Eccentric Left Ventricular Hypertrophy Research Articles

Myocardial work index in endurance athletes with lack of expected left ventricular eccentric hypertrophy remodelling

Myocardial work index in endurance athletes with lack of expected left ventricular eccentric hypertrophy remodelling

Structural and functional abnormalities of left-sided cardiac chambers in Barlow's disease without significant mitral regurgitation.

To explore the presence of left ventricular (LV) and left atrial (LA) morphological and functional abnormalities in patients with Barlow's disease (BD) without significant mitral regurgitation (MR) and to investigate whether these abnormalities may predict MR progression. Consecutive patients with BD were retrospectively identified from two tertiary centers; those with MR graded from trivial to mild-to-moderate were selected and matched with healthy controls in a 1:1 ratio. Conventional and speckle-tracking echocardiographic data were collected. The development of moderate-to-severe or greater MR was evaluated on follow-up echocardiograms.Patients with BD (n=231) showed increased LV dimensions and indexed LV mass (LVMi) in comparison to controls (p<0.001); LV remodeling worsened with higher MR severity and was accompanied by an increased prevalence of eccentric LV hypertrophy (eLVH). Moreover, BD patients had larger LA volumes and more impaired LA reservoir strain versus controls (p<0.001), while LV strain was similar between the two groups. Multivariable linear regression analyses in the overall population identified BD and MR grade as independent predictors of remodeling markers (LV dimensions, LVMi and LA volume), and BD as independent correlate of LA strain.MR progression was observed in 51 BD subjects (out of 170 patients with available follow-up). On Cox regression analysis, age, eLVH, mild-to-moderate MR and mitral annular disjunction (MAD) emerged as independent predictors of MR progression. BD patients without significant MR show early LV and LA remodeling, together with reduced LA strain. MR progression was associated with eccentric LV remodeling, MAD, and MR severity.

Morphometric variants of remodeling and diastolic function of the left ventricle in late postmenopausal patients with vitamin D deficiency

Aim. To reveal the features of the structural-geometric remodeling of the left chambers of the heart, the diastolic function of the left ventricle and to assess the presence of calcification of the valvular structures of the heart in late postmenopausal women with different levels of vitamin D. Material and methods. The cross-sectional study included 123 postmenopausal women. A standard transthoracic echocardiography was performed with an assessment of morphometric variants of remodeling of the left chambers of the heart and its diastolic function according to the transmitral flow. The significance of differences was assessed using the Mann–Whitney test, χ2 Pearson. Differences and correlations were considered significant at p &lt; 0.05. Results. The median concentration of 25(OH)D in the sample was 20.51 ng/ml (15.8÷26.73). Adequate serum concentration of 25(OH)D was observed in 23 (19%) patients (group 1), in 100 (81%) cases vitamin D deficiency was detected (group 2). In group 1 — 7 (31%) patients had normal geometry (NG) of the left ventricle (LV), LV concentric remodeling (CR) was diagnosed in 1 (4%) case, LV concentric hypertrophy (CH) was diagnosed in 3 (13%) cases, and LV eccentric hypertrophy (EH) was detected in 12 (52%) cases. In Group 2, LV NG was diagnosed in 27 (27%) cases, LV CR was detected in 8 (8%) cases, LV CH was detected in 31 (31%) cases, and LV EH was verified in 34 (34%) cases, the differences are insignificant (p = 0.24). Patients of group 2 showed a statistically significant increase in the volume of the right atrium (RA) and thickness of the posterior wall of the left ventricle (TZSLV). In group 1, in 11 (50%) cases, rigid-type diastolic dysfunction (DD) was detected, and in 11 (50%) cases, a pseudo-normal type of DD was detected. In group 2, pseudonormal myocardial DD was detected in 26 (26%) patients, 74 (74%) patients had rigid-type DD, differences between groups were significant (p &lt; 0.001). Calcifications were found in the annulus fibrosus in 16 (70%) cases in group 1 and in 88 (88%) patients in group 2, the differences were significant (p = 0.04). Conclusion. In the study, data were obtained indicating a significant contribution of vitamin D deficiency to changes in the geometry of the left chambers of the heart, diastolic function of the left ventricle, and calcification of valvular structures.

Myocardial Injury in Peritoneal Dialysis Patients Assessed by Multiparametric MRI: Relationship With Left Ventricular Phenotypes.

