Abnormal LV Research Articles

Reclassification of LV geometric patterns in morbidly obese patients. A CRM study

The echocardiographic definition of LV geometric pattern has limitations in terms of accuracy and reproducibility of measurements and the geometric assumptions on LV geometry to calculate volume from linear dimensions. A Cardiac Magnetic Resonance- based volumetric analysis overcomes the limitation of the use of linear parameters to calculate volume and is higly reproducible. Objective: Comparison of LV pattern in morbidly obese patients by echocardiography and CMR. Methods: 37 morbidly obese patients underwent echocardiography and CMR. Results: CMR- LVmass index was lower than echo- LV mass index and LVmass/Volume ratio was normal (table, figure). View this table: Table 1. Patient characteristics, echo and CRM data in morbidly obese patients (n=37) ![Figure][1] Figure 1. LV geometric pattern by Echo vs CRM Conclusions: In morbidly obese patients, CMR reclassifies most abnormal echo-based LV patterns into normal. Ecccentric remodeling is more common than concentric with either Echo or CMR. [1]: pending:yes

Acute changes of glucose and insulin levels during oral glucose tolerance test are related to changes in LV myocardial deformation, untwisting and coronary flow reserve

Increased arterial stiffness caused by insulin resistance may impair LV function. We investigated whether first degree relatives of diabetics have similar changes of coronary microcirculation and myocardial twisting with diabetics during an oral glucose tolerance test (OGTT). Methods: In 76 subjects, we measured glucose, insulin, pulse wave velocity (PWVa) and augmentation index (AI) (Arteriograph) at 0, 30, 60, 90 and 120 min of OGTT. At 0 and 120 min, we measured a)E', A' and E'/A' mitral annular velocities using tissue Doppler b) LV longitudinal systolic (LGSr-l/s) and diastolic strain rate (LGSrE), twisting (Tw-deg), twisting (Tw–deg/sec) and untwisting (unTw)velocity using speckle tracking echocardiography c) coronary flow reserve (CFR) using Doppler echocardiography. We assessed insulin resistance using insulin sensitivity index (ISI- includes both insulin and glucose throughout OGTT). Results: Thirty-six subjects who were first degree relatives of diabetics had normal OGTT (relatives), 20 had normal OGTT and no family history of diabetes (normals), and 20 had abnormal OGTT (diabetics). Compared to normals, diabetics and relatives had both higher baseline PWVa (9.3±2 vs. 8.1±2 vs. 7.2±1.6), AI (23±9 vs. 24±14, 18±1), insulin (median 14 vs. 15 vs. 10 μU/ml), and lower ISI (50±24 vs. 73.±22 vs. 93±17), E'/A' (0.7±0.2 vs. 0.98±0.2 vs 1.1±0.3) LGSr (-0.95±0.1 vs. -0.94±0.1 vs. -1.1±15) LGSrE (0.98±0.1 vs. 1.±0.1 vs 1.3±15), Tw (15±7 vs. 13±5 vs. 17±7) and unTwvelocity (-95±31 vs. -94±40 vs. 116±36) and lower CFR (2.7±1.1 vs. 2.6±0.9 vs. 3.0±0.6) (p<0.05). Insulin was increased at 120min, to 521% in diabetics, 293% in relatives and 190% in normals (p<0.05). PWVa was increased at 120min to 8.9 (10%) in relatives, was reduced to 6.8 (6%) in normals and remained high (9.4±2m/s) in diabetics (p<0.05). Tw and unTwvelocity at 120min, was increased to 17 (13%) and -105 (10%) in diabetics, to 15 (15%) and -105 (10%) in relatives and was reduced to 13 (24%) and -87 (25%) in normals (p<0.05). CFR was decreased to 2.4 (14%) in diabetics, 2.3 (12%) in relatives and 2.8 (6%) in normals (p<0.05). ISI, insulin and glucose at 120 min were related with PWV, CFR, LGSr, LGSrE, TW,Twvelocity unTwvelocity and E'/A' and PWV was related with LGSr E, Tw, Tw velocity, unTw velocity and E'/ A'(in both diabetics and relatives (p<0.05). Conclusions: Acute hyperglycemia and hyperinsulinemia during OGTT are related with abnormal LV myocardial deformation, twisting and untwisting possibly through increases in arterial stiffness and impairment of coronary microcirculatory function in first degree relatives and diabetics

