Incidence Of Left Ventricular Hypertrophy Research Articles

Obesity and Risk of Incident Left Ventricular Hypertrophy in Community-Dwelling Populations With Hypertension: An Observational Study.

The aim of this study was to evaluate the association between obesity and risk of incident left ventricular hypertrophy (LVH) in community-dwelling populations with hypertension and investigate whether this association would be attenuated by a lower achieved systolic blood pressure (SBP). We used the EMINCA (Echocardiographic Measurements in Normal Chinese Adults) criteria, which were derived from healthy Chinese populations to define LVH. A total of 2069 participants with hypertension and without LVH (obesity 20.4%) were included. The association between obesity and risk of incident LVH was evaluated using Cox proportional hazard models and stratified by achieved follow-up SBP levels (≥140, 130-139, and <130 mm Hg). These analyses were also assessed using the American Society of Echocardiography/European Association of Cardiovascular Imaging criteria, which were derived from European populations to define LVH. After a median follow-up of 2.90 years, the rates of incident LVH in the normal-weight, overweight, and obese groups were 13.5%, 20.3%, and 27.8%, respectively (P<0.001). In reference to normal weight, obesity was associated with increased risk of incident LVH (adjusted hazard ratio [aHR], 2.51 [95% CI, 1.91-3.29]), which was attenuated when achieved SBP was <130 mm Hg (aHR, 1.78 [95% CI, 0.99-3.19]). This association remained significant when achieved SBP was ≥140 mm Hg (aHR, 3.45 [95% CI, 2.13-5.58]) or at 130 to 139 mm Hg (aHR, 2.32 [95% CI, 1.23-4.36]). Differences in these findings were noted when LVH was defined by the American Society of Echocardiography/European Association of Cardiovascular Imaging criteria. Obesity was associated with incident LVH and an SBP target <130 mm Hg might be needed to attenuate this risk in patients with hypertension and obesity.

Association between APOL 1 Risk Genotypes and Left Ventricular Hypertrophy among Sub-Saharan Africans in Trypanosoma Brucei Gambiense Endemic Rural Area

Purpose. The relationship between APOL1 variants and cardiovascular disease remains controversial, thus, this study assessed the association between APOL1 high-risk genotypes and left ventricular hypertrophy (LVH) among sub-Saharan African in T.b. gambiense endemic area. Methodology. We enrolled 238 subjects living in the region of Masimanimba, an endemic area of T.b.gambiense HAT. We evaluated the association between LVH on echocardiography and the status of APOL1 genes in participants with or without HAT. APOL1 high-risk genotype (HRG) was defined as the presence of two risk variants (G1/G1, G2/G2, or G1/G2), and a low-risk genotype (LRG) with the presence of 0 or 1 single variant. Student’s and Pearson's Chi2 tests or Fisher’s exact test were used to compare means and proportions. The Wilcoxon/Mann–Whitney test was used to compare medians. A multivariate logistic regression model was used to identify independent determinants of LVH. Odds ratios were provided with their 95% confidence intervals (Cis). Statistical significance was set at p &lt; 0.05, based on 2-tailed test. Findings. The prevalence of LVH (31.5%) increased with age and was similar in HAT-infected and non-infected subjects (29.8% vs. 32.6%; p=0.376). The trend of a greater left ventricular mass in participants with LVH carrying APOL1 HRG compared to those with LRG was not statistically significant (141g/m2 vs. 125 g/m2; p = 0.253). The frequency of HRG among participants with LVH was similar between HAT-infected and non-infected (15.8% vs. 9.1%; p = 0.806). Age ≥ 38 years [OR 2.5 (95% CI: 1.4-4.5), p = 0.001], hypertension [OR 2.4 (95% CI: 1.1-5.3), p = 0.034], WHR &gt; 0.5 [OR 2.0 (95% CI: 1.0-3.6), p = 0.018] and CKD [OR 1.7 (95% CI: 1.0-3.0), p = 0.049] were associated with LVH. In multivariable logistic regression analysis age ≥ 38 years was the only independent determinant of LVH [ORa 2.0 (95% CI: 1.1-3.8), p = 0.020]. Unique contribution to theory, practice and policy. An assessment of cardiovascular risk is essential for individuals with LVH carrying APOL1 HRG in order to benefit from early and appropriate medical intervention. Further larger prospective follow-up survey is required to assess the incidence of LVH in individuals with APOL1 HRG variants.