Myocardial injury is common in end-stage renal disease (ESRD) patients, but the presence and severity of myocardial injury in different left ventricular (LV) phenotypes were still not fully explored. To evaluate myocardial tissue characteristics and deformation in ESRD patients on peritoneal dialysis separated into normal geometry, concentric remodeling, concentric left ventricular hypertrophy (LVH) and eccentric LVH patterns by multiparametric cardiac MRI. Prospective. A total of 142 subjects, including 102 on peritoneal dialysis (69 males) and 40 healthy controls (27 males). At 3.0 T, cine sequence, T1 mapping and T2 mapping. LV mass index and LV remodeling index were used to create four subgroups with normal geometry, concentric remodeling, concentric LVH, and eccentric LVH. LV function, strain and strain rate, myocardial native T1 and T2 were measured. Descriptive statistics, analysis of variance and analysis of covariance, Pearson/Spearman correlation, stepwise regression, and intraclass correlation coefficient. P-value <0.05 was considered statistically significant. Even in normal geometry, LV strain parameters still diminished compared with the controls (global radial strain: 30.5 ± 7.7% vs. 37.1 ± 7.9%; global circumferential strain: -18.2 ± 2.6% vs. -20.6 ± 2.2%; global longitudinal strain: -13.3 ± 2.5% vs. -16.0 ± 2.8%). Eccentric LVH had significantly lower global circumferential systolic strain rate than concentric LVH (-0.82 ± 0.21%/- second vs. -0.96 ± 0.20%/- second). Compared with the controls, the four subgroups all revealed elevated native T1 and T2, especially in eccentric LVH, while concentric remodeling had the least changes including native T1, T2, and LV ejection fraction. After adjusting for covariates, there was no statistically significant difference in T2 between the four subgroups (P = 0.359). Eccentric LVH is associated with the most pronounced evidence of myocardial tissue characteristics and function impairment, while as a benign remodeling, the concentric remodeling subgroup had the least increase in native T1. This study further confirms that native T1 and strain indicators can reflect the severity of myocardial injury in ESRD, providing better histological and functional basis for future grouping treatments. 1 TECHNICAL EFFICACY: Stage 3.

The significance of catestatin and relaxin-2 in the diagnosis of myocardial remodeling in patients with essential hypertension and type 2 diabetes mellitus

Objective — to evaluate the peculiarities of electrocardiographic (ECG) and echocardiographic (EchoCG) parameters in patients with essential hypertension (EH) in combination with type 2 diabetes mellitus (T2DM) and their relationships with plasma catestatin (CTS) and relaxin­‑2 (RLN­­2) levels.&#x0D; Materials and methods. Examinations involved 106 patients with EH, from whom 55 subjects had concomitant T2DM, and 30 practically healthy volunteers. The mean age of the participants was (64.06±8.44) years, and women prevailed in the patients’ group (55.9%). All study participants underwent anthropometric data measurement, laboratory and instrumental investigations. The levels of biomarkers CTS and RLN­­2 were determined with the enzyme‑linked immunosorbent assay. Instrumental investigations included electrocardiography and transthoracic echocardiography.&#x0D; Results. CTS levels were reduced in patients with concentric (5.04±1.14 ng/mL) and eccentric left ventricular hypertrophy (LVH) (5.08±0.89 ng/mL) compared with the normal geometry (6.63±0.73 ng/mL, p &lt;0.001). The significant correlation has been established between CTS levels and ECG parameters of LVH (Cornell voltage criterion (r=–0.222; p=0.009) and Sokolow‑Lyon index (r=–0.226; p=0.008)), and EchoCG parameters, including LV end‑diastolic dimension (EDD (r=–0.388; p &lt;0.001), LV end‑systolic dimension (ESD (r=–0.453; p &lt;0.001), LV end‑diastolic volume index (EDVi (r=–0.329; p &lt;0.001), LV end‑systolic volume index ESVi (r=–0.415; p &lt;0.001), LV ejection fraction (EF (r=0.469; p &lt;0.001), septal sickness (SS) (r=–0.593; p &lt;0.001), posterior wall thickness (PWS) (r=–0.647; p &lt;0.001), relative wall thickness (RWS) (r=–0.568; p &lt;0.001), and LV myocardial mass index (LVMi) (r=–0.576; p &lt;0.001). Patients with RLN­­2 ≥ 4.69 pg/mL had higher EchoCG parameters, including LV EDD, LV ESD, LV EDVi, LV ESVi, SV, SS, PWS, RWS, LVMi (p &lt;0.05). In addition, a significant positive relationship between CTS and RLN­­2 levels has been revealed (r=0.191; p=0.026), which was also confirmed in the subgroup of patients with RLN­­2 levels above 4.69 pg/mL (r=0.585; p &lt;0.001).&#x0D; Conclusions. The decrease in CTS levels at LVH and established correlations with the ECG signs of LVH and EchoCG parameters allow us to consider CTS as a predictor of the development of LVH, especially in patients with EH combined with T2DM.

