Echocardiographic Left Ventricular Hypertrophy Research Articles

Electrocardiographic Abnormalities in Nigerian Hypertensives With Echocardiographic Left Ventricular Hypertrophy.

Introduction To enhance the diagnosis of anatomic left ventricular hypertrophy (LVH) using electrocardiography (ECG), we aimed to identify common ECG amplitude and non-amplitude abnormalities in Nigerian patients with hypertensive echocardiographic LVH. Method The study included 1,765 patients with essential hypertension aged 18 years and older from the Federal Medical Centre Abuja Hypertension Registry (FMCAHR). Participants underwent echocardiography and ECG following the American College of Cardiology and the American Society of Echocardiography guidelines. Results The prevalence of overall ECG LVH amplitude criteria (43.8%) and individual criteria of Cornell voltage (27.1%), Sokolow-Lyon voltage (23.2%), and Gubner-Ungerleider (13.9%) werehigher than non-amplitude ECG abnormalities among patients with echocardiographic LVH. The sensitivity and specificity of LVH criteria were 43.8% and 79.5% for overall ECG LVH, 23.2% and 87.2% for Sokolow-Lyon voltage, 27.1% and 93.3% for Cornell voltage, and 13.9% and 95.4% for Gubner-Ungerleider criteria, respectively. After multivariable adjustment, non-amplitude ECG changes, including prolonged corrected QT (QTc) (odds ratio (OR): 1.68, 95% confidence interval (CI): 1.06-2.66), left ventricular (LV) strain pattern (OR: 1.83, CI: 1.23-2.72), left axis deviation(OR: 1.56, CI: 1.09-2.24), poor R wave progression (OR: 2.36, CI: 1.40-3.97), premature ventricular contractions(OR: 1.80, CI: 1.10-2.91), premature atrial contractions(OR: 2.06, CI: 1.10-3.87), atrial fibrillation(OR: 2.40, CI: 1.20-4.82), and left atrial abnormality (OR: 8.43, CI: 2.95-24.05), were associated with echocardiographic LVH (p < 0.05). Conclusion In our cohort of hypertensive patients, ECG LVH amplitude criteria were the most frequently observed abnormalities associated with echocardiographic LVH. Our findings suggest that despite the low sensitivity, ECG LVH amplitude criteria may remain valuable in diagnosing echocardiographic LVH.

Association of inflammatory and hematological indices with left ventricular hypertrophy in hypertensive patients

Objective. To identify an associative relationship between inflammatory indicators, hematological indices and left ventricular hypertrophy (LVH) in patients with uncontrolled arterial hypertension (HTN). Design and methods. We examined 130 patients with uncomplicated essential HTN I–II with ineffective blood pressure (BP) control (≥ 140/90 mmHg). All patients underwent a clinical examination with determination of risk factors, indicators of inflammation — high-sensitivity C-reactive protein (hs-CRP), interleukin‑1β (IL‑1β), interleukin‑6 (IL‑6), interleukin‑8 (IL‑8), tumor necrosis factor α (TNF-α), hematological indices — systemic immune inflammation index (SII), the monocyte to high density lipoprotein cholesterol ratio (MHR), the platelet to lymphocyte ratio (PLR), the neutrophil to lymphocyte ratio (NLR), and echocardiography. Results. The positive correlations were found between the indicators of nonspecific inflammation and signs of LVH — MHR and left ventricular myocardial mass index (LVMI) (r = 0,448; p &lt; 0,001), the posterior wall thickness (PWT) of left ventricle (LV) in the diastole (r = 0,256; p = 0,003), the interventricular septum (IVS) thickness in the diastole (r = 0,311; p ≤ 0,001); the level of hs-CRP and the relative wall thickness (RWT) (r = 0,283; p = 0,002), PWT of LV in the diastole (r = 0,202; p = 0,043), IVS thickness in the diastole (r = 0,231; p = 0,011); the level of IL‑6 and the PWT of LV in the diastole (r = 0,215; p = 0,018); SII and IVS thickness in the diastole (r = 0,230; p = 0,009), the RWT (r = 0,205; p = 0,016); NLR and IVS thickness in the diastole (r = 0,227; p = 0,009), PWT of LV in the diastole (r = 0,205; p = 0,029), RWT (r = 0,206; p = 0,016). Using multiple linear regression, independent factors associated with increased LVMI in HTN patients were male sex (β = 0,201), waist circumference (WC) (β = 0,258) and MHR (β = 0,236) (p = 0,029). Independent factors for increasing PWT of LV in the diastole in HTN patients were WC (β = 0,354) and male sex (β = 0,266) (p = 0,003); increase of IVS thickness in the diastole — SII (β = 0,254), WC (β = 0,392) and male sex (β = 0,219) (p = 0,021); and an increase of RWT — hs-CRP (β = 0,333) (p = 0,001). Conclusions. In patients with uncontrolled HTN increased levels of hs-CRP, IL‑6, SII, MHR and NLR were associated with echocardiographic LVH criteria—LVMI, PWT and IVS thickness in the diastole, RWT. Independent factors for increasing LVMI were WC, male sex and MHR; IVS thickness in the diastole — SII, WC and male; RWT — hs-CRP.