Subclinical atherosclerosis, vascular dysfunction and abnormal LV myocardial deformation is similar between patients with psoriasis and no hypertension and patients with untreated hypertension

Subclinical atherosclerosis, vascular dysfunction and abnormal LV myocardial deformation is similar between patients with psoriasis and no hypertension and patients with untreated hypertension

FRI0133 Does rheumatoid arthritis predispose to abnormal left ventricular geometry?

BackgroundLeft ventricular (LV) geometry is a strong predictor of cardiovascular death. Less is known about the relation between LV geometry and RA.ObjectivesOur objective was to study if RA or RA...

WAIST CIRCUMFERENCE PREDICTS ABNORMAL LEFT VENTRICULAR RELAXATION IN MEN: DATA OBTAINED THROUGH THOROUGH PHYSICAL EXAMINATIONS IN HEALTHY SUBJECTS

methods: A total of 1055 adults (mean age 63±13, 58.8% men) without diabetes mellitus, systolic dysfunction or other heart disease underwent a thorough physical examination including tissue Doppler echocardiography. We designated peak early mitral annular velocity (e’) of less than 5.0 to indicate abnormal LV myocardial relaxation (LVMR). We performed single and multiple logistic regression analyses of e’ and cardiovascular risk factors, including MetS factors and indicators of major organ dysfunction and evaluated results with regard to three age groups: young (≤ 49 yrs), middle-aged (50-69 yrs) and elderly (≥ 70 yrs) for both men and women.

Assessment of left ventricular geometrical patterns and function among hypertensive patients at a tertiary hospital, Northern Tanzania

BackgroundWith hypertension, the cardiovascular system changes to adapt to the varying neuro-humoral and hemodynamic changes and this may lead to the development of different left ventricular geometric patterns, each carrying a different risk profile for major adverse cardiovascular events.MethodsUsing a consecutive sampling technique, a cross-sectional, prospective, hospital based study was done and two hundred and twenty seven (227) hypertensive patients were studied.ResultsThe distribution of different abnormal LV geometrical patterns was 19.8%, 28.2%, 22% for concentric remodelling, concentric hypertrophy and eccentric hypertrophy respectively. With echocardiographic criteria, the proportion of patients with left ventricular hypertrophy (LVH) was higher when left ventricular mass (LVM) was indexed to height2.7 than to body surface area (70.0% vs. 52.9%). Duration of hypertension markedly influenced the type of LV geometry with normal LV geometry predominating in early hypertension and abnormal geometrical patterns predominating in late hypertension. The left ventricular fractional shortening decreased with duration of hypertension and was common in patients with eccentric hypertrophy. Age of the patient, systolic blood pressure, duration of hypertension and body mass index were found to be independent predictors left ventricular hypertrophy.ConclusionAbout 70% of hypertensive patients had abnormal geometry existing in different patterns. Eccentric hypertrophy had more of clinical and echocardiographic features suggestive of reduced left ventricular systolic function. Hypertensive patients should be recognized as a heterogeneous population and therefore stratifying them into their respective LV geometrical patterns is useful as way of assessing their risk profile as well as instituting appropriate management.

Abstract 18965: Monitoring the Asymptomatic Patient with Severe Mitral Regurgitation: Do Measuring LV Volumes Make a Difference in Predicting Mortality?