Association of left ventricular structural remodeling types with fibronectin deficiency in patients with multivessel coronary artery disease

Aim. To evaluate the serum fibronectin level in patients with multivessel coronary artery disease, and to identify the relationship of fibronectin level with atrial fibrillation (AF) developed in the hospital after coronary artery bypass grafting (CABG) and types of left ventricular (LV) structural remodeling.Material and methods. This prospective observational study of 80 patients after elective CABG at the Cardiac Surgery Department № 1 of the N.V. Sklifosovsky Research Institute for Emergency Medicine from October 2020 to May 2022. The groups were divided depending on the development of AF after CABG surgery (19 patients with AF developed in the hospital after CABG (up to 10 days), 61 patients — control group). All patients underwent a general clinical examination and transthoracic echocardiography, with estimation of left ventricular remodeling type. Serum fibronectin level was determined by enzyme immunoassay using the Fibronectin agent (Technozym, Austria).Results. The median fibronectin values in the group with AF was 110,10 [86,86; 134,00] mcg/ml versus 120,90 [92,01; 161,50] µg/ml of the comparison group (p=0,19). The following LV patterns were observed: normal LV geometry (NLVG) — in 1 patient (5,26%), concentric LV remodeling (CLVR) — in 3 patients (15,79%), concentric LV hypertrophy (CLVH) — in 10 patients (52,63%), eccentric LV hypertrophy (ELVH) — in 5 patients (26,32%). In the group without AF, 25 patients (40,98%) were diagnosed with NLVG, 26 patients (42,62%) — CLVR, 6,56% (n=4) — CLVR, while ELVH was diagnosed in 6 patients (9,84%). Differences in geometry types between groups were significant (p&lt;0,0001). Multivariate analysis adjusted for gender, age, cardiopulmonary bypass time, the predictive value remained for CLVH — odds ratio 15,83 (95% confidence interval, 4,082-1,442,00; p=0,0001) and ELVH — odds ratio 5,17 (95% confidence interval, 1,365-19,573; p=0,015). A further study showed that fibronectin &lt;116,496 µg/ml with a sensitivity of 78% and specificity of 53% is associated with CLVH (p=0,006) in patients of both groups.Conclusion. Fibronectin &lt;116,496 µg/ml is associated with CLVH in patients with multivessel coronary artery disease (sensitivity 78%, specificity 53%; p=0,006).

Role of biomarkers of collagen metabolism and systemic inflammation in myocardial remodeling in patients with stable chronic coronary artery disease and obstructive sleep apnea

Aim. To study the relationship of biomarkers of collagen metabolism and systemic inflammation with left ventricular (LV) remodeling in patients with stable coronary artery disease (CAD) and obstructive sleep apnea (OSA).Material and methods. The study included 195 patients with stable CAD, of which 63 without OSA and 132 patients with combination of CAD and OSA. The mean age of patients was 63,4±3,7 years. Biomarkers of collagen metabolism and systemic inflammation were assessed by determining the concentration of matrix metalloproteinase (MMP)-9, tissue inhibitor of matrix metalloproteinase-1, monocyte chemoattractant protein-1 (MCP-1) and calculating the neutrophil-to-lymphocyte (NLR) and platelet-tolymphocyte ratio (PLR). Echocardiography was performed according to a standard protocol.Results. There were no significant differences in systemic inflammation parameters (MCP-1, NLR, PLR) between the group of patients with CAD and CAD with mild OSA and a significantly higher level of MCP-1, NLR, PLR in more severe OSA. In patients with CAD and severe OSA, the eccentric LV remodeling was diagnosed in 75% of individuals, while the concentric type was diagnosed in only 25%.Conclusion. In patients with stable CAD, the more severe the OSA, the more pronounced systemic inflammation (MCP-1, NLR, PLR), and there are higher proportion of eccentric LV hypertrophy, which may be associated with an imbalance of fibrosis markers (high concentration of MMP-9 with an almost unchanged level of tissue inhibitor of MMP-1).

Additional Impact of Aortic Regurgitation on Left Ventricular Strain and Remodeling in Essential Hypertension Patients Evaluated Using MRI.

Understanding the impact of aortic regurgitation (AR) on hypertensive patients' hearts is important. To assess left ventricular (LV) strain and structure in hypertensive patients and investigate the relationship with AR severity. Retrospective. 263 hypertensive patients (99 with AR) and 62 controls, with cardiac MRI data. Balanced steady-state free precession (bSSFP) sequence at 3.0T. AR was classified as mild, moderate, or severe based on echocardiographic findings. LV geometry was classified as normal, concentric remodeling, eccentric hypertrophy, or concentric hypertrophy based on MRI assessment of LV mass/volume ratio and LV Mass index (LVMI). LV global radial peak strain (GRPS), global circumferential peak strain (GCPS), and global longitudinal peak strain (GLPS) were obtained by post-processing bSSFP cine datasets using commercial software. ANOVA, Kruskal-Wallis test, Spearman's correlation coefficients (r), chi-square test, and multivariable linear regression analysis. A P value <0.05 was considered statistically significant. Hypertensive patients with AR had significantly lower LV myocardial strain and higher LVMI than the group without AR (GRPS 26.25 ± 12.23 vs. 34.53 ± 9.85, GCPS -17.4 ± 5.84 vs. -20.57 ± 3.57, GLPS -9.86 ± 4.08 vs. -12.95 ± 2.94, LVMI 90.56 ± 38.56 vs.58.84 ± 17.55). Of the 99 patients with AR, 56 had mild AR, 26 had moderate AR and 17 had severe AR. The degree of AR was significantly negatively correlated to the absolute values of LV GRPS, GCPS and GLPS (r = -0.284 - -0.416). LV eccentric hypertrophy increased significantly with AR severity (no AR 21.3%, mild AR 42.9%, moderate AR 73.1%, severe AR 82.4%). In multivariable analysis, the degree of AR was an independent factor affecting LV global strain and LVMI even after considering confounding factors (β values for global myocardial strain were -0.431 to -0.484, for LVMI was 0.646). Increasing AR severity leads to decreased cardiac function and worse ventricular geometric phenotypes in hypertensive patients. 4 TECHNICAL EFFICACY: Stage 3.