Electrocardiography versus Echocardiography in Severe Aortic Stenosis with the Consideration of Coexistent Coronary Artery Disease.

(1) Background: Coexistent coronary artery disease (CAD) might influence the ability of electrocardiogram (ECG) to identify echocardiographic left ventricular hypertrophy (ECHO-LVH) in patients with aortic stenosis (AS). We aimed to assess the relation between ECG-LVH (by the Sokolov-Lyon or Cornell criteria) and ECHO-LVH considering coexistent CAD. (2) Methods: We retrospectively analyzed the medical records of 74 patients (36 males) with severe AS who were hospitalized in the University Hospital in Cracow from 2021 to 2022. (3) Results: ECHO-LVH was present in 49 (66%) patients, whereas 35 (47.3%) patients had ECG-LVH. There was no difference between the rate of ECG-LVH in patients with vs. without ECHO-LVH. Single-vessel and multi-vessel CAD were diagnosed by invasive coronary angiography in 18% and 11% of patients, respectively. The sensitivity of the classical ECG-LVH criteria with regard to ECHO-LVH was low, reaching at best 41% for the Sokolov-Lyon and Cornell criteria. The results were similar and lacked a pattern when considering patients without significant stenosis, with single- and multi-vessel disease separately. Correlations between the left ventricular mass index and ECG-derived parameters were weak and present solely for the Lewis index (r = 0.31), R wave's amplitude >1.1 mV in aVL (r = 0.36), as well as the Cornell (r = 0.32) and Sokolov-Lyon (r = 0.31) voltage criteria (p < 0.01). The presence, location of stenoses, and CAD extent were not associated with the presence of either ECHO-LVH or ECG-LVH, irrespective of individual ECG-LVH criteria. (4) Conclusions: The sensitivity of classical ECG criteria for echocardiographic LVH in severe AS is low, regardless of coexistent CAD or its angiographic extent.

Aortic arch calcification increases major adverse cardiac event risk, modifiable by echocardiographic left ventricular hypertrophy, in end-stage kidney disease patients.

The factors affecting cardiovascular risk associated with vascular calcification in patients with chronic kidney disease are less well addressed. Distinct risk factors may contribute synergistically to this elevated cardiovascular risk in this population. We aimed to determine whether echocardiographic left ventricular hypertrophy (LVH) affects the risk of major adverse cardiac events (MACE) associated with vascular calcification in end-stage kidney disease (ESKD) patients. In this retrospective cohort study, ESKD patients underwent chest radiography and echocardiography to assess aortic arch calcification (AoAC) and LVH, respectively, and were classified into three groups accordingly: non-to-mild AoAC without LVH, non-to-mild AoAC with LVH, and moderate-to-severe AoAC. The risks of MACE, cardiovascular mortality, and overall mortality were assessed using Cox proportional hazard analysis. Of the 283 enrolled ESKD patients, 44 (15.5%) had non-to-mild AoAC without LVH, 117 (41.3%) had non-to-mild AoAC with LVH, and 122 (43.1%) had moderate-to-severe AoAC. After 34.1 months, 107 (37.8%) participants developed MACE, including 6 (13.6%), 40 (34.2%), and 61 (50%) from each respective group. Those with moderate-to-severe AoAC (Hazard ratio, 3.72; 95% confidence interval, 1.58-8.73) had a significantly higher risk of MACE than did those with non-to-mild AoAC without LVH or with non-to-mild AoAC and LVH (Hazard ratio, 2.73; 95% confidence interval, 1.16-6.46). A similar trend was observed for cardiovascular and overall mortality. Echocardiographic LVH could modify the risk of adverse cardiovascular events associated with vascular calcification in ESKD patients. Interventions aiming to ameliorate both morbidities might be translated into a lower MACE risk in this population.

Left ventricle hypertrophy and re-modeling in children with essential hypertension: does the race matter?

