Higher Left Ventricle Mass Research Articles

Vitamin D Status and Cardiovascular Disease in College Athletes After SARS-CoV-2 Infection.

To evaluate the association between vitamin D status and CV disease after COVID-19 in college athletes. Retrospective cohort study. National College Athletic Association Division-I college athletes from a single academic institution. A total of 157 athletes (60 female; median age: 20 years) from 9 sports with a positive SARS-CoV-2 test, cardiac magnetic resonance imaging (CMR), and vitamin D level. Serum 25-hydroxyvitamin D level (primary); age, sex (regression models). Differences in age, sex, race, ethnicity, myocarditis, pericarditis, and CMR metrics by vitamin D status were analyzed. Regression models were used to assess the relationship between vitamin D status and CMR metrics accounting for age and sex. Low vitamin D (LVD) was found in 33 (21.0%) of athletes, particularly Black males (P < 0.001). Athletes with LVD had higher biventricular and lower mid-ventricular extracellular volumes, but these differences were not significant when corrected for age and sex. Athletes with LVD had higher left ventricle (LV) mass (P < 0.001) and LV mass index (P = 0.001) independent of age and sex. Differences in global circumferential strain were noted but are likely clinically insignificant. Vitamin D status did not associate with myocarditis and pericarditis (P = 0.544). LVD is common in athletes, particularly in Black males. Although athletes with LVD had higher LV mass, cardiac function and tissue characterization did not differ by vitamin D status. Future studies are needed to determine if the differences in LV mass and LV mass index by vitamin D status are clinically significant. This study suggests that vitamin D status does not impact the development of myocarditis or pericarditis after COVID-19 infection.

Abstract P159: Echocardiographic Cardiac Phenotype in Val122Ile Variant Transthyretin Amyloidosis Among Hispanics/Latinos: Results From the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Background: Transthyretin amyloidosis, most often caused by Val122Ile mutation, is linked to a higher risk of heart failure (HF) and mortality. Subclinical abnormalities in cardiac structure and function linked to Val122Ile mutations are less well defined in Hispanics/Latinos. We studied the cardiac phenotype of Hispanic/Latino Val122Ile carriers versus non-carriers. Methods: Val122Ile carrier status was determined with genome-wide data. We analyzed echocardiographic data from adults 45 years or older (unweighted n= 6376) from HCHS/SOL and the Echocardiographic Study of Latinos, Echo-SOL. Measures of cardiac structure and function (Table) were compared among Val122Ile carriers and non-carriers using age-and-sex-adjusted least square means (continuous variables) and proportions (categorical variables). Prevalence of pre-HF, identified by the presence of at least one abnormal echocardiographic parameter, was also compared among those with vs. without Val122Ile mutation. Complex survey statistics and sample weights are utilized for all analyses. Results: Val122Ile carriers (0.8%; unweighted n= 40) were younger (mean ±SE, 55.5 years ±1.7), had higher systolic blood pressure (mean ±SE, 130 mmHg ±3.6), but lower body mass index (mean ±SE, 28.5 kg/m 2 ±1.4) than non-carriers, p &lt;0.0001. Lower mean values of left ventricle (LV) ejection fraction, LV end diastolic volume, right ventricle (RV) fractional area change, lateral peak e’ velocity and lower pre-HF prevalence was seen among carriers vs non-carriers. Val122Ile carriers also had higher LV mass, worse concentric remodeling, and worse measures of diastolic function than non-carriers. Most measures of RV function were higher among carriers vs non-carriers (Table) . However, none of the differences found in cardiac phenotype of carriers vs non-carriers were statistically significant (p &gt;0.05). Conclusion: There is a lack of difference in the echocardiographic cardiac phenotype among Hispanic/Latinos who carry the Val122Ile mutation versus non-carriers.

Abstract 12022: Predictors of Mortality in Patients With Biopsy-Proven Cardiac AL Amyloidosis