Maternal poor glycemic control increases risk of neonatal left ventricular hypertrophy.

Left ventricular hypertrophy (LVH) is an important complication of infants of diabetic mothers (IDMs). However, the defined factors, such as the influence of glycemic control, insulin administration of diabetic mothers and large for gestational age (LGA) in infants, are largely unknown on the incidence of LVH. Therefore, this study aimed to evaluate the prevalence of maternal and neonatal risk factors associated with LVH in IDMs. This prospective analytic study was conducted at tertiary care hospitals in a 1-year period. Inborn IDMs were enrolled, and ventricular hypertrophy was identified by 2D echocardiography in the first 72 hours after birth. A total of 160 IDMs met the inclusion criteria, 33 (20.6%) of which had LVH. The incidence of infants with LVH born to mothers with poor glycemic control (fasting blood sugar >95 mg/dL) was significantly elevated than those with good glycemic control (45.5% vs. 14.4%, P<0.001). Twelve IDMs (12/33, 36.5%) of LVH and 17 IDMs (17/127, 13.4%) of non-LVH were LGA. IDMs with LVH, compared those with non-LVH, had significantly increased left ventricular (LV) geometry; IVSd (6.5±0.8 vs. 4.0±0, 7 mm), LV IDd (16.8±3.3 mm vs. 18.4±1.1), left ventricular ejection fraction (LVEF) (68.3±8.5% vs. 62.9±17.5%), left ventricular fraction shortening (LVFS) (35.9±6.6% vs. 32.2±5.5%), LV mass (15.3±11.6 vs. 9.3±2.5 g) and LV mass index (66.2±17.5 vs. 46.6±9.7 g/m2), all with P<0.001. There was significant correlation in LV mass with infants' weight, height and body surface area (BSA) (r=0.408, 0.337 and 0.424, respectively; P<0.001). The prevalence of neonatal ventricular hypertrophy in IDMs was 20.6%. Maternal poor glycemic control and LGA status in IDMs were dominant risk factors of LVH.

The effect of intensive blood pressure lowering on left ventricular hypertrophy in patients with hypertension: a systematic review and meta-analysis of randomized controlled trials

Background We conducted a comprehensive systematic review to examine the efficacy of intensive blood pressure lowering on the risk of left ventricular hypertrophy (LVH). Methods We searched PubMed, Scopus, Web of Science, Cochrane Central, and EMBASE for all relevant randomized controlled trials. The primary outcome was the incidence of left ventricular hypertrophy. We used the risk ratio (RR) and hazard ratio (HR) with a 95% confidence interval as our effect sizes. Results Four studies, comprising 20,747 patients, were included. Intensive blood pressure lowering was linked with a diminished LVH incidence (RR: 0.66, 95% CI [0.56–0.77]). We also found that intensive blood pressure lowering increased the risk of LVH regression in patients with baseline LVH (RR: 1.21, 95% CI [1.11–1.32]). Finally, intensive blood pressure lowering was linked with a reduced risk of cardiovascular disease (HR: 0.71, 95% CI [0.60–0.85]). No significant heterogeneity was seen in either outcome. Conclusion Our study suggests that intensive blood pressure lowering effectively reduces the risk of LVH and cardiovascular disease. An interactive version of our analysis can be accessed here: https://databoard.shinyapps.io/lvh_hypertophy/

Assessment of Left Ventricular Hypertrophy Incidence and Antihypertensive Therapy Efficacy in Hypertensive Patients