This is the first study to report on the impact of race on differences in the prevalence of echocardiographic left ventricular hypertrophy and left ventricular adaptation at the time of diagnosis of essential hypertension in children. This cross-sectional, single-centre study included patients aged 3-18 years who had newly diagnosed essential hypertension. Echocardiography was used to assess left ventricular mass index and left ventricular relative wall thickness. An left ventricular mass index > the 95th percentile for age and gender, and an left ventricular relative wall thickness > 0.42, were used to diagnose left ventricular hypertrophy and concentric adaptation. Various echocardiographic parameters were compared between African Americans and Caucasians. The study included 422 patients (289 African Americans and 133 Caucasians) diagnosed with essential hypertension at a median age of 14.6 (interquartile range; 12.1-16.3) years. Eighty-eight patients (20.9%) had left ventricular hypertrophy. There was no statistically significant difference in the prevalence of left ventricular hypertrophy between African Americans and Caucasians (22.5% versus 17.3%, p=0.22). The median left ventricular relative wall thickness was 0.35 (0.29-0.43), and 114 patients (27.0%) had an left ventricular relative wall thickness > 0.42. The presence of an left ventricular relative wall thickness > 0.42 was significantly higher among African Americans compared to Caucasians (30.1% versus 20.3%, p = 0.04). The African American race was a strong predictor for an left ventricular relative wall thickness > 0.42 (odds ratio 1.7, p = 0.04), but not for left ventricular mass index > the 95th percentile (p = 0.22). Overweight/obesity was a strong predictor for an left ventricular mass index > the 95th percentile. There was no difference in the prevalence of left ventricular hypertrophy in children with essential hypertension of different races. Obesity, rather than being African American, is associated with left ventricular hypertrophy.

Imaging for prevalence assessment of cardiac transthyretin amyloidosis in patients &amp;gt; 60 years hospitalized in cardiology : the IMPACT study

Abstract Introduction Transthyretin cardiac amyloidosis (ATTR-CA) is a severe condition with poor prognosis if left untreated (1). Its true prevalence remains unknown because of frequent underdiagnosis, and most published series have focused on highly selected populations (2-3). The objectives of this prospective study were 1) to determine the prevalence of ATTR-CA in consecutive patients &amp;gt; 60 years hospitalized in cardiology wards and presenting with left ventricular hypertrophy (LVH) ≥ 12 mm on transthoracic echocardiography (TTE), using a systematic 99mTc-HMDP bone scintigraphy for diagnosis screening 2) to analyze the characteristics associated with the final diagnosis of ATTR-CA. Population &amp; methods: Between october 2021 and june 2022, 251 patients with echocardiographic LVH (from any cause, including high blood pressure or aortic stenosis) and without any previous diagnosis of CA, were prospectively included and underwent 99mTc-HMDP bone scintigraphy. A monoclonal gammapathy was systematically sought-after to exclude light-chain cardiac amyloidosis (AL-CA) (4). Genetic analysis of the TTR gene was systematically performed in case of definite diagnosis of ATTR-CA. The design of the trial is provided in Figure 1. This is an interim analysis of a private funded study currently being finalized, with a target of 400 patients to be included. Results Among the 251 patients, definite ATTR-CA was diagnosed in 17 patients (6.8%), all of them being wild-type. No AL-CA was identified. The 2 subgroups of patients with the highest prevalence of ATTR-CA (&amp;gt;10%) were patients ≥ 65 years with either heart failure or bilateral carpal tunnel syndrom. The majority of diagnosed patients had symptoms or signs suggestive of ATTR-CA, even though CA was never looked-after during their medical pathway, while 30% had no or only one red flag of ATTR-CA. Using multivariable analysis, we found four parameters independently associated with the diagnosis of ATTR-CA as presented in Table 1, one clinical and three echocardiographic, including the alteration of left atrial strain. Conclusion We report a high prevalence (6.8%) of ATTRwt-CA in a non-selected cardiological population with LVH from any cause. Most patients were underdiagnosed since they had at least 2 red-flags for ATTR-CA, thus emphasizing the need for continuous and strengthened education on CA. On the other hand, 30% of patients had no obvious sign for CA and the diagnosis was only established by our systematic screening strategy. We report 4 factors significantly associated with ATTR-CA in our population, including the alteration of left atrial reservoir strain. These new data confirm the interest of a complete echocardiographic analysis in case of LVH, to refine the selection of patients who could benefit from 99mTc-HMDP bone scan screening.Study designPredictive factors of ATTR-CA

The Importance of Out-of-Office Blood Pressure Measurement, as Highlighted by the Correlation with Left Ventricular Hypertrophy in an Untreated Hypertensive Population.