Introduction: Cardiac involvement occurs in ~50% of patients with light-chain (AL) amyloidosis and conveys a poor prognosis. This study examined the role of histopathologic and echocardiographic parameters in predicting mortality. Methods: Patients with endomyocardial biopsy-proven cardiac AL amyloidosis treated at MD Anderson Cancer Center between 6/2011 and 6/2020 were identified. Stored echocardiographic images were processed for longitudinal strain (global [GLS], apical, mid, basal) as well as radial and circumferential strain of the left ventricle (LV), right ventricle (RV) free wall, left atrium (LA), and right atrium, using the Epsilon EchoInsight Software. A detailed histomorphologic characterization of stored endomyocardial biopsy samples was performed by a cardiac pathologist and scored as &lt; or &gt; 5% AL deposits. Results: We identified 43 patients; 44% were women and 63% white. Median age was 65 years (IQR 59-70). Twenty-two (51%) underwent stem cell transplantation (SCT). A total of 29 patients (67%) died during follow up period (median follow up: 4.2 years (95% CI, 2.8-8.6)). Median overall survival (OS) was 18 months (95% CI, 8.1-37). Lower LA GLS and absence of SCT as a time-varying covariate were significantly and independently associated with increased risk of death in the multivariable cox regression analysis (HR 3.8, 95% CI 1.4-10.2 for LA GLS &lt; 13.5 vs &gt;13.5, p=0.008 and 0.20, 0.06-0.65 for SCT vs no SCT, p&lt;0.001, respectively). Higher LV mass and lower RV TAPSE were associated with increased odds of having &gt;5% of interstitial amyloid deposition on biopsy in the multivariable logistic regression analysis (OR 5.5, 95% CI 1.1-26.8 for &gt;195.6g vs ≤195.6g, p=0.036 and 8.1, 1.2-54.3 for RV TAPSE&lt;1.6cm vs ≥1.6cm, p=0.032, respectively). Conclusions: LA GLS &lt; 13.5 was an independent predictor of mortality in our cohort, and its performance in the routine assessment of AL amyloidosis may be justified. Furthermore, SCT for cardiac AL amyloidosis was associated with improved OS. This finding needs to be confirmed by larger studies in the era of contemporary systemic therapies. Although LV mass and RV TAPSE were associated with higher interstitial amyloid deposition, histopathologic parameters did not predict mortality in this cohort.

Filling the gap between the heart and the body in acromegaly: a case-control study

ObjectiveCardiovascul diseases are the most common comorbidities in acromegaly. Potential parameters in pathology of cardiovascular comorbidities are changes in levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) as well as body composition parameters.PurposeThe aim of this study was to examine morphological and functional parameters of the cardiovascular system by echocardiography and to assess its relationship with disease activity and body composition parameters.MethodsWe prospectively enroled 129 acromegalic patients (82 females, 47 males) and 80 healthy controls (53 females, 27 males) matched for age, gender, and BMI. All patients underwent two-dimensional echocardiography. Body composition parameters were assessed by dual-energy X-ray absorptiometry.ResultsAcromegaly patients presented with higher left ventricle mass (LVM) compared to controls (LVMI: 123 ± 45 g/m2 vs 83 ± 16 g/m2, P < 0.001). Prevalence of left ventricle hypertrophy in acromegaly patients was 67% (78% concentric, 22% eccentric). IGF -1 levels, BMI, and lean mass positively correlated with LVM in all acromegaly patients (P < 0.001). Fat mass positively correlated with LVM in females (R = 0.306, P = 0.005), but this correlation was not found in males. We did not find any difference in size of the left and right ventricle between acromegaly patients and controls. Acromegaly patients presented with left atrium enlargement, diastolic dysfunction and low incidence of systolic dysfunction. Valvopathy was found in 43% of patients with predominant (31%) prevalence of mitral regurgitation.ConclusionOur study demonstrates higher prevalence of cardiovascular comorbidities in acromegaly patients and the impact of IGF-1 levels and body composition parameters in pathology in some of these comorbidities.

Correlation Between Different Parameters of Acute Myocardial Infarction and Obesity.

Objective: To study if obesity had a detrimental effect on troponin after acute coronary syndrome. We investigated the effects of the body mass index (BMI) in post-myocardial infarction (MI) patients, and see the difference in troponin levels and other parameters between normal and overweight patients.Methodology: A retrospective cohort study was conducted. Data were extracted from the electronic medical files of patients hospitalized due to acute ST-elevation MI to examine the association between BMI and MI. Sixty-one patients were categorized into normal BMI category, overweight, and obese/morbid obesity groups using the baseline measurements, to assess the independent factors associated with a patient with a high BMI who had a MI.Results: In total, 61 post-myocardial infarction patients with a mean age of 56.9 ± 11.2 years were included in the study. The average BMI was 28.5 ± 6.5 kg/m2. Just more than a third (37.4%, n=23) were in the normal BMI category, 19 (31.2%) overweight, and 19 (31.2%) obese/morbid obesity. The mean left ventricle mass was 93.74 ± 32.69 gram and the mean left ventricular ejection fraction was 44.02% ± 10.02. A significant difference in the mean level of troponin and mean heart rate between the body mass index groups (normal vs. overweight groups) was noted. A fair correlation was noted between BMI and left ventricle mass. No statistically significant relation could be linked to high BMI with total cholesterol, low-density lipoprotein (LDL), or aspartate transferase/alanine transaminase (AST/ALT) levels.Conclusions: In this pilot study, the group with a high BMI had a statistically significant lower troponin level and higher mean heart rate. Such data need to be considered when assessing a patient’s risk. In addition, obese persons with a MI had a higher left ventricle mass.