Background: The ACC/AHA Valvular Heart Disease Guidelines include a class I recommendation for surgery in asymptomatic patients with chronic severe mitral regurgitation (MR) if the EF is ≤ 60% and/ or the end-systolic diameter (ESD) &gt; 40 mm. However, the ESD has inherent limitations because it only detects changes in one dimension while LV volume can detect subtle changes in LV geometry in multiple dimensions. We sought to measure the impact of shifting from ESD to end systolic volume (ESV) in predicting mortality. Methods: We performed a retrospective search of our single center echocardiography database over a 5 year period for all cases with severe (4+) MR. From this list of 240 patients, we reviewed the medical records to identify the subgroup of patients who remained asymptomatic at the time of echo evaluation (N = 61). Since the ACC/AHA Guidelines recommend surgical referral for asymptomatic patients with an EF ≤ 60%, these patients were also excluded in order to isolate the impact of LV size on mortality. This resulted in a total of 31 study subjects. Study subjects were classified according to 2 different methods: “classic” LV size criteria (ESD &gt; 40mm) or “volume” LV size criteria (ESV ≥ “mildly dilated” per ASE Chamber Quantification Guidelines). Volumes were obtained using a biplane Simpson. Results: As compared to classic LV size criteria using ESD, a change to volume criteria using ESV would significantly increases the percentage of patients identified with abnormal LV geometry (61% vs 25%, p &lt; 0.01). However, despite identifying a larger number of patients with abnormal LV geometry, the difference in mortality using volume criteria or classic criteria was not significant. Conclusion: Although there are conceptual advantages to the assessment of LV size using LV volumes rather than 2D linear measurements, the difference in the two methods for predicting mortality in the context of asymptomatic MR with normal EF was not significant. Further refinements in the assessment of LV volumes, larger studies, and inclusion of additional end-points such as CHF admissions may be needed to further understand the relationship between changes in LV geometry and adverse events in this population.

Associations between Kidney Function and Subclinical Cardiac Abnormalities in CKD

Heart failure is a common consequence of CKD, and it portends high risk for mortality. However, among patients without known heart failure, the associations of different stages of estimated GFR (eGFR) with changes in cardiac structure and function are not well described. Here, we performed a cross-sectional analysis to study these associations among 3487 participants of the Chronic Renal Insufficiency Cohort Study. We estimated GFR using cystatin C. The prevalence of left ventricular hypertrophy (LVH) assessed by echocardiography was 32%, 48%, 57%, and 75% for eGFR categories ≥60, 45-59, 30-44, and <30 ml/min per 1.73 m(2), respectively. In fully adjusted multivariable analyses, subjects with eGFR levels of <30 ml/min per 1.73 m(2) had twofold higher odds of LVH (OR=2.20, 95% CI=1.40-3.40; P<0.001) relative to subjects with eGFR≥60 ml/min per 1.73 m(2). This reduction in kidney function also significantly associated with abnormal LV geometry but not diastolic or systolic dysfunction. An eGFR of 30-44 ml/min per 1.73 m(2) also significantly associated with LVH and abnormal LV geometry compared with eGFR≥60 ml/min per 1.73 m(2). In summary, in this large CKD cohort, reduced kidney function associated with abnormal cardiac structure. We did not detect significant associations between kidney function and systolic or diastolic function after adjusting for potential confounding variables.

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.

Cardiac resynchronization therapy (CRT): Clinical trials, guidelines, and target populations