Background and Objectives: Hypertensive heart disease, especially left ventricular hypertrophy (LVH), is considered to be one of the main types hypertension-mediated organ damage. Hence, the purpose of this study was to examine which method of measuring BP (office BP measurement (OBPM), 24 h ambulatory BP monitoring (ABPM), or home BP monitoring (HBPM)), can be better correlated with echocardiographic LVH in the untreated hypertensive population. Materials and Methods: This study's population consisted of 202 patients 58 ± 15 years old (40.8% males). All patients reported elevated home BP measurements for at least 3 months, but they had never been treated before for hypertension. Office and out-of-office BP measurements, including ABPM on a usual working day and seven-day HBPM, as well as 2D echocardiography, were performed. Results: In the univariate analysis, LVH was associated (p < 0.05) with a mean 24 h systolic BP (OR: 1.93, CI: 1.29-2.91), a mean 24 h diastolic BP (OR: 1.30, CI: 1.16-1.80), ambulatory daytime systolic (OR: 1.11, CI:1.01-1.82) and diastolic BP (OR: 1.13, CI:1.09-1.17), ambulatory nighttime systolic BP (OR: 2.11, CI: 1.04-4.31), and mean home systolic BP (OR: 1.05, CI:1.01-1.12). Pearson's correlation analysis showed a significant correlation between the LV mass index and the mean 24 h systolic BP (r = 0.58, p < 0.05), daytime systolic BP (r = 0.59, p < 0.05), and nighttime systolic BP (r = 0.57, p < 0.05). Most of the population with confirmed LVH presented confirmed hypertension (based on ABPM, 48.1% or HBPM, 40%). The second most dominant phenotype was masked hypertension (ABPM, 32.7% and HBPM, 23.7%). The majority (59.3%) had non-dipping status, 20.4% had a reverse dipping pattern, 13% had a dipping pattern, and only 7.3% had extreme dipping BP. Conclusions: Out-of-office BP measurement devices seemed to be superior compared to in-office. This advantage is highlighted by better correlations in the identification of LVH as well as the diagnosis of masked hypertension, a condition also highly correlated with LVH.

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.

Community echocardiographic left ventricular hypertrophy and mortality in South Asians in the UK: E-ECHOES study

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): British Heart Foundation (PG/05/036) Primary Care Research Network-Central England. Background People of South-Asian origin have high cardiovascular morbidity, contributed by health inequalities. Hypertension is the key modifiable cardiovascular risk factor but is underdiagnosed, but its scale in South Asian communities is unknown. Left ventricular hypertrophy (LVH) on echocardiography is a measure of target organ damage related to uncontrolled hypertension. The study aims to assess prevalence of LVH in South Asian community and its impact on mortality. This study is based on the large prospective UK community Ethnic-Echocardiographic Heart of England Screening Study (E-ECHOES, age ≥45 years). Methods Left ventricular mass index (LVMI) was calculated using echocardiography. LVH was established as increased LVMI. Predictive value of LVH all-cause and cardiovascular mortality was assessed using Cox regression. Results The study included 3200 South Asians (age 59±10, 52% women, 45% had a history of hypertension). There were 182 deaths, including 64 cardiovascular deaths during a 5.8±1.0-year follow-up. LVH was found in 1568 (49%). In those with LVH, 705 (45%) did not have a diagnosis of hypertension. On Cox regression LVH was independently associated with all-cause mortality (hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.01-1.88), cardiovascular mortality (HR 2.64, 95% CI 1.21-3.73). The projected overall hypertension prevalence was 82%. Conclusion South Asians in the UK have a very high prevalence of hypertension which is often underdiagnosed and poorly controlled, leading to LVH and excess in overall and cardiovascular mortality. The findings call for more effective screening and management of hypertension with lower BP targets.

Targeting Hypertensive Response To Exercise And The Association Of Masked Hypertension With Subclinical Organ Damage : A Mini-Review And Meta-Analysis.

Emerging evidence suggests that a hypertensive response to exercise (HRE) during dynamic or isometric stress tests assessing cardiac function is predictive of hypertension and cardiovascular events such coronary artery disease, heart failure and stroke. Whether HRE represents a marker of masked hypertension (MH) in individuals with no prior history of hypertension is still unclear. This is also the case for the association between MH and hypertension-mediated organ damage (HMOD) in the HRE setting. We addressed this issue through a review and a meta-analysis of studies providing data on this topic in normotensive individuals undergone both to dynamic or static exercise and to 24-hour blood pressure monitoring (ABPM). A systematic search was performed using Pub-Med, OVID, EMBASE and Cochrane library databases from inception up to February 28 th 2023. Six studies including a total of 1155 untreated clinically normotensive individuals were considered for the review. Data provided by the selected studies can be summarized as follows: I) HRE is a BP phenotype linked to a high prevalence of MH (27.3% in the pooled population ); II) MH is, in turn, associated with a greater, consistent likelihood of echocardiographic left ventricular hypertrophy (OR: 4.93, CI: 2.16-12.2, p < 0.0001) and vascular organ damage, as assessed by pulse wave velocity, (SMD: 0.34±0.11, CI: 0.12-0.56, p=0002). On the basis of this, albeit limited, evidence, the diagnostic work-up in individuals with HRE should primarily be addressed to look for MH as well as for markers of HMOD, a highly prevalent alteration in MH.

Urinary proteomics combined with home blood pressure telemonitoring for health care reform trial-First progress report.