Objectives: This study aimed to assess the incidence of left ventricular hypertrophy (LVH) in hypertensive individuals in Karachi, Pakistan, and to evaluate the effectiveness of antihypertensive therapy in preventing LVH. Methodology: A total of 200 hypertensive patients were referred from the Cardiac OPD to the Radiology department of Medicare Cardiac and General Hospital, Karachi, for echocardiography. Echocardiographic measurements of cardiac chambers were performed by expert echocardiographers, and left ventricular mass (LVM) was calculated using the formula recommended by the American Society of Echocardiography. Results: Among the hypertensive patients, 100 had uncontrolled blood pressure (≥140/90 mmHg) while 100 had controlled blood pressure (≤130/80 mmHg). The female-to-male ratio was 3:1, with ages ranging from 21 to 80 years. Patients with uncontrolled hypertension exhibited a higher mean body mass index (29 ± 5 kg/m2) and significantly elevated LVM (mean 154 ± 4 g/m2). Angiotensin receptor inhibitors were the most commonly prescribed and effective antihypertensive agents, either as monotherapy or in combination therapy (60%), demonstrating utility in preventing LVH. Conclusion: This study highlights a high incidence of LVH in uncontrolled hypertensive individuals compared to those with controlled hypertension. Transthoracic echocardiography emerged as a highly valuable, non-invasive tool for measuring LVM and assessing the effectiveness of antihypertensive therapy.

The correlation between serum fibroblast growth factor-23 levels and left ventricular hypertrophy in chronic kidney disease patients

Introduction: Hyperphosphatemia in chronic kidney disease (CKD) patients can stimulate the production of the fibroblast growth factor-23 (FGF-23) phosphatonin hormone, which is associated with cardiac remodeling resulting in left ventricular hypertrophy (LVH). Objectives: To determine the correlation between FGF-23 level and LVH incidence in CKD patients and establish the associated risk factors. Materials and Methods: This cross-sectional study involved 74 CKD patients who were classified as stage 3 (n=18), stage 4 (n=17), stage 3 (n=18), dialysis stage 5 (n=20), or non-dialysis stage 5 (n=19). The FGF-23 levels of the patients were measured using the ELISA (enzyme-linked immunosorbent assay) kit method, whereas a cardiologist verified LVH using an echocardiographic examination based on the LVH criteria of &gt;95 g/m2 for females and &gt;115 g/m2 for males. Results: A significant difference was observed in the mean FGF-23 values between the LVH and non-LVH patients (443.27±437.047 RU/mL and 172.68±185.56 RU/mL, respectively; P&lt;0.05). The receiver operating characteristics revealed that patients with FGF-23 levels &gt;123.95 RU/mL had a 3.6 times greater risk of LVH compared to those with values ≤123.95 RU/mL. The LVH risk factors of gender and age, as well as hypertension, diabetes mellitus, and obesity diagnoses were not associated with LVH incidence in CKD patients. Conclusion: A significant association was found between FGF-23 level and LVH incidence in CKD patients, in which an FGF-23 level &gt;123.95 RU/mL corresponded to a 3.6 times greater risk of LVH than those with FGF-23 levels below this value.

Analysis of etiology and complications in children with stage 5 chronic kidney disease