Structural and functional abnormalities of cardiac chambers in Barlow disease without significant mitral regurgitation

Abstract Background Limited and conflicting data have been reported on the existence of an early chamber remodelling in patients with Barlow disease (BD) without significant mitral regurgitation (MR). Purpose To explore the presence of left ventricular (LV) and left atrial (LA) morphological and functional abnormalities, evaluated by conventional and speckle-tracking echocardiography, in patients with BD and without significant MR; in addition, potential determinants of MR progression in these patients have been investigated. Methods We retrospectively identified consecutive patients with BD evaluated in two tertiary centers between 2010 and 2021. Only patients with MR graded from trivial to mild-to-moderate, as defined by an integrated multiparametric echocardiographic assessment, were selected. BD patients were matched with healthy controls with similar demographic characteristics and prevalence of cardiovascular risk factors, in a 1:1 ratio. A comprehensive echocardiographic evaluation, including LV and LA strain assessment by speckle-tracking analysis, was performed in all patients. Follow-up echocardiograms, when available, were reviewed in BD patients to evaluate the MR progression. Results A total of 231 patients with BD were included, of which 109 (56%) had trivial or mild MR and the remaining 122 (44%) had mild-to-moderate MR. As showed in Figure 1, patients with BD showed increased LV dimensions and indexed LV mass (LVMi), as compared with controls (all p&amp;lt;0.001); LV remodelling worsened with higher degree of MR (trivial-mild vs mild-to-moderate) and was accompanied by an increased prevalence of eccentric LV hypertrophy (eLVH). Conversely, parameters of LV systolic performance, including LV strain, were similar to controls and between the two groups. In addition, BD patients had larger LA volumes and more impaired LA reservoir strain than controls (p&amp;lt;0.001), without differences in the latter according to MR severity. Multivariable linear regression analyses in the overall population identified BD and MR grade as independent predictors of remodelling markers (LV dimensions, LVMi and LA volumes), and BD as independent correlate of LA reservoir strain. Progression to moderate-to-severe or greater MR was observed in 51 subjects (on 172 with available follow-up) after a median time of 38 (range: 24-68) months. On multivariable Cox regression analysis, LVMi (or alternatively eLVH), together with age, MR grade and the presence of mitral annular disjunction emerged as independent predictors of MR progression (Figure 2). Conclusions Patients with BD and no significant MR show an early LV and LA remodeling, together with a mild impairment of LA reservoir strain, but not of LV function. LV remodelling, and the presence of eLVH in particular, portends a higher risk of MR progression.Comparative echocardiographic analysisMultivariable Cox regression analyses

Abstract 17679: Prognostic Implications of Left Ventricular Hypertrophy Regression Based on 4-Tiered Classification of Left Ventricular Hypertrophy

Introduction: 4-tiered classification of left ventricular (LV) hypertrophy (LVH), which accounts for increased LV wall thickness and LV volume, has been suggested to identify subgroups of patients at differential risk. This study was conducted to evaluate prognostic impact of 4-tiered classification of LVH in newly diagnosed hypertension patients with LVH. Methods: We retrospectively enrolled patients who had LVH on echocardiography at the time of diagnosis and had serial echocardiography taken within a 6-18-month interval with anti-hypertensive medication. Patients were divided into 5 groups based on 4-tiered LVH classification (eccentric LVH with dilatation or without dilatation, concentric with dilatation or without dilatation), and LVH regression group by the follow up echocardiography. The primary outcome was the composite of adverse cardiovascular (CV) outcomes, including CV death, hospitalization for heart failure, coronary revascularization, stroke, and aortic events. Results: Among the 837 patients in the five groups the concentric LVH group and dilated eccentric group demonstrated significantly higher incidence of CV outcomes. Compared with LVH regression group, those with dilated concentric (adjusted hazard ratio [adjHR]: 8.95; 95% confidence interval [CI]: 4.34 to 18.48), dilated eccentric (adjHR: 6.24; 95% CI: 2.96-13.18), non-dilated concentric (adjHR: 2.04; 95% CI: 1.26-3.32) LVH exhibited increased in CV risk according to multivariable cox-regression analysis. However, the non-dilated eccentric LVH group did not demonstrate a significant increase in CV risk (adjHR: 0.75; 95% CI: 0.24-2.35). Conclusions: In patients with hypertension, regression of LVH during anti-hypertensive treatment is associated with better CV outcomes. However, non-dilated eccentric group were not increase CV risk compared with regression group. The 4-tiered LVH classification can be helpful to stratifying CV risk in patients with hypertension.