Association between Coronary Artery Disease and Left Ventricle Remodeling Parameters in Hypertensive Patients: A Cross-Sectional Study in a Limited Resource Setting

BACKGROUND: Coronary artery disease (CAD) and hypertension are related with left ventricle (LV) remodeling, however evidence about association between CAD and remodeling in hypertensive patient is still limited, especially in limited resource setting like Indonesia. AIM: Evaluating impact of CAD on LV remodeling within hypertensive patients at tertiary referral hospital, Hasan Sadikin General Hospital Bandung, Indonesia. METHOD: Cross-sectional study involving 120 hypertensive patients who visited cardiology outpatient clinic from September-December 2019 and underwent transthoracic echocardiography examination for any medical indications. LV remodeling parameters, such as mass (LV Mass Index [LVMi]), volume (end-diastolic volume/body surface area [BSA]), and relative wall thickness (RWT), were compared between CAD and non-CAD groups. RESULTS: There were 108 patients to be analyzed, 12 patients were excluded due to technical difficulty (n = 9) and non-cooperative during interview (n = 3). Mean (standard deviation) age of patients was 56.9 (±11.8) years, 50 (46.3%) patients were male, and median (interquartile range) hypertension duration was 3 (±4.40) years. CAD was found in 40 (37.0%) patients. In the adjusted analysis, patients with CAD had average 27.75 g/m2 higher LVMi (95% confined interval [CI] 2.03; 53.47; p = 0.035) and 16.20 ml/m2 higher LV end-diastolic volume/BSA (95% CI 4.14; 28.25; p = 0.009) compared to those without. This was independent of age, duration of hypertension, consumption of antihypertensive therapy, and type-2 diabetes mellitus, but disappeared after heart failure (HF) was included in the study. CAD and non-CAD groups were not different, respectively, to RWT. CONCLUSION: In hypertensive patients, CAD was independently associated with higher LV mass and volume. These associations, however, were largely explained by the presence of HF. CAD did not associate with RWT.

Right atrium enlargement is related to increased heart damage and mortality in well-controlled hypertension

Background and aimLeft heart remodeling is a well-known pathophysiological effect of arterial hypertension. Right Heart status is not considered in its evaluation. No data are available on right atrium (RA) and its impact on the outcome in hypertension.We wondering to understand whether RA may play a role as a marker of an increased risk for organ damage in well-controlled hypertensives, to probe the clinical significance and whether it could indicate an increased risk. Methods and resultsWe studied well-controlled hypertensive patients. Heart damage was assessed by echocardiography. Patients were subdivided into those with RA area ≤18 cm2 (normal RA - Group 1) (554 pts, 227 M, aged 60.35 ± 10.48 years) and those >18 cm2 (Increased RA - Group 2) (101 pts, 71 M, age 61.65 ± 9.46 years). Group 2 had a higher left ventricle mass (LVM) and left atrium volume (LAV) both as absolute value (both p < 0.0001) and indexed for body surface area (LVMi p < 0.013; LAVi p = 0.0013). Group 2 showed an increased vascular stiffness (p < 0.0001) and carotid stenosis percentage (p = 0.011). TAPSE (p < 0.0001) resulted significantly increased. In The RA area was significantly correlated directly to LVM and LAV in both groups, but these correlations persisted in indexed values only in Group 2. Moreover, in this group there was a significant direct correlation between RA area and Tricuspid s'wave at echocardiography TDI analysis. Finally, Group 2 had an increased mortality rate compared to Group 1 (Log-Rank p = 0.0006). ConclusionGroup 2 hypertensive patients showed more alterations in dimensional and volumetric left heart parameters, and an increased mortality.

Decreased Native T1 Values and Impaired Myocardial Contractility in Anabolic Steroid Users.

