Concentric Hypertrophy Of Left Ventricle Research Articles

Abstract 16851: Simultaneous Mitral Valve Replacement, Aortic Valve Replacement, Tricuspid Valve Repair, Left Atrial Appendage Ligation, Maze Procedure And Cabg In A 57-year Old Female With History Of Tavr And Severe Mitral Annular Calcification

Background: Open heart surgery is preferred for patients with multiple valvular issues with conflicting physiology. Case: A 57-year-old female with a past medical history of Type I Diabetes Mellitus complicated by kidney & pancreatic transplant in 1999 s/p failed kidney transplant in 2016 subsequently back on dialysis, aortic stenosis leading to Transcatheter Aortic Valve Replacement (TAVR) in 2016 who presented to the hospital for profound cardiogenic shock and was found to have severe tricuspid regurgitation, severe mitral stenosis secondary to mitral annular calcification with severe concentric hypertrophy of left ventricle. Decision Making: Her conflicting right and left heart physiology due to Tricuspid Regurgitation and Mitral Stenosis was very difficult to manage medically. She was not deemed a candidate for a heart transplant due to a history of a failed kidney transplant. She underwent surgery which included Mitral Valve Replacement, explant TAVR and repeat aortic valve replacement, Tricuspid repair, Left atrial appendage ligation and maze procedure, and CABG x1 with saphenous vein graft to PDA. She stayed on V-V extracorporeal membrane oxygenation (ECMO) post-operatively and was discharged on post-operative Day # 14. Conclusion: Severe tricuspid Regurgitation & coexisting mitral stenosis pose a dilemma for medical management and only feasible option is surgery which could be extremely challenging.

ОСОБЛИВОСТІ СТРУКТУРНО-ФУНКЦІОНАЛЬНОГО СТАНУ СЕРЦЯ У ПАЦІЄНТІВ НА РІЗНИХ СТАДІЯХ ЦЕРЕБРАЛЬНОГО АТЕРОСКЛЕРОЗУ

Cerebrovascular diseases is one of the most important causes of morbidity and mortality in the adult population. Objective: to conduct a comparative analysis of the morpho-functional changes of the heart, intracardiac and systemic hemodynamics in elderly patients with cerebral atherosclerosis (CA) of 1–3 degree. Materials and methods: 229 patients with cerebral atherosclerosis of 2–3 degree took part in a comprehensive study. The patients were divided into 4 groups: Group 1 – patients with ischemic stroke (IS) in the right hemisphere (RH), Group 2 ­– with IS in the left hemisphere (LH), Group 3 – with cerebral atherosclerosis of 1–2 degree (no IS – comparison group) and Group 4 – a general group of patients who have IS. Design: simple, prospective, non-randomized, with the consistent inclusion of patients. Results and discussion: The compared groups differed statistically significantly by the LA diameter index (ILA), the LV diastolic index (LVIDd), the LV systolic index (LVIDs) and the wall thickness of the left ventricle (LV). Thus, the highest ILA value was observed in patients with CA (1.1 times more than in patients with IS), the highest values of LVIDd and LVIDs – in the group of patients with left-hemispheric localization of IS (1.14 and 1.18 times more, accordingly, than in patients with CA without IS). The minimal thickness of the interventricular septum (IVS) and the posterior wall of the LV was in the group of patients with CA (1.18 and 1.17 times less, respectively, compared with the group of patients with AI, without taking into account the hemispheric localization of IS). Interhemispheric differences were observed only in the assessment of LVIDd, LVIDs, and the thickness of the IVS. So, in patients with left hemispheric localization of IF LVIDd, it was 1.09 times greater, and LVIDs was 1.16 times greater than in patients with right hemispheric IF, while the IVS was 1.15 times thicker in the IS ​​group with the right hemisphere than with left hemispheric localization of IF. In the compared groups, we also observed statistically significant differences in the assessment of the parameters of systemic and intracardiac hemodynamics. So, in patients with CA, the index of the end-diastolic volume (iEDV) was 1.14 times higher and the index of the end-systolic volume (iESV) was 1.09 times less than in patients with IS, while in patients with left-hemispheric localization of IS the lowest ejection fraction and iEDV were observed compared with the group of patients with CA (1.02 and 1.15 times, respectively). Interhemispheric differences were recorded only in terms of the magnitude of the stroke index (SI). Thus, patients with IS in LН SI was 1.2 times more than in patients with IS in RH. In the group of patients with CA and IS, non-dilatational eccentric and concentric hypertrophy of LV (LVH) was most common (37.4 % and 48.1 %–26.0 % and 61.6 %, respectively), but type III was 1.44 times more common in patients with CA, and type V – 1.28 times more often in patients with IS. Eccentric dilated LVH was most often observed in patients with IS – 2.2 times more often than in patients with CA, and concentric dilated LVH was more common in patients with CA – 1.8 times more often than in patients with IS. Interhemispheric differences were observed only in relation to types III and V LVH. Thus, in patients with right hemispheric localization of IF, concentric non-dilated LVH was 1.66 times more common, and in patients with left-hemispheric IF localization – 4.4 times eccentric non-dilated LVH. Conclusions: in patients with CA of 1–3 degree, there were statistically significant differences in the morpho-functional changes in the heart, intracardiac and systemic hemodynamics and LV geometry, and some of these differences were hemispheric.