The sympathetic nervous system in heart failure revisited.

Several attempts have been made, by the scientific community, to develop a unifying hypothesis that explains the clinical syndrome of heart failure (HF). The currently widely accepted neurohormonal model has substituted the cardiorenal and the cardiocirculatory models, which focused on salt-water retention and low cardiac output/peripheral vasoconstriction, respectively. According to the neurohormonal model, HF with eccentric left ventricular (LV) hypertrophy (LVH) (systolic HF or HF with reduced LV ejection fraction [LVEF] or HFrEF) develops and progresses because endogenous neurohormonal systems, predominantly the sympathetic nervous system (SNS) and the renin-angiotensin-aldosterone system (RAAS), exhibit prolonged activation following the initial heart injury exerting deleterious hemodynamic and direct nonhemodynamic cardiovascular effects. However, there is evidence to suggest that SNS overactivity often preexists HF development due to its association with HF risk factors, is also present in HF with preserved LVEF (diastolic HF or HFpEF), and that it is linked to immune/inflammatory factors. Furthermore, SNS activity in HF may be augmented by coexisting noncardiac morbidities and modified by genetic factors and demographics. The purpose of this paper is to provide a contemporary overview of the complex associations between SNS overactivity and the development and progression of HF, summarize the underlying mechanisms, and discuss the clinical implications as they relate to therapeutic interventions mitigating SNS overactivity.

Left Ventricular Hypertrophy Geometry and Vascular Calcification Co-Modify the Risk of Cardiovascular Mortality in Patients with End-Stage Kidney Disease: A Retrospective Cohort Study.

Patients with end-stage kidney disease (ESKD) have an unparalleled risk of left ventricular hypertrophy (LVH) and vascular calcification (VC), both of which introduce excessive cardiovascular risk. However, it remains unclear whether LVH geometry co-modulates cardiovascular outcomes with VC in this population. A retrospective cohort study was conducted. Patients with ESKD requiring chronic hemodialysis were identified from Shin Kong Wu Ho-Su Memorial Hospital between October and December 2018, with echocardiographic LVH geometry and aortic arch calcification (AoAC) determined. They were divided into four groups according to AoAC severity and eccentric or concentric LVH. We used Kaplan-Meier analysis and Cox proportional hazard regression to analyze their cardiovascular and all-cause mortality after multivariate adjustment. Overall, 223 patients with ESKD with LVH were analyzed, among whom 29.1%, 23.3%, 25.1%, and 22.4% had non-to-mild AoAC with eccentric and concentric LVH and moderate-to-severe AoAC with eccentric and concentric LVH, respectively. After 3.5 years of follow-up, patients with ESKD with moderate-to-severe AoAC and concentric LVH had a significantly higher risk of cardiovascular mortality than those with non-to-mild AoAC and eccentric LVH (hazard ratio 3.35, p=0.002). However, those with moderate-to-severe AoAC but eccentric LVH did not have higher cardiovascular mortality. Similarly, patients with ESKD with moderate-to-severe AoAC and concentric LVH had a significantly higher all-cause mortality than those with non-to-mild AoAC and eccentric LVH, whereas the other two groups did not have higher risk. LVH geometry could help stratify the risk of patients with ESKD when they had severe VC, and co-existing severe VC and concentric LVH aggravated cardiovascular risk.

Pulmonary Hypertension and Left Ventricular Geometric Types in Sickle Cell Anemia

Pulmonary hypertension (PHT) is multifactorial in origin and a major cause of morbidity and mortality in the sickle cell populace. Its correlation with abnormal left ventricular geometric patterns has not been established. Subjects were sickle cell anemic patients of the hematology clinic of a tertiary hospital who gave informed consent. A modified Medical Research Council questionnaire was used to obtain the demographic, anthropometric, and clinical variables of the subjects. Blood samples were taken for hematologic and biochemical analysis. Spirometry, electrocardiography, and echocardiography were done for all subjects. SPSS version 25 was used for analysis. A p ≤0.05 was used for significance. In total 111 subjects with sickle cell anemia were recruited. Male:female ratio was 1:1.4. The prevalence of PHT was 8.1%. Those with PHT were older and had higher blood pressure, lower respiratory rate, higher body mass index, lower estimated glomerular filtration rate, and a higher prevalence of avascular necrosis of the head of femur, stroke, and chest pain. About 2/3 (66.7%) of those with PHT had concentric left ventricular hypertrophy (LVH) whereas none of those with eccentric LVH had PHT. Age, body mass index, systolic blood pressure, aortic root diameter, concentric LVH, serum creatinine, history of stroke, chest pain, and avascular necrosis of the head of femur correlated directly whereas eccentric LVH correlated inversely with PHT. Concentric LVH, relative systemic hypertension, history of chest pain, and respiratory rate were the independent correlates of PHT in subjects with sickle cell anemia. PHT is known to be of poor prognostic significance. Its association with relative systemic hypertension and concentric LVH suggests the need to initiate early treatment to reduce morbidity and mortality in this group.