Anabolic androgenic steroid (AAS) abuse leads to myocardial toxicity. Human studies are conflicting about the myocardial fibrosis in AAS users. We evaluated cardiac tissue characterization, left ventricle (LV) function, and cardiac structure by cardiovascular magnetic resonance (CMR). Twenty strength-trained AAS users (AASU) aged 29±5 yr, 20 strength-trained AAS nonusers (AASNU), and 7 sedentary controls (SC) were enrolled. Native T1 mapping, late-gadolinium enhancement (LGE), extracellular volume (ECV), and myocardial strain were evaluated. AASU showed lower Native T1 values than AASNU (888±162 vs. 1020±179 ms p=0.047). Focal myocardial fibrosis was found in 2 AASU. AASU showed lower LV radial strain (30±8 vs. 38±6%, p<0.01), LV circumferential strain (-17±3 vs. -20±2%, p<0.01), and LV global longitudinal strain (-17±3 vs. -20±3%, p<0.01) than AASNU by CMR. By echocardiography, AASU demonstrated lower 4-chamber longitudinal strain than AASNU (-15±g3 vs. -18±2%, p=0.03). ECV was similar among AASU, AASNU, and SC (28±10 vs. 28±7 vs. 30±7%, p=0.93). AASU had higher LV mass index than AASNU and SC (85±14 vs. 64±8 vs. 58±5 g/m2, respectively, p<0.01). AAS abuse may be linked to decreased myocardial native T1 values, impaired myocardial contractility, and focal fibrosis. These alterations may be associated with maladaptive cardiac hypertrophy in young AAS users.

Short-Term Prognosis Value of sST2 for an Unfavorable Outcome in Hypertensive Patients.

Background sST2 represents a useful biomarker for the diagnosis and prognosis of patients with heart failure, but limited data is available on its role in patients with hypertension. The aim of this study is to evaluate the short-term prognosis value of sST2 for an unfavorable outcome in hypertensive patients. Methods This was a prospective observational study which enrolled 80 patients with hypertension, who were followed for one year. All patients underwent clinical, laboratory (including sST2), and echocardiographic assessment at baseline. The patients were grouped according to the cardiovascular (CV) events reported during the follow-up: group A (with CV events) and group B (without CV events). Results Overall, 59 CV events were reported during the follow-up period. Compared to group B, the patients in group A had significantly higher sST2 levels, a higher number of CV risk factors, and a higher left ventricle mass. Except for the diastolic dysfunction parameters, the echocardiographic findings were similar in the two groups. Patients in group A had a lower E/A ratio, larger deceleration time, and increased telediastolic pressure as quantified by the E/E/p = 0.006, Kaplan-Meier analysis). Conclusions sST2 levels were correlated with the risk of adverse CV outcomes in hypertensive patients and may represent a useful prognostic marker in these patients.

P4132Decreased myocardial native T1 times and impaired myocardial contractility in young anabolic androgenic steroids users

Abstract Background Anabolic androgenic steroids (AAS) have been associated with several injuries on the cardiovascular system. AAS abuse may have a direct toxic effect on the myocardium that could lead to cardiac function and structure alterations. Clinical and forensic cases have been reported myocardial fibrosis in AAS users. Myocardial fibrosis increases the risk of heart failure and sudden death. However, recent studies did not show evidence of focal myocardial fibrosis and diffuse myocardial fibrosis in AAS users using T1-mapping techniques. Thus, it remains unclear the association between AAS and cardiac structure alterations. Purpose The aim of this study was to evaluate cardiac structure by cardiovascular magnetic resonance (CMR) imaging with late-gadolinium enhancement (LGE), cardiac T1-mapping and extracellular volume measurements (ECV). Additionally, we also evaluated the cardiac contractility by CMR and echocardiography in young AAS users. Methods Twenty strength-trained AAS users (AASU) age 29±5 yr, 20 age-matched strength-trained AAS nonusers (AASNU), and 10 sedentary controls (SC) were enrolled. Cardiac structure was assessed by LGE, native T1-mapping and ECV. Cardiac contractility was evaluated as cardiac strain measured by CMR (feature tracking imaging technique) and echocardiography (speckle tracking technique). Results Global native T1 times [753 (683–870) vs 916 (815–1239) vs 1205 (825–1242) ms, respectively, p=0.03], and native T1 times at the left ventricle mid-ventricular slice [813 (695–1096) vs 922 (825–1095) vs 1140 (840–1322) ms, respectively, p=0.03] were lower in AASU compared with AASNU and SC. Mid-ventricular ECV was similar between AASU, AASNU and SC (22±6 vs 23±4 vs 24±4%, respectively, p=0.37). Focal myocardial fibrosis was found in 2 individuals (11%) of AASU. The mid anteroseptal and mid inferoseptal were the most affected segments. The total estimated mass of the LV mass was 1.25 g (0.65%). Three participants of SC showed focal myocardial fibrosis. The mid anterolateral, mid inferolateral and mid inferomedial were the most affected segments. The total estimated mass of the LV mass was 3.43 g (2.30%). In contrast, none of the AASNU had myocardial fibrosis. By CMR, AASU showed a lower medial radial strain (30±8 vs. 38±6%, p&lt;0.01), medial circumferential strain (−17±3 vs −20±2%, p&lt;0.01) and global longitudinal strain (−17±3 vs −20±3%, p&lt;0.01) compared with AASNU. Echocardiography also demonstrated a lower 4CH longitudinal strain in AASU compared with AASNU (−15.5±3 vs −18.3±2%, p=0.03). Moreover, the AASU shower a higher left ventricle mass compared with AASNU and SC (185±20 vs 130±17 vs 112±14 g, respectively, p&lt;0.01). Conclusion This study indicates that AAS abuse may be associated with decreased myocardial native T1 times, impaired myocardial contractility and focal myocardial fibrosis. These myocardial structural and functional alterations may be associated to unadapted cardiac hypertrophy in young AAS users. Acknowledgement/Funding Fundação de Amparo à Pesquisa do Estado de São Paulo [FAPESP], Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes).