Over the last 10 years, several large, well-designed clinical trials have firmly established the role of cardiac resynchronization therapy (CRT) as a recommended treatment strategy for moderate-to-severe heart failure (HF). A review of the relevant results from the MUSTIC, MIRACLE, CONAK-CD, and MIRACLE ICD trials reveals that in patients with New York Heart Association (NYHA) class III-IV HF, CRT produces consistent improvements in quality of life, functional status, and exercise capacity while also providing strong evidence for reverse remodeling and diminished functional mitral regurgitation, resulting in reductions in both HF hospitalizations and all-cause morbidity and mortality. In patients with earlier NYHA class I-II HF, the benefit of CRT has been more controversial. The principal ongoing challenges addressed in this article include the substantial 30% of patients who receive a CRT device but fail to respond, the wide variations in how to define "response" vs "nonresponse," and how to identify patients who will benefit from CRT, especially narrow QRS (<120 ms), those with right bundle branch block, and those with mild-to-moderate (NYHA class I-II) HF. An important result of this uncertainty is the lack of a good sense of the optimal rate of CRT implantation, making consideration of the data reviewed in this article crucial for identifying important gaps of knowledge and mechanisms of action that need to be studied in the near future.

Abstract MP058: Longitudinal Determinants of LV Mass and Geometry: The CARDIA Study

There is little long term data on LV mass and geometry. The Coronary Artery Disease in Young Adults Study (CARDIA), a longitudinal study of the evolution of cardiovascular disease risk factors in young adults, performed echocardiograms in years 5 and 25. The purpose of this study is to assess change in prevalence of LV hypertrophy and LV geometry categories (LV mass &gt; 51g/m 2.7 = LV hypertrophy; LV relative (wall thickness/LV diastolic diameter ratio) &gt; 0.41 = concentric geometry) over 20 years of follow up and to identify determinants of change in LV mass and geometry over that time interval. We used preliminary data on 1469 black and white men and women aged 43-55 years with complete data from the year 5 and 25 examinations for this analysis. Regression models had year 25 LV mass or relative wall thickness as the dependent variable and year 5 LV mass or relative wall thickness, age, gender, race, BMI, change in BMI, SBP, change in SBP, heart rate (HR), change in (HR), tobacco use, presence of diabetes, alcohol use, and physical activity score as independent variables. LV mass and relative wall thickness increased in each race/gender group (Table). Prevalence of normal LV mass/eccentric geometry decreased (84 to 63%) whereas concentric LV geometry increased (11 to 16%), as did LV hypertrophy (concentric (1 to 10%) and eccentric (3 to 11%) geometry). Significant determinants of year 25 LV mass/m 2.7 were baseline LV mass, baseline and change in BMI, baseline and change in SBP, baseline and change in HR, presence of diabetes, and year 5 tobacco and/or alcohol use (r 2 = 0.39). Significant determinants of year 25 LV wall thickness/diameter ratio were baseline ratio, black race, baseline and change in BMI, baseline and change in SBP, and presence of diabetes.(r 2 = 0.08). We conclude prevalence of abnormal LV hypertrophy/geometry increased dramatically from young adulthood to middle age. Both young adult risk traits and change in these traits predicted change in LV mass/geometry. DM, for the first time, emerged in this analysis as a significant determinant. LV mass and relative wall thickness at years 5 and 25 LV mass (g) LV mass (g/m2.7) Relative Wall Thickness Black Men Yr 5 176.2 (43.3) 37.4 (8.7) 0.37 (0.07) n=262 Yr 25 216.5 (68.3) 46.1 (15.5) 0.39 (0.09) White Men Yr 5 166.7 (39.0) 35.1 (8.2) 0.34 (0.06) n=362 Yr 25 198.8 (54.8) 42.0 (11.4) 0.35 (0.07) Black Women Yr 5 133.7 (37.6) 35.2 (9.7) 0.35 (0.06) n=439 Yr 25 174.2 (53.9) 45.5 (14.0) 0.38 (0.08) White Women Yr 5 122.0 (29.8) 31.5 (7.9) 0.33 (0.05) n=406 Yr 25 149.4 (42.7) 38.8 (11.1) 0.35 (0.08) values are mean (SD)

Abnormal right atrial and right ventricular diastolic function relate to impaired clinical condition in patients operated for tetralogy of Fallot