Glycosylated CD147 reduces myocardial collagen cross-linking in cardiac hypertrophy.

The mechanism of transition from chronic pressure overload-induced cardiac hypertrophy to heart failure is still unclear. Angiotensin II (Ang II) may be an important factor that mediates the transition in the end-stage of cardiac hypertrophy. In the present study, Goldblatt two-kidney one-clip (2K1C) rat model was used to simulate Ang II-induced hypertension. The elevated Ang II not only induced the concentric hypertrophy of left ventricle and cardiac fibrosis, but also increased the expression and glycosylation of CD147 in 2K1C rats. The left ventricular structure and function detected by echocardiogram showed a sign of the transition from cardiac hypertrophy to heart failure in 16 weeks of 2K1C rats. Ang II can activate N-acetylglucosamine transferase V (GnT-V), a key enzyme for CD147 glycosylation. Retinoic acid, an agonist of GnT-V, further increased glycosylated CD147, and activated matrix metalloproteinase-2/-9 (MMP-2 and MMP-9) in the hypertrophied left ventricle of 2K1C rat. Meanwhile, collagen cross-linking in the hypertrophied left ventricle significantly reduced in 2K1C rats. On the contrary, tunicamycin, an inhibitor of N-glycan biosynthesis, inhibited glycosylation of CD147 and activity of MMP-2 and MMP-9, and then maintained a stable of collagen cross-linking in the 2K1C rat hearts. The above results suggested that Ang II increased glycosylated CD147 which activated MMP-2 and MMP-9. Collagens were degraded by the activated MMPs and then reduced collagen cross-linking. Finally, the hypertrophied left ventricle was progressively dilated in chronic pressure overload due to losing the limitation of collagen cross-linking. Therefore, the compensated hypertrophy of left ventricle gradually transited to congestive heart failure.

The role of the insulin-like factor of growth 1 in the development of the processes of myocardial remodeling in women with arterial hypertension and metabolic syndrome

Aim: to establish the role of insulin-growth factor (IGF)-1 in myocardial remodeling in female patients with arterial hypertension (AH) and metabolic syndrome (MS) and different stages of obesity Materials and methods. The study included 108 women with AH and MS, divided into 3 groups according to stage of obesity, and 28 healthy women. It was assessed the concentration of IGF-1, status of hemodynamic and types of left ventricle's remodeling. Results. Concentric remodeling and IGF-1 elevation prevailed in patients with AH and first stage of obesity. Concentric hypertrophy of left ventricle and normal level of IGF-1 were established in patients with second stage of obesity. Lack of IGF-1 were determined in women with obesity 3rd stage and eccentric hypertrophy. Correlation analysis in patients with 2-3 stages of obesity showed the linkages between concentration of IGF-1 and hemodynamic parameters. Conclusion. The level of concentration of IGF-1 in patients with AH and MS correlates with remodeling types and stage of obesity.