Association between nonalcoholic fatty liver disease and cardiac function and structure-a meta-analysis.

Nonalcoholic fatty liver disease is increasingly recognized as the hepatic counterpart of metabolic syndrome. It is hypothesized that structural and functional cardiac changes may be associated with this metabolic disease. We aimed to gather the existing information on the association of nonalcoholic fatty liver disease with cardiac alterations, and to evaluate a possible correlation between them. Systematic review of Medline searching results for original articles studying NAFLD and cardiac parameters until August 2018. A meta-analysis was conducted to each parameter of cardiac structure and function selected, using Review Manager 5.3 software. This study was conducted according to preferred reporting items for systematic reviews and meta-analysis (PRISMA). A total of 16 studies met the eligibility criteria and were included in the meta-analysis. There was a significant association between nonalcoholic fatty liver disease and (1) higher left ventricle mass and ratios between left ventricle mass and both height and body surface area; (2) higher LVEDD; (3) higher left atrium diameter and ratio between left atrial volume and body surface area; (4) higher posterior wall and septum thickness; (5) lower E/A wave ratio; (6) higher E/E' ratio; (7) longer deceleration time and (8) longer relaxation time. NAFLD associates with adverse structural alterations and cardiac dysfunction. Our results highlight the importance of identifying NAFLD in patients with metabolic dysfunction as this may represent an additional contributor to cardiovascular risk.

Urocortin 2 in patients with hypertension treated with angiotensin converting enzyme inhibitors or angiotensin receptor blockers.

Urocortin 2 (Ucn2) - corticotropin-releasing hormone receptor 2 signalling has favourable effects in the cardiovascular system, including vasodilation, lowering of blood pressure and systemic peripheral resistance, increase in cardiac output and cardiac contractility, as well as cardioprotection against ischemia-reperfusion injury. Vasodilation and lowering of blood pressure seem to be very interesting and important effects, but their mechanism and interaction with the antihypertensive drugs have not been evaluated. The aim of the present study was to assess the relationship between Ucn2 concentration and antihypertensive therapy in patients with primary hypertension. We examined a group of 65 patients with primary hypertension receiving at least 3 antihypertensive drugs. In all of them plasma level of Ucn2, anthropometric measurements, biochemical tests, ambulatory blood pressure monitoring (ABPM), and echocardiography were performed. There were no differences in Ucn2 level related to beta-blockers, calcium channel blockers or diuretics, but we observed that in patients treated with angiotensin converting enzyme inhibitors (ACEI) (n = 52) serum Ucn2 levels were significantly higher than in patients treated with angiotensin-receptor blockers (ARBs) (n = 13) (10.93 versus 5.56 ng/mL; P < 0.05). Moreover, we did not observe any differences in terms of blood pressure on ABPM, biochemical measurements, left ventricular mass index, or presence of diabetes. In addition, in a small subgroup receiving alpha-blockers we also found a lower level of Ucn2, with coexisting higher systolic blood pressure at night, higher left ventricle mass index (LVMI) and more frequent occurrences of diabetes compared to non-alpha-blockers. Our findings suggest that the hypotensive action of renin-angiotensin-aldosterone system blockade may be related to the urocortin system. Ucn2 may be an important element in the mosaic of blood pressure-lowering factors in patients treated for essential hypertension.