Validation of a predictive model of the left atrium appendage thrombosis in patients with nonvalvular atrial fibrillation

Aim: To test the previously developed predictive model on a test set, including patients with non-valvular atrial fibrillation (AF).Material and Methods. A predictive model was previously developed on a training set of 638 patients with non-valvular AF. The test set included 175 randomly selected patients with non-valvular AF hospitalized at the Tyumen Cardiology Research Center for radiofrequency ablation (RFA) or electrical cardioversion in 2018-2021. The quality of the predictive model was assessed using ROC analysis.Results. Arterial hypertension, coronary heart disease, congestive chronic heart failure, and persistent AF were more common in patients of both sets with left atrial appendage (LAA) thrombosis. Patients of the training and test sets with LAA thrombus had more pronounced structural changes in the heart cavities and similar changes in the geometry of the heart: normal left ventricle (LV) geometry was less common and eccentric LV hypertrophy was more common. According to the results of a previous retrospective analysis of the data, independent predictors of LAA thrombosis were persistent type of AF, left atrium size, and eccentric LV hypertrophy. Based on the data gathered, a predictive model LAA thrombosis was developed as an equation that includes 3 variables. The cut-off point for calculating the probability of LAA thrombosis is 0.07. Applying this model on a test set showed the good quality of the model: the area under the curve obtained using ROC analysis was 0.750 (p &lt; 0.001). At the same time, the sensitivity and specificity of this model for the detection of LAA thrombosis were 72.3% and 71%, respectively.Conclusion. The evaluation of the quality of the LAA thrombosis predictive model developed on the training set confirmed its good quality on a similar test set of patients with non-valvular AF hospitalized for RFA or electrical cardioversion.

Classifying hypertension mediated left ventricular hypertrophy phenotypes from the 12-lead electrocardiogram using machine learning

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): British Heart Foundation Pat Merriman Clinical Research Training Fellowship Background Hypertension is the commonest cause of left ventricular hypertrophy (LVH), an established independent predictor of cardiovascular morbidity and mortality. Four distinct LVH phenotypes with varying prognostic implications have been reported using cardiac magnetic resonance (CMR) LV mass to volume ratio: normal LV, LV remodelling, eccentric LVH and concentric LVH. Current electrocardiogram (ECG) criteria can detect LVH but their ability to differentiate between hypertension mediated LVH phenotypes is unknown. Purpose The aim of this study was to classify hypertension mediated LVH phenotypes using 12-lead electrocardiogram (ECG) and clinical data for cost-effective patient stratification. Methods 24,535 hypertensive participants from UK Biobank imaging study were categorised into the CMR-defined LVH phenotypes. ECG biomarkers with a physiological association with LVH (including QRS biomarkers, Sokolow-Lyon and Cornell voltage) were extracted from the 12-lead ECG of each participant using in-house algorithms. Vascular risk factors known to be associated with LVH were also ascertained from the clinical data of each participant. Classification models integrating ECG biomarkers and clinical data were built using logistic regression, support vector machine (SVM) and random forest (RF). The dataset was split into 80% train and 20% test sets for performance measurement. Ten-fold cross validation was applied and the training set was downsampled to the minority class. Results Among the participants (mean age ± standard deviation 65.3 ± 7.4 years), 23,312 (95.0%) had normal LV, 900 (3.7%) LV remodelling, 220 (0.8%) eccentric LVH and 103 (0.4%) concentric LVH. R wave amplitude V5, S wave amplitude V3 and QT duration V6 (P&amp;lt;0.001) were the top ECG biomarkers and systolic blood pressure (p&amp;lt;0.001) the top clinical predictor of LVH phenotypes (Figure 1). Classification with logistic regression had an accuracy of 77% (sensitivity 55%, specificity 85%, Area under the receiver operator curve [AUC] 0.76), SVM 80% accuracy (sensitivity 61%, specificity 87%, AUC 0.75) and RF 75% accuracy (sensitivity 49%, specificity 83%, AUC 0.75). ECG biomarkers enhanced model performance of all classifiers, compared to using clinical data alone. Conclusion A combination of automatically extracted ECG biomarkers and clinical data were able to discriminate the hypertension mediated LVH phenotypes. An advanced classification approach improves selection of hypertensive patients with LVH, thereby adding prognostic value to traditional risk models. We are currently validating our findings in an external population and using deep learning for comparison.