High blood pressure (BP) and type-2 diabetes (T2DM) are forerunners of chronic kidney disease and left ventricular dysfunction. Home BP telemonitoring (HTM) and urinary peptidomic profiling (UPP) are technologies enabling risk stratification and personalized prevention. UPRIGHT-HTM (NCT04299529) is an investigator-initiated, multicenter, open-label, randomized trial with blinded endpoint evaluation designed to assess the efficacy of HTM plus UPP (experimental group) over HTM alone (control group) in guiding treatment in asymptomatic patients, aged 55-75 years, with ≥5 cardiovascular risk factors. From screening onwards, HTM data can be freely accessed by all patients and their caregivers; UPP results are communicated early during follow-up to patients and caregivers in the intervention group, but at trial closure in the control group. From May 2021 until January 2023, 235 patients were screened, of whom 53 were still progressing through the run-in period and 144 were randomized. Both groups had similar characteristics, including average age (62.0 years) and the proportions of African Blacks (81.9%), White Europeans (16.7%), women 56.2%, home (31.2%), and office (50.0%) hypertension, T2DM (36.4%), micro-albuminuria (29.4%), and ECG (9.7%) and echocardiographic (11.5%) left ventricular hypertrophy. Home and office BP were 128.8/79.2mmHg and 137.1/82.7mmHg, respectively, resulting in a prevalence of white-coat, masked and sustained hypertension of 40.3%, 11.1%, and 25.7%. HTM persisted after randomization (48 681 readings up to 15 January 2023). In conclusion, results predominantly from low-resource sub-Saharan centers proved the feasibility of this multi-ethnic trial. The COVID-19 pandemic caused delays and differential recruitment rates across centers.

Accuracy of ECG left ventricular hypertrophy (LVH) criteria compared to echocardiographic LVH among hypertensives in an African population

Objectives: Hypertension remains one of the important risk factors for cardiovascular diseases and a major global public health problem. The left ventricular hypertrophy is a recognized complication of systemic hypertension and strongly predicts cardiovascular morbidity and mortality. In Nigeria, few studies have evaluated the accuracy of multiple electrocardiography (ECG) criteria in the diagnosis of the left ventricular hypertrophy among hypertensives. This study sets out to determine ECG criterion or criteria that define most accurately echocardiographic left ventricular hypertrophy (LVH) among patients with hypertension in a tertiary health institution in Nigeria. Materials and Methods: One hundred and seventy-eight hypertensives and 89 age- and sex-matched controls were recruited consecutively into the study. All participants including hypertensives and control subjects had echocardiography whereas only hypertensive subjects had both echocardiography and ECG. ECG LVH was determined using various ECG criteria. Results: The various ECG criteria for diagnosis of LVH were lower in sensitivities (23.5–38.6%) compared to specificities (64.1–72.9%). The sensitivities and specificities were 28.9% and 64.0%, 38.6% and 72.9%, 23.5% and 64.1%, 34.6% and 69.4%, 34.4% and 68.0%, and 38.6% and 72.9% for Sokolow-Lyon, Cornell voltage, Romhilt-Estes, Cornell duration product, Goldberger, and Massoleini criteria, respectively. The areas under the various receiver operating characteristic (ROC) curves were 0.7010, 0.6040, 0.5960, 0.5950, 0.4790, and 0.4660 for Sokolow-Lyon, Cornell voltage, Massoleini, Romhilt-Estes, Goldberger, and Cornell product duration criteria, respectively. Conclusion: Cornell voltage, Sokolow-Lyon, and Massoleini ECG criteria had the highest combination of sensitivities and specificities with the highest ROC values and thus most accurate ECG LVH criteria

Electrocardiographic and echocardiographic predictors of greater carotid intima-media thickness in tactical athletes: The CHIEF atherosclerosis study.

Both electrocardiographic and echocardiographic left ventricular hypertrophy (LVH) have been reported with an association with greater carotid intima-media thickness (cIMT), a marker of subclinical atherosclerosis in patients with hypertension, while the associations are unclear in physically fit young adults. A total of 1822 Taiwanese military personnel, aged 18-40 years, received an annual health examination including electrocardiography (ECG) and echocardiography in 2018-2020. Left carotid bulb cIMT was measured by high-resolution ultrasonography. Multiple logistic regression analysis with adjustments for age, sex, smoking, alcohol consumption, body mass index, mean blood pressure, and physical fitness was used to determine the associations between echocardiographic and ECG parameters and the highest quintile of cIMT (≥0.8 mm). Cornell-based LVH, Myers et al.-based RVH and heart rate ≥75/min were associated with cIMT ≥0.8 mm [odds ratios (ORs) and 95% confidence intervals: 1.54 (1.01, 2.35), 1.66 (1.18, 2.33), and 1.39 (1.06, 1.83), respectively], while echocardiographic LVH defined as ≥46.0g/m2.7 for men and ≥38.0g/m2.7 for women was inversely associated with cIMT ≥0.8 mm [OR: 0.45 (0.24, 0.86)]. In tactical athletes of military, the associations of ECG and echocardiographic LVH with cIMT were in opposite directions. Higher physical fitness may cause cardiac muscle hypertrophy and reduce the atherosclerosis severity, possibly leading to the paradoxical echocardiographic finding. This study suggests that ECG-based LVH remains a good marker of subclinical atherosclerosis in our military population.