Features of cardiac hemodynamics at chronic heart failure with overweight and obesity depending on the functional state of the kidneys

Several researches had demonstrated connection between the kidney dysfunction and worse prognosis in patients with both acute and chronic heart failure (CHF). The aim of research was to study the special features of cardiac hemodynamics at CHF with overweight and obesity depending on functional state of kidneys.Methods. There were examined 347 patients with CHF 0f 1-111 functional class on the background of overweight and abdominal obesity of 1-111 degree and different functional state of kidneys. There was calculated the speed of glomerular filtration (on MDRD formula) and carried out Doppler echocardiography for all examined persons. There was used an unpaired Student t-criterion or Mann-Whitney U-criterion depending on the size of sample and distribution of indicators.Results. Concomitant kidney functional state disorder complicates the clinical course of CHF on the background of overweight and obesity. It is demonstrated as an increase of functional class of disease at moderate and heavy kidney dysfunction. It is based on an increase of the degree of dilatation of the left and right atrium, left ventricle (LV) and the more degree of myocardium hypertrophy. The more significant calcination of mitral and aortic valves, the growth of degree of mitral regurgitation takes place. Simultaneously with structural changes in heart there take place functional disorders namely the worsening of contractility of LV and spread of systolic and diastolic myocardium function of 1 type, development of kidney hypertension. The remodeling of myocardium in this category of patients is mainly presented as concentric hypertrophy although at progression of kidney dysfunction the tendency to gradual elevation of excentric hypertrophy of LV takes place.Conclusions: It was established that CHF on the background of overweight and obesity associated with kidney dysfunction is characterized with heavier clinical course, elder age and more representation of women, dilatation of heart chambers, progression of hypertrophy of LV, calcination of valves and complication of mitral regurgitation. There took place a decrease of contractility of LV and spread of systolic and diastolic function by the type of relaxation disorder, kidney hypertension was forming. Among the types of myocardium remodeling the most widespread is concentric hypertrophy of LV that tends to decrease in favor of ecxentric hypertrophy at intensification of kidney dysfunction

Insulin-like growth factor-1 and myocardial remodeling in female patients with arterial hypertension and metabolic syndrome

Aim. To establish the role of insulin-like growth factor-1 (IGF-1) in left ventricular remodeling in female patients with arterial hypertension (HT) and metabolic syndrome (MS) with different stages of obesity. Material and methods. The study included 108 women with HT and MS, who were divided into 3 groups according to the stage of obesity, and 28 healthy women. The level of IGF-1, hemodynamic status and types of left ventricular remodeling were assessed. Results. Concentric remodeling and IGF-1 elevation (165.3±12.03 ng/ml) prevailed in patients with HT and first stage of obesity. Concentric hypertrophy of left ventricle and normal level of IGF-1 (118.5±10.05 ng/ml) were established in patients with second stage of obesity. Lack of IGF-1 (96.4±8.11 ng / ml) was determined in women with third stage of obesity and eccentric hypertrophy. Correlation analysis in patients with 2-3 stages of obesity showed significant associations between the level of IGF-1 and hemodynamic parameters. Conclusion. Changes in the level of IGF-1 in patients with AH and MS correlate with types of remodeling and stage of obesity.

OP-028 TRANSCORONARY SEPTAL ALCOHOL ABLATION IN OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY WITH HIGH PRESSURE GRADIENT: UNICENTER SHORT TERM RESULTS

left ventricular wall was noted, where in 28 patients hypertrophy was asymmetric while 14 had concentric hypertrophy of left ventricle. Left ventricular ejection fraction was depressed in the 21 patients, all with signs of heart failure. Patients in cardiac failure received various combinations of diuretics, B-blockers, ACE inhibitors and aspirin. Surgical intervention was not performed to none of them, despite of clinical and echocardiographic indications. Death occurred in 8 patients, in 4 of them shortly after admission, 3 left Kosovo against medical advice and continued examination in Italy and Germany, and the remaining 32 were followed-up for a mean 42 months, with a range from 5 to 115 months. Recovery was noted in 14 patients but still requiring anti-failure medications. Slightly over two-fifths died. Of those with asymmetric form, 45% died, in half of those presenting in infancy, and 89% of those who presented with signs of cardiac failure. Conclusion: Hypertrophic cardiomyopathy manifested often in severe form in our patients, and the response to standard anti-failure therapy was unsatisfactory. The goals of therapy in HCM are symptoms control and prolongation of survival. In summary, randomized clinical trials would be quite valuable to help define optimal care of children with hypertrophic cardiomyopathy. Significant challenges exist, such as various medical combinations in therapy, surgical intervention and heart transplantation.