LINKAGE OF LEFT VENTRICLE HYPERTROPHIC GEOMETRIC MODELS WITH CLINICAL, METABOLIC-HORMONAL PARAMETERS AND MINERAL METABOLISM IN HYPERTENSIVE PATIENTS

Objective: To analyze the association of hypertrophic geometric models of the left ventricle (LV) with changes in clinical, anthropometric and metabolic-hormonal parameters and of mineral metabolism data in patients with essential arterial hypertension (EAH). Design and method: The case-control study involved 100 patients with EAH stage II, 1-3 degrees of blood pressure value (BP), high and very high cardiovascular risk. Among the patients there were 21% (21) men, 79% (79) women, the mean age 59.86±6.22y.o. The control group consisted of 60 practically healthy individuals, relevant in age (49.13±6.28y.o.) and gender distribution (63% - women, 37% - men). The lipid panel parameters, such as: TC (Total cholesterol), TG (Triglycerides), LDL-C (Low-density lipoprotein cholesterol), HDL-C (High-density lipoprotein cholesterol) were investigated in blood plasma. All recruited subjects were tested for serum levels of fasting glucose, ionized calcium, parathyroid hormone (PTH), 25-hydroxyvitamin D (Vit D). LV hypertrophy (LVH) and LVH models were assessed by echocardiography. Results: Eccentric LVH (ELVH) in EAH patients is associated with higher blood pressure than Concentric LVH (CLVH): Systolic blood pressure and Diastolic blood pressure are higher by 3.29% and 3.95%(p&lt;0,05-0,04). ELHV associates with higher body mass index and waist circumference in women - by 7.80% and 7.40% (p&lt;0.05-0.048), respectively. In addition, the ELVH was characterized by a lower ionized Ca2+ level in the blood than CLVH by 2.54% (p = 0.021) with a compensatory higher concentration of PTH by 23.86% (p = 0.047), which indicates the calcium homeostasis intensity in EAH patients. The lipids and glucose serum concentration as well as Vit D level do not associate with any of hypertrophic models of myocardium. Conclusions: Lipid profile, blood glucose and Vit D concentration do not determine the development of any type of the LVH. ELVH is associated with lower Ca2+ level of and consequently with elevated PTH value.

Benefits of 4-tiered classification of exercise-induced left ventricular hypertrophy in adolescent athletes

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Innovation and Technology Ministry Hungary - National Research, Development and Innovation Office (Innovációs és Technológiai Minisztérium - Nemzeti Kutatási, Fejlesztési és Innovációs Hivatal Hungary. Introduction Exercise-induced left ventricular hypertrophy (LVH) is widely investigated in adolescent athletes characterized by 2-tiered classification (2TC). Though, the differentiation of normal adaptive changes from pathological LVH can be challenging. 4-tiered classification (4TC) may discriminate better different forms of exercise-induced LVH providing three-dimensional information of the left ventricle (LV). Purpose, methods The main objective of our study was to distinguish alterations between 2TC and 4TC examining 121 adolescent athletes with echocardiography. Moreover, these results were also compared to the matched LV parameters of 114 adult athletes. Results Examining the 4TC allocation representing parameters (LV mass, LV mass/BSA, LV end-diastolic volume/BSA, concentricity) of the adolescent and adult athletes we identified significant differences (p&amp;lt; 0,05) between the different LVH groups and normal geometry, suggesting that the applied classification provides proper group distinguishing power. There were no significant differences between the cumulative training times of the different LVH groups (p &amp;gt;0,05). Furthermore, the BSA corrected LV parameters did not show any correlation with training time. Totally 25 athletes (22%) were reclassified in 4TC into completely different groups, highlighted the 6 athletes (5%) reclassified from normal geometry to concentric LVH and the 11 adolescent (9%) reclassified from normal to eccentric LVH. The reclassifications rate showed similar pattern in adult athletes. Conclusion Based on all these data we assume that training time has no significant impact on the classification. Cardiac remodeling develops already in young age, and further training time has less impact on the adaptive changes. We prefer to apply 4TC in the routine echocardiographic examination of endurance athletes to specify a more sensitive and distinct screening method.