Prevalence of smoking and clinical characteristics in fibromuscular dysplasia. The ARCADIA-POL study

Purpose: Smoking was identified as a potential factor contributing to fibromuscular dysplasia (FMD). To evaluate the prevalence of smoking and clinical characteristics in FMD subjects.Material and Methods: We analysed 190 patients with confirmed FMD in at least one vascular bed. The rate of smokers in FMD patients was compared to that in two control groups selected from a nationwide survey.Results: The rate of smokers in FMD patients was 42.6%. There were no differences in frequency of smokers between FMD patients and: a group of 994 matched control subjects from general population and a group of matched hypertensive subjects. There were no differences in the characteristics of FMD (including rates of multisite FMD and significant renal artery stenosis) and its complications (including rates of dissections and aneurysms) between smokers and non-smokers. Smokers as compared with non-smokers were characterized by higher left ventricle mass index.Conclusions: There is no difference in the rate of smokers between FMD patients and subjects from the general population. Moreover, we did not find any association between smoking and clinical characteristics of FMD patients nor its extent and vascular complications. Our results do not support the hypothesis that smoking is involved in the pathophysiology of FMD.

Impact of obstructive sleep apnea on cardiac organ damage in patients with acute ischemic stroke.

Both obstructive sleep apnea (OSA) and cardiac organ damage have a crucial role in acute ischemic stroke. Our aim is to explore the relationship between OSA and cardiac organ damage in acute stroke patients. A total of 130 consecutive patients with acute ischemic stroke were enrolled. Patients underwent full multichannel 24-h polysomnography for evaluation of OSA and echocardiography to evaluate left ventricle (LV) mass index (LV mass/BSA, LV mass/height), thickness of interventricular septum (IVS) and posterior wall (LVPW), LV ejection fraction and left atrium enlargement. Information on occurrence of arterial hypertension and its treatment before stroke was obtained from patients' history. 61.9% (70) of patients, mostly men (67.1%), with acute stroke had OSA (AHI > 10). Patients with acute stroke and OSA showed a significant increase (P < 0.05) of LV mass index, IVS and LVPW thickness and a significant left atrial enlargement as compared with patients without OSA. LV ejection fraction was not significantly different in stroke patients with and without OSA and was within normal limits. No relationship was found among cardiac alterations, occurrence of OSA and history of hypertension. Acute stroke patients with OSA had higher LV mass and showed greater left atrial enlargement than patients without OSA. This study confirms the high prevalence of OSA in stroke patients, suggesting also an association between OSA and cardiac target organ damage. Our finding of structural LV abnormalities in acute stroke patients with OSA suggests a potential role of OSA as contributing factor in determining both cerebrovascular and cardiac damage, even in absence of clear link with a history of blood pressure elevation.

Myocardial injury following aortic valve replacement for severe aortic stenosis: risk factor of postoperative myocardial injury and its impact on long-term outcomes.

BackgroundAs hypertrophied myocardium predisposes the patient to decreased tolerance to ischemia and increased reperfusion injury, myocardial protection is of utmost importance in patients undergoing aortic valve replacement (AVR) for severe aortic valve stenosis (AS).MethodsConsecutive 314 patients (mean age, 62.5±10.8 years; 143 females) with severe AS undergoing isolated AVR were included. Postoperative myocardial injury (PMI) was defined as 1) maximum postoperative creatinine kinase isoenzyme MB or troponin-I levels ≥10 times of reference, 2) postoperative low cardiac output syndrome or episodes of ventricular arrhythmia, or 3) left ventricular ejection fraction of less than 55% and decrease in left ventricle (LV) ejection fraction of more than 20% of the baseline value.ResultsThere were 90 patients (28.7%) who developed PMI. There were five cases of early death (1.6%), all of whom had PMI. On multivariable analysis, the use of histidine-tryptophan-ketoglutarate (HTK) solution instead of blood cardioplegia (odds ratio [OR], 3.06; 95% confidence interval [CI], 1.63 to 5.77; p=0.001), greater LV mass (OR, 1.04; 95% CI, 1.01 to 1.07; p=0.007), and increased cardiac ischemic time (OR, 1.13; 95% CI, 1.05 to 1.22; p<0.001) were independent predictors for PMI. Patients who had PMI showed significantly inferior long-term survival than those without PMI (p=0.049).ConclusionPMI occurred in a considerable proportion of patients undergoing AVR for severe AS and was associated with poor long-term survival. HTK cardioplegia, higher LV mass, and longer cardiac ischemic duration were suggested as predictors of myocardial injury.