BackgroundAtrial enlargement may reflect ventricular diastolic dysfunction. Although patients with tetralogy of Fallot (TOF) have been studied extensively, little is known about atrial size and function. We assessed bi-atrial size and function in patients after TOF repair, and related them to biventricular systolic and diastolic function, and clinical parameters. Methods51 Patients (21±8years) and 30 healthy controls (31±7years) were included and underwent magnetic resonance imaging to assess bi-atrial and biventricular size, systolic and diastolic function. Patients also underwent exercise testing, and N-terminal prohormone brain natriuretic peptide (NT-proBNP) assessment. ResultsIn patients, right atrial (RA) minimal volume (34±8ml/m2 vs. 28±8ml/m2, p=0.001) and late emptying fraction were increased; RA early emptying fraction was decreased. Patients had longer right ventricular (RV) deceleration time (0.24±0.10 vs. 0.13±0.04, p<0.001), reflecting impaired RV relaxation, and larger RV volumes. Patients with end-diastolic forward flow (EDFF) had larger RA and RV size, abnormal RA emptying, higher NT-proBNP levels, higher VE/VCO2 slope (ventilatory response to carbon dioxide production), and the most abnormal LV diastolic function (impaired compliance). Patients with abnormal RA emptying (reservoir function <30% and pump function >24%) had higher NT-proBNP levels and worse exercise capacity. RA minimal volume was associated with RV end-diastolic volume (r=0.35, p=0.013). ConclusionsIn TOF patients with moderate RV dilatation, abnormal bi-atrial function and biventricular diastolic dysfunction are common. Abnormal RA emptying was associated with signs of impaired clinical condition, as was the presence of EDFF. These parameters, together with RA enlargement, could serve as useful markers for clinically relevant RV diastolic dysfunction.

Left ventricular hypertrophy and geometry in type 2 diabetes patients with chronic kidney disease. An echocardiographic study.

We assessed left ventricular structural alterations associated with chronic kidney disease (CKD) in Congolese patients with type 2 diabetes. This was a cross-sectional study of a case series. We obtained anthropometric, clinical, biological and echocardiographic measurements in 60 consecutive type 2 diabetes patients (37 females, 62% ) aged 20 years or older from the diabetes outpatient clinic, University of Kinshasa Hospital, DRC. We computed creatinine clearance rate according to the MDRD equation and categorised patients into mild (CrCl > 60 ml/min per 1.73 m(2)), moderate (CrCl 30-60 ml/min per 1.73 m(2)) and severe CKD (< 30 ml/min per 1.73 m(2)). Left ventricular hypertrophy (LVH) was indicated by a LV mass index (LVMI) > 51 g/m(2.7) and LV geometry was defined as normal, or with concentric remodelling, eccentric or concentric hypertrophy, using relative wall thickness (RWT) and LVMI. Compared to patients with normal kidney function, CKD patients had higher uric acid levels (450 ± 166 vs 306 ± 107 µmol/l; p ≤ 0.001), a greater proportion of LVH (37 vs 14%; p ≤ 0.05) and longstanding diabetes (13 ± 8 vs 8 ± 6 years; p ≤ 0.001). Their left ventricular internal diameter, diastolic (LVIDD) was (47.00 ± 6.00 vs 43.00 ± 7.00 mm; p ≤ 0.001), LVMI was (47 ± 19 vs 36.00 ± 15 g/m2.7; p ≤ 0.05) and proportions of concentric (22 vs 11%; p ≤ 0.05) or eccentric (15 vs 3%; p ≤ 0.05) LVH were also greater. Severe CKD was associated with increased interventricular septum, diastolic (IVSD) (12.30 ± 3.08 vs 9.45 ± 1.94 mm; p ≤ 0.05), posterior wall thickness, diastolic (PWTD) (11.61 ± 2.78 vs 9.52 ± 1.77 mm; p ≤ 0.01), relative wall thickness (RWT) (0.52 ± 0.17 vs 0.40 ± 0.07; p ≤ 0.01) rate of LVH (50 vs 30%; p ≤ 0.05), and elevated proportions of concentric remodelling (25 vs 15%; p ≤ 0.05) and concentric LVH (42 vs 10%; p ≤ 0.05) in comparison with patients with moderate CKD. In multivariable adjusted analysis, hyperuricaemia emerged as the only predictor of the presence of LVH in patients with CKD (adjusted OR 9.10; 95% CI: 2.40-33.73). In keeping with a higher rate of cardiovascular events usually reported in patients with impaired renal function, CKD patients exhibited LVH and abnormal LV geometry.