P313 AN UNUSUAL CASE OF SEVERE LEFT VENTRICULAR DYSFUNCTION: MILANESE ‘BREAKING BAD‘

Abstract A 39–year–old Filipino man was admitted for dyspnea and lower limb edema for about a month, in combination with stable cardiac enzymes movement (TnT 128&amp;gt;78&amp;gt;115 ng/dl), fluctuating unspecific inflammatory profile and hepatic impairment. Trans–thoracic echocardiography confirmed heart failure (HF) in a setting of eccentric left ventricular hypertrophy, diffuse hypokinesia and severe global functionreduction. Despite the absence of typical chest pain, the presence of cardiovascular (CV) risk factors (DMT2, smoking, dyslipidemia), previous alcoholism and the finding of widespread ventricular repolarization ECG changes seemed to suggest an ischemic or multifactorialorigin of the HF. After the finding of a critical trivascular coronary artery disease on coronarography and a pulmonary nodule on chest CT, the cardiac magnetic resonance (CMR) confirmed the diagnosis of severe dilated HF with evidence of a diffuse wall signal hyperintensity in STIR sequences and a intramyocardial and subepicardial patchy LGE pattern of non–ischemic meaning. The possible ischemic etiology was thus overlaid with an inflammatory disease, leading to assume sarcoidosis or myocarditis be the cause of HF. The main screening tests (ACE and immunologic–infectious profile) were negative a a PET/CT scan confirmed a diffuse cardiac inflammation with no focal hypercaptant lesions. Therefore, sarcoidosis was ruled out, and an endomyocardial biopsy (BEM) was performed, and resulted, however, inconclusive. Following, an unexpected finding revealed through a more scrupulous anamnesis: a long–time abuse of a methamphetamine (MDMA) prevalent in the Filipino community called Shaboo. This type of MDMA is accompanied by multiple CV system impacts, including MDMA–associated cardiomyopathy (MACM), a clinical picture compatible with the findings obtained by CMR and BEM performed. After discussion in Heart Team and therapeutic optimization, the patient was candidate for coronary artery bypass. Thus, with the correct diagnostic definition and treatment of HF triggers, an improvement in clinical and left ventricularfunction was marked (EF 45%). Monitoring will allow evaluation of the evolution of the changes found at CMR and will document eventually reversibility of MACM after protracted abstention from MDMA abuse.

Peculiarities of the structural and functional state of the heart in patients with arrhythmias depending on the severity of cognitive disorders

Background. The purpose of our work was to find out the dependence of changes in the cognitive sphere on the features of the structural and functional state of the heart and central hemodynamics in patients with arrhythmias. Material and methods. We have examined 139 patients with different clinical forms of arrhythmias. All of them underwent extended neuropsychological testing and central hemodynamic studies. The state of central hemodynamics was assessed by an ultrasound examination of the heart. The state of intracardiac hemodynamics, structural changes in various parts of the heart were evaluated; based on this, the type of heart remodeling was determined. Correlations of hemodynamic indicators with the results of neuropsychological testing were evaluated. Results. In patients with mild cognitive disorders (CD), the left ventricular myocardial contractility index did not differ significantly from that in patients without CD, but in people with moderate CD it was 9.6 % lower (p = 0.044). With moderate CD, the dilatation of the left parts of the heart increased (end-diastolic volume — by 16.5%, p =0.049; left atrium — by 9.9 %, p = 0.049), which, along with increased hypertrophy of the interventricular septum by 12.8 % (p = 0.048) and of the left ventricular posterior wall by 12.9 % (p = 0.048), led to an increase in the pulmonary artery pressure by 24.8 % (p = 0.015). Among patients with CD, concentric (42.2 %) and eccentric (22.6 %) left ventricular hypertrophy was more often detected (p = 0.048 and p = 0.027); in those without CD, concentric remodeling of the left ventricle prevailed (p = 0.037). In patients with mild CD, higher stroke volume was recorded — by 8.3 % (p = 0.049) compared to those without CD. However, according to indicators of cardiac output, cardiac index and total peripheral vascular resistance, differences were unreliable (p &gt; 0.05). Patients with moderate CD reported an increase in stroke volume and cardiac output by 7.6 (p = 0.043) and 14.9 % (p = 0.014), respectively, compared to those without CD. Indicators of central hemodynamics had the greatest impact on the sphere of attention, regulatory functions, visual-spatial and mnestic deficits. The highest odds ratio for the development of CD were found for left ventricular ejection fraction (2.52, 95% confidence interval: 1.82–3.29, p &lt; 0.001). Conclusions. The identified associations of cognitive dysfunction, central hemodynamics and heart remodeling are important for optimizing an individualized approach to patient management and predicting the development of CD.

Sport-related differences in QT dispersion and echocardiographic parameters in male athletes

The aim of this study was to compare QT dispersion (QTd) and echocardiographic parameters in male athletes competing across different sports (long-distance running, volleyball, football, powerlifting, and bodybuilding) and a control population. Significant moderate-strong differences (p < 0.001, {eta }_{p}^{2} = 0.52–0.71) were found in corrected QTd, intraventricular septal wall thickness (ISWT), posterior wall thickness (PWT), relative wall thickness (RWT) and LV (left ventricular) index between groups. Corrected QTd, ISWT, PWT, and RWT were significantly (p < 0.001) higher in powerlifters and bodybuilders compared to other athlete groups and controls. While all athlete groups displayed a significantly higher LV index (p < 0.05) compared to controls, corrected QTd was significantly lower (p < 0.001) only in long-distance runners, volleyball athletes, and football athletes compared to controls. Normal or eccentric LV hypertrophy (LVH) was observed in most long-distance runners (58% and 33%), volleyball athletes (50% and 50%), and football athletes (56% and 41%). In contrast, concentric LVH was observed in most powerlifters (58%) and bodybuilders (54%). Advanced LVH, predominantly concentric in nature, appears to be accompanied with increased QTd in powerlifters and bodybuilders. On the other hand, runners, volleyball athletes, and football athletes experienced LVH toward the upper threshold of the normal reference range alongside reduced QTd compared to other groups.