Objective: To investigate the etiology, complications, and prognostic factors of stage 5 chronic kidney disease (CKD5) in children. Methods: A case series study was conducted to retrospectively analyze the general situation, clinical manifestations, laboratory tests, genetic testing, and follow-up data (until October 2022) of 174 children with CKD5 who were diagnosed and hospitalized at the Children's Hospital of Chongqing Medical University from April 2012 to April 2021. The characteristics of complications in the children were compared based on age, gender, and etiology. Based on the presence or absence of left ventricular hypertrophy (LVH), patients were divided into LVH group and non LVH group for analyzing the influencing factors of cardiovascular disease. Patients were also divided into death group and survival group, peritoneal dialysis group and hemodialysis group based on the follow-up data for analyzing the prognostic factors. The chi-square test, independent sample t-test, Fisher exact probability test, Mann-Whitney U test and Kruskal Wallis test were used to analyze data among different groups. Multivariate Logistic regression analysis was used to identify the prognostic factors. Results: A total of 174 children with CKD5 were enrolled in the study (96 boys and 78 girls), aged 11.2 (8.2, 13.0) years. Congenital kidney and urinary tract malformations (CAKUT) were the most common causes of the CKD5 (84 cases, 48.3%), followed by glomerular diseases (83 cases, 47.7%), and among which 28 cases (16.1%) were hereditary glomerular diseases. The common complications of CKD5 included anemia (98.2%, 165/168), mineral and bone disorder in chronic kidney disease (CKD-MBD) (97.7%, 170/174), lipid metabolism disorders (87.5%, 63/72), hypertension (81.4%, 127/156) and LVH (57.6%,57/99). The incidences of hypertension in primary glomerular disease were higher than that in CAKUT(93.8%(30/32) vs.73.7%(56/76),χ2=5.59,P<0.05). The incidences of hypertension in secondary glomerular disease were higher than that in CAKUT and that in hereditary kidney disease (100.0%(20/20) vs. 73.7%(56/76), 68.2%(15/22), both P<0.05). The incidence of hypocalcemia in CAKUT, primary glomerular disease, and hereditary kidney disease was higher than that in secondary glomerular disease (82.1%(69/84), 88.2%(30/34), 89.3%(25/28) vs. 47.6%(10/21), χ2=10.21, 10.75, 10.80, all P=0.001); the incidence of secondary hyperparathyroidism in women was higher than that in men (80.0%(64/80) vs. 95.0%(57/60), χ2=6.58, P=0.010). The incidence of LVH in children aged 6-<12 was higher than that in children aged 12-18 (73.5%(25/34) vs. 43.1%(22/51), χ2=7.62, P=0.006). Among 113 follow-up children, the mortality rate was 39.8% (45/113). Compared to the survival group, the children in the death group had lower hemoglobin, higher blood pressure, lower albumin, lower alkaline phosphatase and higher left ventricular mass index ((67±19) vs. (75±20) g/L, 142 (126, 154) vs. 128(113, 145) mmHg(1 mmHg=0.133 kPa), (91±21) vs. (82±22) mmHg, 32 (26, 41) vs. 40 (31, 43) g/L, 151 (82, 214) vs. 215 (129, 37) U/L, 48 (38, 66) vs. 38(32, 50) g/m2.7,t=2.03, Z=2.89, t=2.70, Z=2.49, 2.79, 2.29,all P<0.05), but no independent risk factors were identified (all P>0.05). The peritoneal dialysis group had better alleviation for anemia, low calcium, and high phosphorus than the hemodialysis group ((87±22) vs. (72±16) g/L, (1.9±0.5) vs. (1.7±0.4) mmol/L, (2.2±0.7) vs. (2.8±0.9) mmol/L, t=2.92, 2.29, 2.82, all P<0.05), and the survival rate of the peritoneal dialysis group was significantly higher than that of the hemodialysis group (77.8% (28/36) vs. 48.4% (30/62), χ2=8.14, P=0.004). Conclusions: CAKUT is the most common etiology in children with CKD 5, and anemia is the most common complication. The incidence of complications in children with CKD 5 varies with age, gender and etiology. Anemia, hypertension, hypoalbuminemia, reduced alkaline phosphatase and elevated LVMI may be the prognostic factors in children with CKD5. Peritoneal dialysis may be more beneficial for improving the long-term survival rate.

Abstract 18294: The Effect of Intensive Blood Pressure Lowering on Left Ventricular Hypertrophy in Patients With Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Introduction: The effect of intensive blood pressure (BP) lowering on cardiac remodeling remains uncertain, with emerging evidence suggesting that it can prevent the development of left ventricular hypertrophy (LVH) in patients with hypertension (HTN). We aim to investigate the effect of intensive BP lowering on LVH and cardiovascular disease (CVD) incidence in HTN patients. Methods: A systematic review and meta-analysis synthesizing randomized controlled trials (RCTs), which were retrieved by systematically searching: PubMed, Web of Science, SCOPUS, and Cochrane through June 8 th , 2023. We used the random-effect model to pool dichotomous data using risk ratio (RR) and hazard ratio (HR), with a 95% confidence interval (CI). Trial sequential analysis (TSA) was performed to weigh type I and II errors, estimating if the effect is large enough to be unaffected by further studies. Results: We included four RCTs with a total of 20,747 patients. Two RCTs investigated an intensive target of &lt; 120 mmHg, and another two investigated &lt;130 mmHg. Intensive BP lowering was associated with a decreased risk of LVH incidence (RR: 0.66, with 95% CI [0.56 - 0.77]). Our TSA revealed that the cumulative Z-curve consistently crossed the TSA boundary, indicating a statistically significant effect, signifying that the available evidence has reached a predefined threshold for statistical significance, providing robust evidence. Also, intensive BP lowering was associated with a decreased risk of CVD (HR: 0.71, with 95% CI [0.60 - 0.85]). Conclusion: Intensive BP lowering protects against LVH in HTN patients. TSA suggests that additional RCTs may not be necessary to establish the efficacy of intensive BP lowering on LVH. Also, intensive BP lowering was associated with decreased CVD incidence; however, LVH did not explain this effect in the included RCTs. Therefore, further research is warranted to explore possible mechanisms of decreasing CVD with intensive BP lowering in HTN patients.