Cardiac hypertrophy and oxidative metabolism in novel congenic leptin receptor deficient BBDR.cg‐lepr.cp rats (1155.10)

Congenic BBDR.cg‐lepr.cp rats generated by introgression of the Koletsky leptin receptor mutation into the BioBreeding Diabetes Resistant (BBDR) rat develop obesity and diabetes mellitus, known risk factors for heart failure. Here we studied cardiac function and myocardial oxidative metabolism in these rats by non‐invasive imaging. Myocardial glucose utilization (18F‐fluorodeoxyglucose uptake) and oxygen consumption (washout constant for 11C‐acetate derived from monoexponential fitting) were measured by positron emission tomography (PET); left ventricle (LV) mass, systolic function and cardiac output by echocardiography. Compared with non‐diabetic littermates, diabetic rats were obese (body weight 463±36 vs. 706±65 g, p&lt;0.01), hyperglycemic (6±1 vs. 22±10 mM, p&lt;0.01), had elevated blood pressure (136±5 vs. 151±13 mmHg, p=0.02), comparable systolic function (fractional shortening 49 vs. 48%), but higher LV mass (0,6±0,1 vs. 0,9±0,1 g, p&lt;0.01). Diabetic rats had lower fasting myocardial glucose uptake (p=0.04) and lower efficiency of myocardial forward work (LV work / oxygen consumption * myocardial mass; 69000±8000 vs. 54000±12000 mmHg L/min; p=0.03), despite having comparable resting myocardial oxygen consumption in fasting state. Results suggest that BBDR.cg‐lepr.cp rats should prove a useful new model to study the adverse effects of obesity and diabetes on cardiac metabolism.Grant Funding Source: Supported by: VR 2011‐3900; EFSD, SSMF, the SUMMIT consortium (IMI‐2008/115006).

Heparin-binding EGF-like growth factor in human serum. Association with high blood cholesterol and heart hypertrophy

Heparin-binding epidermal growth factor-like growth factor (HB-EGF) belongs to the EGF family of growth factors which are ligands of the ErbB receptors. Studies in animals suggest the role of HB-EGF in several pathogenic processes such as atherosclerosis and heart hypertrophy. Here, we set up an assay to measure HB-EGF in human serum. Our ELISA determined serum HB-EGF in the range of 0.03–3 nM. It did not cross-react with EGF or with transforming growth factor-α. The mean serum HB-EGF was 0.26 nM (confidence interval: 0.13–0.39) in women and 0.28 nM (confidence interval: 0.09–0.47) in men. In a cohort of 121 healthy volunteers, we identified nine individuals with high serum HB-EGF (above 0.47 nM). These individuals had higher left ventricle mass (determined by Colour Doppler echocardiography) and greater total and low density lipoprotein cholesterol than control. On the basis of our results, we propose that increased serum HB-EGF is associated with heart hypertrophy and elevated blood cholesterol.

Left ventricular diastolic function and carotid artery wall in elderly athletes and sedentary controls

Advancing age is characterized by structural and functional change of left ventricle (LV) and large elastic arteries. Recent advances in tissue Doppler imaging (TDI) and integrated backscatter (IBS), new ultrasound tools, have allowed non-invasive assessment of structural and functional characterization of myocardium and artery wall. Our aim was to compare LV diastolic function and carotid artery remodeling in elderly athletes and sedentary controls. Twenty-five elderly athletes (males, aged 68.6 ± 4.2 years) were compared to 25 age-sex-matched sedentary controls. All the subjects underwent either conventional Doppler echocardiography with pulsed TDI to evaluate LV diastolic function, and conventional ultrasonography and integrated backscatter (IBS) analysis to evaluate the carotid wall. Corrected IBS values (C-IBS) were obtained by subtracting the IBS value of the adventitia. Body mass index and blood pressure were not different in the two groups; athletes showed lower heart rate ( P < 0.0001) and, as expected, higher LV mass than sedentary subjects ( P < 0.0001). Transmitral Doppler analysis showed in trained subjects a significantly lower peak A and a higher E/ A ratio ( P < 0.001). On regards to TDI measurements, athletes exhibited a higher E m, a lower A m, and, subsequently, an increased E m/ A m ratio of both lateral wall and septum ( P < 0.0001). The IVRT m was shorter in trained subjects ( P < 0.001). Athletes showed a lower C-IBS (–26.8 ± 2.9 vs. –23.4 ± 3.8 dB, P < 0.001) and a smaller intima-media thickness (IMT: 0.66 ± 0.14 vs. 0.80 ± 0.18 mm, P < 0.001) respect to sedentary controls. Moreover, a significant direct correlation was found between E m/ A m of LV septal and lateral wall and C-IBS values (respectively, r = 0.62 and r = 0.56, P < 0.001). Thus the aging heart manifests structural and functional changes in response to physical activity. The expected pattern of cardiac and arterial alterations normally seen in response to age is modified in the older athletes, suggesting the exercise training is an effective stimulus in shaping arterial structure and left ventricular function in older heart. It would appear that pulsed TDI and IBS analysis may play an important role in detecting training-induced LV and carotid artery structural and functional modifications.

