as the LV posterior wall thickness/internal radius ratio and considered increased if >0.43. LV geometry was defined from LV mass index and RWT in combination. Results: Compared to type 1 patients, type 2 diabetics had higher prevalence of hypertension (65 vs 7%) and abnormal LV geometry (67 vs 42%, both p < 0.01). In both groups concentric remodelling was the most prevalent type of abnormal LV geometry (Table 1). In univariate analysis, RWT was associated with higher age, blood pressure, LV mass and larger waist circumference and with lower eGFR, transmitral early velocity, early diastolic mitral annular tissue velocity (E’) and midwall fractional shortening (all p < 0.05). In multivariate linear regression (multiple R2 = 0.42, p < 0.01), higher RWT was independently associated with known hypertension (ß = 0.22), lower E’ (ß = -0.26) and higher LV mass (ß = 0.43, all p < 0.05). No independent association was found with renal function, diabetes control, obesity or systolic LV function. Conclusion: Concentric remodelling is common both in type 1 and type 2 diabetics. Increased RWT is primarily associated with hypertension and impaired diastolic LV function.

Current cardiac imaging techniques for detection of left ventricular mass

Estimation of left ventricular (LV) mass has both prognostic and therapeutic value independent of traditional risk factors. Unfortunately, LV mass evaluation has been underestimated in clinical practice. Assessment of LV mass can be performed by a number of imaging modalities. Despite inherent limitations, conventional echocardiography has fundamentally been established as most widely used diagnostic tool. 3-dimensional echocardiography (3DE) is now feasible, fast and accurate for LV mass evaluation. 3DE is also superior to conventional echocardiography in terms of LV mass assessment, especially in patients with abnormal LV geometry. Cardiovascular magnetic resonance (CMR) and cardiovascular computed tomography (CCT) are currently performed for LV mass assessment and also do not depend on cardiac geometry and display 3-dimensional data, as well. Therefore, CMR is being increasingly employed and is at the present standard of reference in the clinical setting. Although each method demonstrates advantages over another, there are also disadvantages to receive attention. Diagnostic accuracy of methods will also be increased with the introduction of more advanced systems. It is also likely that in the coming years new and more accurate diagnostic tests will become available. In particular, CMR and CCT have been intersecting hot topic between cardiology and radiology clinics. Thus, good communication and collaboration between two specialties is required for selection of an appropriate test.

Left Ventricular Geometric Patterns In Obese Nigerian Adults: An Echocardiographic Study.

Background Obesity has recorded a global rise in its prevalence in the past decade and now constitutes a world wide epidemic. Left ventricular hypertrophy (LVH), and abnormal left ventricular geometry have also been associated with obesity. Prospective studies have shown that left ventricular geometric patterns have prognostic implications with the worst prognosis associated with concentric hypertrophy followed by eccentric hypertrophy and concentric remodeling. It is therefore necessary to know what pattern of hypertrophy is associated with obesity and the relationship between degrees of obesity and the development of left ventricular hypertrophy and abnormal geometry in Nigerians. Method: A total of two hundred and thirty (230) subjects were recruited for the study. One hundred and fifty (150) were obese while eighty (80) were non obese controls. Anthropometric data were obtained from all subjects and body mass index (BMI) was calculated. Based on BMI, the subjects were classified as obese and non obese. Blood pressure was measured on at least two occasions and fasting Blood sugar estimations were done to identify normotensive normoglycemic subjects who were included in the study. Echocardiography was done on all subjects after physical examination. Left ventricular mass was calculated using the Devereux modified ASE cube formula and this was indexed to height. 2 The relative wall thickness and the presence or absence of echocardiographic LVH was used to identify the geometric patterns.Results- The Left ventricular geometric patterns in the obese group were as follows: - 16.7% had normal geometry, 12.6% had concentric remodeling, 46.0% had eccentric hypertrophy and 24.7% had concentric hypertrophy. In the control group, 71.3% had normal geometry, 22.5% had concentric remodeling, 3.7% had eccentric hypertrophy and 2.5% had concentric hypertrophy. In the BMI subgroups, the prevalence of abnormal geometry worsened progressively with the degree of obesity such that in class III obesity, 100% had abnormal geometry and none had normal geometry.Conclusion Obesity is associated with eccentric left ventricular hypertrophy and the risk of its development worsens with the degree of obesity.