Hypersensitive C-reactive protein as a potential indicator for predicting left ventricular hypertrophy in elderly community-dwelling patients with hypertension

BackgroundThe aim of this study was to investigate the relationship between Hypersensitive C-reactive protein (hs-CRP) and left ventricular hypertrophy (LVH) in elderly community-dwelling patients with hypertension.MethodsA cross-sectional study was conducted, involving the recruitment of 365 elderly hypertensive residents ≥ 65 years of age from five communities. The participants were divided into two groups: an LVH group (n = 134) and a non-LVH group (n = 231), based on the left ventricular mass index (LVMI) determined by echocardiography. Spearman correlation analysis was used to assess the relationship between hs-CRP and LVH. Univariate and Multivariate analysis was performed to detect variables associated with LVH. The diagnostic value of hs-CRP for LVH was expressed as the area under the receiver operating characteristic (ROC) curve.ResultsThe incidence of LVH in elderly hypertension patients in the community was 36.7%. The hs-CRP levels were significantly higher in subjects with LVH compared to those without LVH (1.9 [0.8, 2.9] vs. 0.7 [0.4, 1.4], P = 0.002). Spearman correlation analysis demonstrated a positive correlation between hs-CRP and LVMI (r = 0.246, P < 0.001), as well as with IVST (r = 0.225, P < 0.001) and LVPWT (r = 0.172, P = 0.001). Among elderly hypertensive residents in the community, the cut-off value of hs-CRP for diagnosing LVH was 1.25 mg/L (sensitivity: 57.5%; specificity: 78.4%), and the area under the ROC curve for hs-CRP to predict LVH was 0.710 (95%CI: 0.654–0.766; P < 0.001). In the final model, hs-CRP ≥ 1.25 mg/L (OR = 3.569; 95%CI, 2.153–5.916; P<0.001) emerged as an independent risk factor for LVH. This association remained significant even after adjusting for various confounding factors (adjusted OR = 3.964; 95%CI, 2.323–6.765; P < 0.001).ConclusionsThis community-based cohort of elderly hypertensive individuals demonstrates a strong association between hs-CRP levels and the presence of LVH. The hs-CRP ≥ 1.25 mg/L may serve as an independent predictor for LVH in hypertensive subjects and exhibit good diagnostic efficacy for LVH.

Evidence of increased vascular stiffness and left ventricular hypertrophy in children with cystic kidney disease.

Cardiovascular disease (CVD) is the most common cause of mortality in chronic kidney disease (CKD). Children with early-onset CKD arguably experience the greatest lifetime CVD burden. We utilized data from the Chronic Kidney Disease in Children Cohort Study (CKiD) to evaluate two pediatric CKD cohorts: congenital anomalies of the kidney and urinary tract (CAKUT) and cystic kidney disease for CVD risks and outcomes. CVD risk factors and outcomes including blood pressures, left ventricular hypertrophy (LVH), left ventricular mass index (LVMI), and ambulatory arterial stiffness index (AASI) scores were evaluated. Forty-one patients in the cystic kidney disease group were compared to 294 patients in the CAKUT group. Cystic kidney disease patients had higher cystatin-C levels, despite similar iGFR. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) indexes were higher in the CAKUT group, but a significantly higher proportion of cystic kidney disease patients was on anti-hypertensive medications. Cystic kidney disease patients had increased AASI scores and a higher incidence of LVH. This study provides a nuanced analysis of CVD risk factors and outcomes including AASI and LVH in two pediatric CKD cohorts. Cystic kidney disease patients had increased AASI scores, higher incidence of LVH, and higher rates of anti-hypertensive medication use which could imply a greater burden of CVD despite similar GFR. Our work suggests that additional mechanisms may contribute to vascular dysfunction in cystic kidney disease, and that these patients may need additional interventions to prevent the development of CVD. A higher resolution version of the Graphical abstract is available as Supplementary information.