LV Mass Index Significantly Impacts on Patient and Renal Outcomes in Patients with Coronary Artery Bypass Grafting and Poor Left-Ventricular Function

Background. A recent report demonstrated that the presence of left ventricular hypertrophy was an independent predictor of mortality in patients with coronary artery bypass grafting (CABG) severely depressed left ventricular function. However, the impact of left ventricle (LV) mass index on the renal and patient outcomes in such patients with CABG has previously not been addressed. The present study thus considers this group of patient and uses LV mass index to assess renal and patient outcomes for these patients. Material and Method. All patients who arrived at the emergency room with severe cardiac dysfunction (EF<60%), triple vessel disease, and required CABG and LV hypertrophy (LVH) (LV mass index γ110 g/m2 in women, γ134 g/m2 in men) were admitted preoperatively to the intensive care unit (ICU) for supportive intervention from 01 1, 1998 to 01 1, 2001. Of all LVH patients, 44 underwent CABG, and were divided into two groups according to LV mass index. Results. Of all patients, 72.7% had severe echocardiographic LVH. The echocardiographic data of both dialysis and non-dialysis groups showed no difference with respect to echocardiographic findings. Histories of myocardial infarction were more frequent in the severe LVH group that in the mild LVH group. As for pre-operative systolic blood pressure and diastolic blood pressure, mean systolic and diastolic blood pressure values were significantly lower in the severe LVH group. Ejection fraction was also significantly lower in the severe LVH group than in the mild LVH group. The patients in the severe LVH group were significantly more likely to have received hemodialysis following CABG surgery (62.5% vs. 33.4%, p<0.05). Mortality was higher in the higher LV mass index group that in the lower LV mass index group (56.2% vs. 25%, p<0.05). Conclusion. Patients with a significantly higher LV mass index usually manifest lower pre-operative blood pressure and poor cardiac function. Consequently, these patients will have a poor renal outcome and higher mortality.

Left ventricular changes in isolated office hypertension: a blood pressure-matched comparison with normotension and sustained hypertension.

Isolated office (IO) hypertension is a benign condition according to some researchers, whereas others believe it is associated with cardiovascular abnormalities and increased cardiovascular risk. The aim of this study is to compare morphofunctional characteristics of the left ventricle (LV) in IO hypertensive subjects, normotensive subjects (hereafter, hypertensives and normotensives), and never-treated sustained hypertensives. The 3 groups were matched not only by age, sex, and body mass index but also by clinic blood pressure (BP) (IO hypertensives and sustained hypertensives) and daytime BP (IO hypertensives and normotensives). We enrolled 42 IO hypertensives (clinic BP > 140 and/or 90 mm Hg and daytime BP < or = 130/80 mm Hg), 42 sustained hypertensives (clinic BP > 140 and/or 90 mm Hg and daytime BP > or = 140 and/or 90 mm Hg) and 42 normotensives (clinic BP < 135 and/or 85 mm Hg and daytime BP < or = 130/80 mm Hg). Left ventricular morphologic features and function were assessed using digitized M-mode echocardiography. Compared with normotensives, IO hypertensives had significantly thicker LV walls, increased LV mass, reduced diastolic function, increased prevalence of LV hypertrophy, and preclinical diastolic dysfunction. Sustained hypertensives, compared with IO hypertensives, had significantly thicker LV wall, higher LV mass, and lower diastolic function, whereas the prevalence of LV hypertrophy and preclinical diastolic dysfunction was greater than in IO hypertensives, but the difference did not reach statistical significance (P = .29). Comparing matched BP groups, IO hypertensives have LV morphofunctional characteristics considerably different from normotensives and qualitatively similar to sustained hypertensives. Therefore, our results support the hypothesis that IO hypertension should not be considered as simply a benign condition.