Abstract 17945: Abnormal Left Ventricular Torsion Assessed by Speckle Tracking Echocardiography in Orthotopic Heart Transplant Patients as Early Predictor of the Acute Myocardial Rejection

Background LV torsion is a critical aspect of cardiac biomechanics and hold promise for better understanding the ventricular dysfunction. The aim of this study was to determine whether LV torsion assessed by 2D-speckle tracking imaging can predict rejection in transplanted hearts. Methods From Oct 2010 to Feb 2011, patients who had transplant and underwent echocardiogram as well as RV biopsies in our Center, were analyzed. The echocardiograms and RV biopsies were done within 3 days of each other. Patients who did not have any prior cardiac surgeries or valvular heart disease were analyzed for comparison (controls). Torsion measurements were performed off-line using commercially available software. Basal and apical short-axis views were used for measurement of torsion. LV torsion was calculated as (apical LV rotation minus basal LV rotation)/LV diastolic longitudinal length. By speckle tracking echocardiography, global longitudinal strain was also calculated in all the patients. LVEF was assessed using modified Simpson's method. Patients with incomplete data were excluded. Results 14 transplant patients were compared with 6 matching controls. 4 transplanted patients had a biopsy-confirmed rejection. Torsion, global strain and LVEF were all reduced in patients with rejection as compared to those without rejection and with controls. When mean value of torsion in controls was applied as a normal threshold to the study population, 75% (3/4) of the patients with rejection had an abnormal torsion despite normal LVEF. Torsion analysis provided a sensitivity and specificity of 75% and 70% for detecting rejection in transplant patients. Conclusion To our knowledge this is the first study to demonstrate the value of LV torsion in predicting rejection in patients post heart transplant. In patients with rejection, abnormal LV torsion at initial presentation can be utilized as an early non-invasive predictive marker to help in identification of these patients.

Does cardiovascular phenotype explain the association between diabetes and incident heart failure? The Strong Heart Study

Background and aimsDiabetes remains a predictor of incident heart failure (HF), independent of intercurrent myocardial infarction (MI) and concomitant risk factors. Initial cardiovascular (CV) characteristics, associated with incident heart failure (HF) might explain the association of diabetes with incident HF. Methods and resultsParticipants to the 2nd Strong Heart Study exam, without prevalent HF or coronary heart disease, or glomerular filtration rate <30 mL/min/1.73 m2, were analyzed (n = 2757, 1777 women, 1278 diabetic). Cox regression of incident HF (follow-up 8.91 ± 2.76 years) included incident MI censored as a competing risk event. Acute MI occurred in 96 diabetic (7%) and 84 non-diabetic participants (6%, p = ns). HF occurred in 156 diabetic (12%) and in 68 non-diabetic participants (5%; OR = 2.89, p < 0.001). After accounting for competing MI and controlling for age, gender, BMI, systolic blood pressure, smoking habit, plasma cholesterol, antihypertensive treatment, heart rate, fibrinogen and C-reactive protein, incident HF was predicted by greater LV mass index, larger left atrium, lower systolic function, greater left atrial systolic force and urinary albumin/creatinine excretion. Risk of HF was reduced with more rapid LV relaxation and anti-hypertensive therapy. Diabetes increases hazard of HF by 66% (0.02 < p < 0.001). The effect of diabetes could be explained by the level of HbA1c. ConclusionsIncident HF occurs more frequently in diabetes, independent of intercurrent MI, abnormal LV geometry, subclinical systolic dysfunction and indicators of less rapid LV relaxation, and is influenced by poor metabolic control. Identification of CV phenotype at high-risk for HF in diabetes should be advised.