Heart failure with preserved ejection fraction phenogroup classification using machine learning.

Heart failure (HF) with preserved ejection fraction (HFpEF) is a complex syndrome with a poor prognosis. Phenotyping is required to identify subtype-dependent treatment strategies. Phenotypes of Japanese HFpEF patients are not fully elucidated, whose obesity is much less than Western patients. This study aimed to reveal model-based phenomapping using unsupervised machine learning (ML) for HFpEF in Japanese patients. We studied 365 patients with HFpEF (left ventricular ejection fraction >50%) as a derivation cohort from the Nara Registry and Analyses for Heart Failure (NARA-HF), which registered patients with hospitalization by acute decompensated HF. We used unsupervised ML with a variational Bayesian-Gaussian mixture model (VBGMM) with common clinical variables. We also performed hierarchical clustering on the derivation cohort. We adopted 230 patients in the Japanese Heart Failure Syndrome with Preserved Ejection Fraction Registry as the validation cohort for VBGMM. The primary endpoint was defined as all-cause death and HF readmission within 5years. Supervised ML was performed on the composite cohort of derivation and validation. The optimal number of clusters was three because of the probable distribution of VBGMM and the minimum Bayesian information criterion, and we stratified HFpEF into three phenogroups. Phenogroup 1 (n=125) was older (mean age 78.9±9.1years) and predominantly male (57.6%), with the worst kidney function (mean estimated glomerular filtration rate 28.5±9.7mL/min/1.73m2 ) and a high incidence of atherosclerotic factor. Phenogroup 2 (n=200) had older individuals (mean age 78.8±9.7years), the lowest body mass index (BMI; 22.78±3.94), and the highest incidence of women (57.5%) and atrial fibrillation (56.5%). Phenogroup 3 (n=40) was the youngest (mean age 63.5±11.2) and predominantly male (63.5±11.2), with the highest BMI (27.46±5.85) and a high incidence of left ventricular hypertrophy. We characterized these three phenogroups as atherosclerosis and chronic kidney disease, atrial fibrillation, and younger and left ventricular hypertrophy groups, respectively. At the primary endpoint, Phenogroup 1 demonstrated the worst prognosis (Phenogroups 1-3: 72.0% vs. 58.5% vs. 45%, P=0.0036). We also successfully classified a derivation cohort into three similar phenogroups using VBGMM. Hierarchical and supervised clustering successfully showed the reproducibility of the three phenogroups. ML could successfully stratify Japanese HFpEF patients into three phenogroups (atherosclerosis and chronic kidney disease, atrial fibrillation, and younger and left ventricular hypertrophy groups).

The role of ultrasonic cardiogram in the diagnosis of hypertension complicated with type 2 diabetes mellitus

ABSTRACT Hypertension diabetes mellitus is one of the serious complications of hypertension. In this study, ambulatory blood pressure monitoring (ABPM) and ultrasonic cardiogram (UCG) were used to investigate the cardiac changes and its influencing factors in hypertensive patients with type 2 diabetes mellitus. The ABPM, UCG, Hemoglobin A1c (HbA1c) and body mass index (BMI) of patients were examined. The comparison of HbA1c, BMI, gender, age, daytime and nighttime blood pressure, left ventricular mass index (LVMI), left ventricular hypertrophy (LVH), isovolumic relaxation time (IVRT) and E/A ratio were made between the two groups. The cardiac function of control group was better than that of group B, while that of group B was better than group A. The cardiac index level in group B was better than that in group A, but lower than that in control group. The LVMI in group A was clearly higher than group B and control group, and the incidence of LVH increased. In group A, the nocturnal systolic blood pressure was higher than control group and group B. Nocturnal diastolic blood pressure, daytime diastolic blood pressure and systolic blood pressure in groups A and B were higher than those the control group. The findings indicated that hypertension complicated with type 2 diabetes mellitus can cause degeneration of the heart, and complicated with type 2 diabetes mellitus can accelerate ventricular remodeling and functional deterioration. Hypertension with type 2 diabetes mellitus are more prone to left ventricular damage.

Effects of arteriovenous fistulas and central venous catheters on the cardiac function and prognosis of patients on maintenance hemodialysis.