Left ventricular hypertrophy in patients treated with regular hemodialyses

Left ventricular hypertrophy is the main risk factor for development of cardiovascular morbidity and mortality in patients on hemodialysis. Left ventricular hypertrophy is found in 75% of the patients treated with hemodialysis. Risk factors for left ventricular hypertrophy in patients on hemodialysis include: blood flow through arterial-venous fistula, anemia, hypertension, increased extracellular fluid volume, oxidative stress, microinflammation, hyperhomocysteinemia, secondary hyperparathyroidism, and disturbed calcium and phosphate homeostasis. Left ventricular pressure overload leads to parallel placement of new sarcomeres and development of concentric hypertrophy of left ventricle. Left ventricular hypertrophy advances in two stages. In the stage of adaptation, left ventricular hypertrophy occurs as a response to increased tension stress of the left ventricular wall and its action is protective. When volume and pressure overload the left ventricle chronically and without control, adaptive hypertrophy becomes maladaptive hypertrophy of the left ventricle, where myocytes are lost, systolic function is deranged and heart insufficiency is developed. Left ventricular mass index-LVMi greater than 131 g/m2 in men and greater than 100 g/m2 in women, and relative wall thickness of the left ventricle above 0.45 indicate concentric hypertrophy of the left ventricle. Eccentric hypertrophy of the left ventricle is defined echocardiographically as LVMi above 131 g/m2 in men and greater than 100 g/m2 in women, with RWT ?0.45. Identification of patients with increased risk for development of left ventricular hypertrophy and application of appropriate therapy to attain target values of risk factors lead to regression of left ventricular hypertrophy, reduced cardiovascular morbidity and mortality rates and improved quality of life in patients treated with regular hemodialyses.

Right ventricle diastolic function in hypertensive patients

Aim of this study were determination of correlation of changes of diastolic function of right (RV) and left ventricle (LV) in patients with essential arterial hypertension. 98 new founded hypertensives and 18 healthy volunteers were examined with pulse-wave Doppler echocardiography for determination of parameters of RV diastolic filling and connection between ones and diastolic function and remodeling of LV. We determined that positive correlation between isovolumic relaxation time in both ventricles increase with growth of LV myocardial mass: in patients with LV hypertrophy (n=36) r=0.67 (p<0.01) and in patients without one (n=62) r=0.48 (p<0.05). Correlation between early diastolic fraction of LV and RV was middle in patients with normal type and eccentric hypertrophy of LV (r=0.34, p<0.05) and strong in patients with concentric remodeling and concentric hypertrophy of LV (r=0.62, p<0.01). In control group we did not observe any connection between above mention parameters. Diastolic function of RV in hypertensives is impaired according to changes of LV's one. Correlation between filling of both ventricles is increased with growth of LV myocardial mass and concentric transformation. It can be explained with ones mechanisms of neuro-humoral regulation of myocardial remodeling (renin-angiotensin system etc.) and one middle and external layers of myocardium for both ventricles.

Endothelial function and diastolic filling in hypertensive patients

Aim of this study were determination of correlation between endothelium-depended vasodilatation and of diastolic function of left ventricle (LV) in patients with essential arterial hypertension. 67 new founded hypertensives and 18 healthy volunteers were examined with pulse-wave Doppler echography of shoulder artery and Doppler echocardiography for determination of correlation between growth of maximal systolic velocity ( MSV, %) on 5 minute compression test and parameters of LV diastolic function (isovolumic relaxation time (IVRT, ms) and early filling fraction (EFF, %)). Correlation's coefficient between changes of MSV and IVRT were 0,71 in patients with concentric remodeling and concentric hypertrophy of LV(n=44) (p<0.01) and 0,52 in patients with normal type and eccentric hypertrophy of LV (n=23) (p<0.05) and between growth of MSV and EFF -0,26 and -0,44 (p<0.05). In control group we did not observe any correlation between above mention parameters. Our results shows that changes of active relaxation of muscle cells of LV and arterial wall in hypertensives is parallel processes and have one pathogenic mechanisms, for example - dysfunction of endothelium.