Early identification of mutation carriers in familial hypertrophic cardiomyopathy by combined echocardiography and tissue Doppler imaging

Preliminary studies suggested that tissue Doppler imaging (TDI) was able to identify mutation carriers in familial hypertrophic cardiomyopathy (HCM) before the development of hypertrophy. However, data are limited. We performed a systematic analysis of echocardiography, TDI, and electrocardiogram (ECG) in familial HCM to identify parameters associated with genetic status. We analysed 120 adults spread out in three groups: HCM patients with hypertrophy (LVH+, n = 48), mutation carriers without hypertrophy (LVH-/G+, n = 24), and normal control subjects (n = 48). Several parameters were significantly different in LVH-/G+ compared with controls. Multivariate logistic regression identified only three independent echographic/TDI parameters associated with genetic status: the inter-ventricular septum/left posterior wall ratio (P = 0.006), relative wall thickness (P = 0.026), and septal E/Ea ratio (P = 0.008). An echo/TDI score determined after receiver operating characteristic analysis identified mutation carriers with 67% sensitivity and 96% specificity. In comparison, only 29% were identified by the previously proposed TDI criterion (lateral Ea velocity <14 cm/s) and only 33% by major ECG abnormalities. Tissue Doppler imaging velocities alone were not reliable enough to identify LVH-free mutation carriers in HCM. In contrast, abnormal LV remodelling was a frequent early manifestation of HCM. We developed a new score, combining echocardiographic and TDI parameters, that identifies mutation carriers before and independently of hypertrophy with high accuracy.

079 Early Identification of mutation carriers by echodoppler and TDI in familial Hypertrophic Cardiomyopathy

Some studies suggested that abnormal diastolic dysfunction was an early manifestation of Hypertrophic Cardiomyopathy (HCM) and that Tissue Doppler Imaging (TDI) was able to correctly identify mutation carriers before the development of hypertrophy. Data are however limited and still controversial. We therefore performed a systematic analysis of Echocardiography, TDI and ECG in familial HCM to identify predictive parameters for genetic status. We recruited 120 adults spread out in three groups: HCM patients with hypertrophy (LVH+, n=48), mutation carriers without hypertrophy (LVH-/G+, n=24), normal control subjects (n=48). Several parameters were significantly different in G+/LVH- as compared to controls, including septal Ea peak velocity. Multivariate logistic regression identified three Echographic/TDI independent predictors for genetic status in LVH-free subjects: the inter-ventricular/left posterior wall (IVS/LPW) ratio, the relative wall thickness (RWT) and the septal E/Ea ratio. An Echo/TDI score determined after ROC analysis, showed 67% sensitivity and 96% specificity for the identification of mutation carriers. In comparison, sensitivity and specificity of septal Ea peak velocity (<13 cm/s) were 63% and 69% respectively. Major ECG abnormalities were not correlated with the Echo/TDI score and sensitivity of ECG was only 33%. Although DTI velocities alone were not reliable enough to identify LVH-free mutation carriers in HCM, a new Echo/TDI score can achieve preclinical diagnosis with high accuracy. Abnormal LV remodeling, and not only functional abnormalities, might be an early manifestation of HCM in human.