To investigate the effects of arteriovenous fistulas (AVFs) and central venous catheters (CVCs) on the left ventricular function (LVF) and prognosis of maintenance hemodialysis (MHD) patients. This retrospective cohort study included 270 patients (139 with AVF and 131 with CVC) undergoing dialysis with newly established vascular access in the blood purification center of Nanhua hospital, University of South China, from January 2019 to April 2021. Dialysis efficiencies, LVF indexes, and one-year prognoses were compared. At six and twelve months after the establishment of vascular access, the mean urea clearances (Kt/V) and urea reduction ratio (URR) between the AVF- and the CVC-group were similar (P>0.05). The mean LVF values between the two groups were also similar before the establishment of vascular access (P>0.05), but the mean values of left ventricular end diastolic diameter (LVEDd), interventricular septal thickness (IVSTd), and left ventricular posterior wall thickness (LVPWT) in the AVF-group were higher than those in the CVC-group one year later, and mean early (E) and late (A) diastolic mitral velocities, E/A, and ejection fraction (EF) were lower than those in the CVC-group (P<0.05). The incidence of left ventricular hypertrophy and systolic dysfunction in the AVF-group was higher than that in the CVC-group (P<0.05). The hospitalization rate of AVF-group (23.02%) was lower than that of the CVC-group (49.61%) (P<0.05). Both AVF and CVC can achieve appropriate dialysis effects in MHD patients. AVF has a negative impact on cardiac function while CVC has a high hospitalization rate.

Relationship Between Left Ventricular Hypertrophy and Diabetes Is Likely Bidirectional: A Temporality Analysis.

Background The temporal relationship between type 2 diabetes (T2DM) and left ventricular hypertrophy (LVH) is not well established. This study aims to examine the temporal sequence between T2DM and LVH/cardiac geometry patterns in middle-aged adults. Methods and Results The longitudinal cohort consisted of 1000 adults (682 White individuals and 318 Black individuals; 41.1% men; mean age, 36.2 years at baseline) who had data on fasting glucose/T2DM, left ventricular mass index (LVMI), and relative wall thickness collected twice at baseline and follow-up over 9.4 years on average. The cross-lagged path analysis model in 905 adults who did not take antidiabetic medications and the longitudinal prediction model in 1000 adults were used to examine the temporal relationships of glucose/T2DM with LVMI, LVH, relative wall thickness, and remodeling patterns. After adjustment for age, race, sex, smoking, alcohol drinking, body mass index, heart rate, hypertension, and follow-up years, the path coefficient from baseline LVMI to follow-up glucose was 0.088 (P=0.005); the path from baseline glucose to follow-up LVMI was -0.009 (P=0.758). The 2 paths between glucose and relative wall thickness were not significant. The path analysis parameters did not differ significantly between race, sex, and follow-up duration subgroups. Incidence of T2DM was higher in the baseline LVH group than in the normal LVMI group (24.8% versus 8.8%; P=0.017 for difference). Incidence of LVH and concentric LVH was higher in the baseline T2DM group than in the group without T2DM (50.0% versus 18.2% for LVH [P=0.005 for difference]; 41.7% versus 12.6% for concentric LVH [P=0.004 for difference]), with adjustment for covariates. Conclusions This study suggests that the temporal relationship between T2DM and LVH is likely bidirectional. The path from LVMI/LVH to glucose/T2DM is stronger than the path from glucose/T2DM to LVMI/LVH.

Abstract P475: Left Ventricular Hypertrophy Prevalence by Electrocardiogram in Patients Presenting With Cerebrovascular Accident