Screening for hypertension-mediated organ damage and aetiology: still of value after 65 years of age?

Secondary forms and hypertension-mediated organ damage (HMOD) may differ between younger and older hypertensive patients. The aim of the present study was to explore the specificity of HMOD and secondary forms in patients ≥ 65 years in comparison to younger ones in a contemporary cohort. We analysed 938 patients recruited between 2004 and 2014 (Cardiology department, Croix-Rousse Hospital, Lyon) who had at baseline HMOD and secondary forms screening among them 190 were ≥ 65 years. The mean (2.1 ± 0.8 vs. 1.2 ± 0.9, P < 0.001) and frequency of HMOD (96.3% vs. 72.9%, P < 0.001) was higher in patients ≥ 65 years than younger ones. Carotid femoral pulse wave velocity > 10 m/s was the most frequent HMOD in patients ≥ 65 years (90.1%), while echocardiographic left ventricular hypertrophy was the most common in the younger patients (45.0%). Among ECG left ventricular indexes, only R wave in aVL lead was significantly more frequently observed in patients ≥ 65 years (32.6%) than in younger ones (19.0%, P < 0.001). The frequency of secondary hypertension was not significantly different between younger and older patients (respectively; 30.5% vs. 27.8%, P = 0.487). The most frequent aetiology was primary aldosteronism regardless of age, followed by renovascular hypertension (6.3% vs. 3.3%, P = 0.038). Among older patients, 3.2% were treated with adrenalectomy and 6.3% with percutaneous transluminal renal angioplasty. Extensive screening of HMOD in older patients may be questionable as nearly all patients had one; aetiology must however be explored as a third of older patients had a secondary form.

Lower serum magnesium is a predictor of left ventricular hypertrophy in patients on dialysis.

Left ventricular hypertrophy (LVH) represents one of the main risk factors for cardiovascular mortality in dialysis patients. Low serum magnesium Mg is related with increased mortality in general and dialysis population. Aim of our study was to evaluate the association of Mg with LVH and cardiac geometry in dialysis patients. Hemodialysis (HD) and peritoneal dialysis (PD) patients from nine nephrology departments were included. Echocardiographic LVH was defined by LV mass index > 95g/m2 in women and > 115g/m2 in men. Four LV geometric patterns were defined: normal, concentric remodeling, eccentric LVH and concentric LVH. Demographic and laboratory data were collected. 133 patients (68 HD, 65 PD) with a median age of 63years (IQR 52-74) were studied. Mg correlated positively with creatinine, HDL and negatively with CRP levels and BMI. There were no significant differences in Mg between the modality groups. 80 patients presented LVH (43 HD and 37 PD patients). Patients with LVH were older (median age 68 vs 55years, p < 0.001), with higher BMI (median 26.9 vs 24.7kg/m2, p = 0.009), had a history of PVD or CAD (55% vs 30.2%, p = 0.003), had higher pulse pressure (median 60 vs 50, p = 0.017), MIS score (median 5 vs 4, p = 0.011), lower albumin (median 3.5 vs 3.8g/dl, p = 0.011) and Mg levels (median 2.1 vs 2.4mg/dl, p < 0.001). In univariate analysis age, CVD comorbidities, pulse pressure, CRP, BMI, albumin, Mg, MIS and use of b-blockers or calcium blockers were LVH predictors. In multivariate analysis, Mg was an independent predictor of LVH, adjusted for age, MIS and b-blockers. Considering LV geometry, lower Mg levels were mainly correlated with concentric LVH. Low serum magnesium levels seem to be an independent factor for LVH in hemodialysis and peritoneal dialysis patients.

Association between Berlin questionnaire index and blood pressure, organ damage and metabolic profilein a general population.

We evaluated the relationships between Berlin questionnaire (BQ) scores, hypertension and other metabolic variables in 598 subjects (age: 65.8±10 years, mean±SD) enrolled in the PAMELA (Pressioni Arteriose Monitorate E Loro Associazioni) study representative of the general population, treated or untreated with antihypertensive drugs. Two hundred and eleven subjects (35%) had a positive BQ with two or more positive categories of the inquiry. Compared to those without sleep disorders these subjects showed a greater male prevalence (55.9%), worse serum cholesterol, triglycerides and glucose profile, greater body mass index (BMI) (28.9±4.9vs. 24.9±3.4kg/m2 ), higher office (and to a lesser extent 24-h) BP and HR values, higher serum creatinine values and greater rate of echocardiographic left ventricular (LV) hypertrophy (25%vs. 13%). These differences were not detected when the data analysis was restricted to treated hypertensive patients. Thus, BQ scores allow to identify among subjects belonging to a general population those with elevated BP, organ damage and altered metabolic. When antihypertensive drug treatment is present, however, the approach fails to detect differences between groups with low or high BQ index.