Left Ventricular Geometry Predicts Cardiovascular Outcomes Associated with Anemia Correction in CKD

Partial correction of anemia in patients with chronic kidney disease (CKD) reduces left ventricular hypertrophy (LVH), which is a risk factor for cardiovascular (CV) morbidity, but complete correction of anemia does not improve CV outcomes. Whether LV geometry associates with CV events in patients who are treated to different hemoglobin (Hb) targets is unknown. One of the larger trials to study the effects of complete correction of anemia in stages 3 to 4 CKD was the Cardiovascular Risk Reduction by Early Anemia Treatment with Epoetin Beta (CREATE) trial. Here, we analyzed echocardiographic data from CREATE to determine the prevalence, dynamics, and prognostic implications of abnormal LV geometry in patients who were treated to different Hb targets. The prevalence of LVH at baseline was 47%, with eccentric LVH more frequent than concentric. During the study, LVH prevalence and mean left ventricular mass index did not change significantly, but LV geometry fluctuated considerably within 2 yr in both groups. CV event-free survival was significantly worse in the presence of concentric LVH and eccentric LVH compared with the absence of LVH (P = 0.0009 and P < or = 0.0001, respectively). Treatment to the higher Hb target associated with reduced event-free survival in the subgroup with eccentric LVH at baseline (P = 0.034). In conclusion, LVH is common and associates with poor outcomes among patients with stages 3 to 4 CKD, although both progression and regression of abnormal LV geometry occur. Complete anemia correction may aggravate the adverse prognosis of eccentric LVH.

Prevalence and Risk Factors of Myocardial Remodeling in Hemodialysis Patients

Background. Left ventricular hypertrophy (LVH) is an independent risk factor for morbidity/mortality in patients with end stage renal disease (ESRD). Our study aimed to identify prevalence as well as independent risk factors that contribute to the development of LV geometric remodeling in our HD patients. Methods. The left ventricles of 116 HD patients were classified echocardiographically into four different geometric patterns on the basis of LV mass and relative wall thickness. Furthermore, we measured inferior vena cava (IVC) diameter and its collapsibility index (CI) by echocardiography. Finally, we modeled a stepwise multiple regression analysis to determine the predictors of LV geometry. Results. Our study provides evidence that HD patients had a prevalence of abnormal LV geometry in 92% and LVH in 81%. We found all four geometric models of LV. Most dominant were eccentric LVH. Concentric LVH was observed in 37, normal geometry (NG) in 9, and concentric remodeling (CR) in 13 of HD patients. Mean arterial blood pressure was significantly higher in the cLVH group (95 ± 10 mmHg) than in the NG and CR groups (81.6 ± 12.3 and 80 ± 11.8, respectively, p < 0.001). The cLVH and eCLVH groups had significantly lower mean hemoglobin (10.3 ± 1.4g/dL and 10.6 ± 1g/dL, respectively) compared with the NG group (11.9 ± 1.4g/dL), p < 0.001. Furthermore, interdialytic weight gain (kg) was significantly higher in eCLVH group (3.13 ± 0.8) than in NG group (2.3 ± 1.1), p < 0.001. Mean IVC index of the eLVH group (10.83 ± 2.07 mm/m2) was significantly higher than corresponding indexes of NG (10.83 ± 2.07 mm/m2), CR (8.31 ± 1.32 mm/m2) and cLVH (8.12 ± 2.06 mm/m2) groups (p < 0.001 for each comparisons). Conclusion. Mean arterial pressure, hemoglobin, IVC index, and interdialytic weight gain were found to be independent predictors of LV geometry (R2 = 0.147; p < 0.001) in HD patients.

Hypertension in Heart Failure with Normal LVEF Is Characterized by LVH, Decreased Atrial Ejection Function and Two Distinct Patterns of Abnormal LV Filling

Background: Hypertension (HT) is associated with LVH, abnormal LV diastolic function and CHF with normal systolic function. Although LV size and function has been characterized in this group, left atrial (LA) size and function have not been well studied. Therefore, we characterized LA size and function in a group of patients with HT, with acute left heart failure and normal systolic function. Methods: Twenty-seven patients with HT and normal EF hospitalized with pulmonary congestion were compared to six normal individuals.