Sex differences in prevalence of electrocardiographic and echocardiographic left ventricular hypertrophy among patients with coronary artery disease

Abstract Background Both electrocardiographic left ventricular hypertrophy (ECG-LVH) and echocardiographic LVH (echo-LVH) are associated with higher risk of cardiovascular and sudden cardiac death. ECG-LVH seems to be partly distinct from echo-LVH as many subjects with echo-LVH do not have ECG-LVH and vice versa. The difference between sexes have not been studied earlier. Purpose The aim of this study was to determine sex differences in prevalence of ECG-LVH and echo-LVH among patients with coronary artery disease (CAD) and to study if ECG-LVH would have higher accuracy for echo-LVH in either of sexes. Methods Standard 12-lead electrocardiograms and echocardiographic measurements were studied from 1,894 subjects of ARTEMIS Study (31.8% women). Echo-LVH was determined as estimated left ventricular (LV) mass ≥201 g in men and ≥151 g in women and was categorized as mildly, moderately and severely abnormal. ECG-LVH was determined if either criteria of Sokolow-Lyon or Cornell were met. Results Echo-LVH was found from 1,162 of the study subjects (women 34.3%, p=0.004) and ECG-LVH only from 222 of the subjects (women 55.9%, p&amp;lt;0.001). Of those with ECG-LVH, 82.0% had increased LV mass (p&amp;lt;0.001), and ECG-LVH seemed to correlate slightly better to echo-LVH in women than in men (82.3% vs. 81.6%, p&amp;lt;0.001). Of those with ECG-LVH, 47.7% had severe echo-LVH (p&amp;lt;0.001). The prevalence of ECG-LVH was the higher the greater the LV mass was. Among men with ECG-LVH, 46.9% had severe echo-LVH (p&amp;lt;0.001). Among women with ECG-LVH, 16.1% had mild echo-LVH (p=0.029) and 48.4% severe echo-LVH (p&amp;lt;0.001). In addition, 18% of those with ECG-LVH did not have echo-LVH (p&amp;lt;0.001). This proportion was slightly smaller in women than in men (17.7% vs. 18.4%, p&amp;lt;0.001). Only 15.7% of the subjects with echo-LVH had ECG-LVH (p&amp;lt;0.001). This proportion was significantly higher in women than in men (25.6% vs. 10.5%, p&amp;lt;0.001). ECG-LVH was more common finding in subjects with severe echo-LVH as 20.9% of those CAD patients had ECG-LVH (p&amp;lt;0.001). Among women with severe echo-LVH, ECG-LVH was found in 35.3% (p&amp;lt;0.001) whereas only in 13.7% of men with severe echo-LVH (p&amp;lt;0.001). The prevalence of ECG-LVH seemed to be considerably higher among female CAD patients with T2DM and without prior MI as ECG-LVH was seen in 33.0% of those subjects with at least midl echo-LVH (p&amp;lt;0.001) and 43.8% of those subjects with severe echo-LVH (p&amp;lt;0.001). In male patients from similar subgroup and some degree of echo-LVH, ECG-LVH was seen in 6.7% (p=0.042) and with severe echo-LVH in 12.2% (p&amp;lt;0.001) of the subjects. Conclusions In patients with CAD echo-LVH was often seen without signs of ECG-LVH, especially in men. Majority of the CAD patients with ECG-LVH had also echo-LVH and the prevalence on ECG-LVH was the higher the greater the LV mass was. ECG-LVH seemed to correlate better to anatomic LVH in women with CAD than in men, and the sex difference was highlighted in CAD patients with T2DM and no prior MI. Funding Acknowledgement Type of funding sources: None.

Adherence to the Mediterranean Diet Is Associated with a More Favorable Left Ventricular Geometry in Patients with End-Stage Kidney Disease.

Introduction. The aim of the study was to examine the impact of adherence to a Mediterranean-style diet (MD) on left ventricular hypertrophy (LVH) and cardiac geometry in chronic kidney disease patients on dialysis (CKD-5D), given the high prevalence of cardiovascular morbidity in this population. Methods. n = 127 (77 men and 50 women) CKD-5D patients (69 on hemodialysis and 58 on peritoneal dialysis) with a mean age of 62 ± 15 years were studied. An MD adherence score (MDS) (range 0–55, 55 representing maximal adherence) was estimated with a validated method. Echocardiographic LVH was defined by LV mass index (LVMI) > 95 g/m2 in women and >115 g/m2 in men. Based on LVMI and relative wall thickness (RWT), four LV geometric patterns were defined: normal (normal LVMI and RWT), concentric remodeling (normal LVMI and increased RWT > 0.42), eccentric LVH (increased LVMI and normal RWT), and concentric LVH (increased LVMI and RWT). Results. Patients with LVH (n = 81) as compared to patients with no LVH (n = 46) were older in age (66 ± 13 vs. 55 ± 16 years; p < 0.001) had lower MDS (24 ± 2.7 vs. 25 ± 4.3; p < 0.05) and higher malnutrition-inflammation score (5.0 ± 2.7 vs. 3.9 ± 1.9; p < 0.05), body mass index (27.5 ± 4.9 vs. 24.1 ± 3.5 kg/m2; p < 0.001), prevalence of diabetes (79% vs. 20%; p < 0.05), coronary artery disease (78% vs. 20%; p < 0.05) and peripheral vascular disease (78% vs. 20%; p < 0.01). In a multivariate logistic regression analysis adjusted for all factors mentioned above, each 1-point greater MDS was associated with 18% lower odds of having LVH (OR = 0.82, 95% CI: 0.69–0.98; p < 0.05). MDS was inversely related to LVMI (r = −0.273; p = 0.02), and in a multiple linear regression model (where LVMI was analyzed as a continuous variable), MDS emerged as a significant (Β = −2.217; p < 0.01) independent predictor of LVH. Considering LV geometry, there was a progressive decrease in MDS from the normal group (25.0 ± 3.7) to concentric remodeling (25.8 ± 3.0), eccentric (24.0 ± 2.8), and then concentric (23.6 ± 2.7) group (p < 0.05 for the trend). Conclusions. The greater adherence to an MD is associated with lesser LVH, an important cardiovascular disease risk factor; MD preserves normal cardiac geometry and may confer protection against future cardiac dysfunction in dialysis patients.

Prevalence of echocardiographic left ventricular hypertrophy among hypertensives in a tertiary health institution in Nigeria

Objective: Systemic hypertension remains an important risk factors for cardiovascular diseases and a major global public health problem. Left ventricular hypertrophy (LVH) is a recognized complication of hypertension and strongly predicts cardiovascular morbidity and mortality. In Nigeria, few studies evaluated the role of echocardiography in the diagnosis of LVHs among hypertensives. This study sets out to determine the prevalence of LVH among hypertensives as determined by echocardiography. Material and Methods: One hundred and seventy-eight hypertensives and eighty-nine age and sex-matched controls were recruited consecutively into the study. They all had echocardiography done to determine which among had LVH. The partition value for LVH for hypertensives was determined using the 97th percentile of the left ventricular mass for controls as a cutoff point. Results: Echocardiographic determined the prevalence of LVH among hypertensives was 32.4%. Conclusion: The echocardiographic prevalence of LVH was 32.4% in the study population. This is a significant proportion among the study population considering the clinical impact of LVH among patients with hypertension.

WHITE-COAT HYPERTENSION WITHOUT ORGAN DAMAGE: IMPACT OF LONG-TERM MORTALITY, NEW HYPERTENSION AND NEW ORGAN DAMAGE

Objective: According to some guidelines white-coat hypertension (WCH) carries little or no increase of cardiovascular (CV) risk in absence of organ damage (OD) but no data are available on this issue. Design and method: Using the population data from Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA), we evaluated CV and total mortality over a median follow-up of 29 years in WCH (elevated office and normal 24-hour or home blood pressure, BP) and normotensive controls (N, normal in- and out-of-office BP) with no echocardiographic left ventricular hypertrophy and no reduction of estimated glomerular filtration rate. Analysis was extended to sustained hypertension (SH, in- and out-of-office BP elevation) and to N, WCH and SH with cardiac and renal OD. Results: During the 29 years follow-up there were in the 1423 subjects nalysed 165 CV and 526 all cause deaths. OD was detected in 10.6%, 30.5% and 43.8% of N, WCH and SH, respectively. After adjustment for confounders no-ODWCH exhibited a risk of fatal CV events lower than that of no-ODSH but greater than that of no-ODN (HR 2.0, 95% CI: 1.1–3.6, P = 0.02), this being the case also for all cause mortality. Compared with no-ODN, no-ODWCH also exhibited a greater 10 year adjusted risk to develop new SH or OD. Similar findings were obtained in N, WCH and SH with OD. The present study provides the first evidence that WCH with no cardiac and renal OD is accompanied by an increased long-term risk of mortality, new hypertension and new OD, thereby not representing a clinically innocent condition. Conclusions: The present study provides the first evidence that WCH with no cardiac and renal OD is accompanied by an increased long-term risk of mortality, new hypertension and new OD, thereby not representing a clinically innocent condition.