Background: A strong association has been previously suggested between left ventricular hypertrophy (LVH) and stroke. The prevalence of LVH and hypertension, however, differs depending on demographic variables. In light of the most recent hypertension guidelines, more aggressive blood pressure control is called for to achieve the lower goals set forth. This will hopefully translate into lower incidence of LVH and stroke. Objectives: To examine the prevalence of left ventricular hypertrophy in patients receiving an electrocardiogram (EKG) for a diagnosis of stroke, transient ischemic attack, or cerebrovascular accident; all of which will be referred to as CVA. Methods: An EKG database from a university cardiology noninvasive lab was examined for the diagnosis of CVA over a one year period. The EKGs were evaluated for the presence of LVH or atrial fibrillation/flutter. The results were analyzed using Chi square test. Results: There was a total of 14,798 EKGs performed over one year. There were 272 EKGs with a diagnosis of CVA (1.7%); 2364 EKGs (16%) with diagnosis of LVH, and 481 (3.2%) with diagnosis of atrial fibrillation/flutter. Out of the 272 EKGs in patients with CVA diagnosis, there were 174 EKGs in sinus rhythm without LVH (64%), 78 EKGs in sinus rhythm with LVH (29%, P &lt; 0.05), and 20 EKGs in atrial fibrillation or atrial flutter (7.4%, P &lt; 0.05). Discussion: Stroke is a major health problem associated with increased mortality and morbidity. While atrial fibrillation and atrial flutter are well-established causes of stroke and were nearly twice as frequent in CVA patients as the general population in our cohort, LVH by EKG, in the absence of atrial fibrillation/flutter, was also nearly twice as prevalent, underscoring its importance as a potential marker for CVA. Hypertension is a well established risk factor for stroke in addition to cardiovascular events, and is a major cause of LVH on EKG. In our cohort nearly one third of patients with stroke were in sinus rhythm, but had left ventricular hypertrophy by EKG, a prevalence that was nearly four times that of atrial fibrillation/flutter. Since hypertension is the most common cause of left ventricular hypertrophy in our population, this places further significance on hypertension as a major modifiable risk factor and predictor of CVA and cardiovascular disease in general. In light of the most recent hypertension guidelines, aggressive blood pressure management to achieve the newly defined lower limits for a diagnosis of hypertension, with monitoring for signs of left ventricular hypertrophy by EKG, should be emphasized in order to decrease the incidence of stroke and other cardiovascular events.

S-29-4: ASSOCIATION BETWEEN OBESE STATUS AND INCIDENT LEFT VENTRICULAR HYPERTROPHY DIFFERED BY ACHIEVED SYSTOLIC BLOOD PRESSURE LEVEL

Background: Obesity frequently coexists with hypertension, and both confer additive effects on left ventricular hypertrophy (LVH) development. Little is known whether a more intensive blood pressure (BP) control is needed to mitigate this risk. The primary aim of this study was to evaluate the association between obese status and incident LVH according to achieved systolic BP (SBP) level at follow-up in community hypertensive populations. Methods: Hypertensive patients without LVH at baseline (n = 1842; obesity was 19.7%) were included. The China and American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) criteria were used to define LVH. The association between obese status and incident LVH according to achieved SBP level at follow-up (equal to or greater than 140, 130–139 and less than 130 mm Hg) was evaluated using Cox regression model. Results: After a median follow-up of 2.90 years, the incidence of LVH in the normal weight, overweight and obese groups were 17.0%, 25.0% and 31.1% (P &lt; 0.001). Obesity was associated with incident LVH, with adjusted hazard ratio (HR) of 3.64 (95% CI 2.39–5.55). When achieved SBP equal to or greater than 140 mm Hg and at 130–139 mm Hg, this association remained significant; when achieved SBP less than130 mm Hg, this association was attenuated (adjusted HR 1.51 and 95% CI 0.89–2.56). When applying the ASE/EVCAI criteria, the results were consistent except for the differences in classification of LV geometry. Conclusion: A lower achieved SBP level may be needed to mitigate the additive effects of obesity and hypertension on LVH development. Randomized clinical trials are needed to corroborate these findings.

Possibilities of achieving target levels of arterial pressure and atherogenic lipids in patients with arterial hypertension with obesity at the outpatient stage (results of a 12-week follow-up)

The aim: To study the possibility of achieving target levels of blood pressure (BP) and atherogenic lipids’ levels in patients with arterial hypertension with abdominal obesity (AO) using combined antihypertensive and lipid‑lowering therapy against the background of recommendations for lifestyle correction at the outpatient stage.&#x0D; Materials and methods. The study involved 54 patients with AH of 2 and 3 degrees with AO of I — II degrees, who were examined in the polyclinic of the GI «L. T. Malaya Therapy National Institute of the NAMS of Ukraine». The investigated group included 30 (56 %) men and 24 (44 %) women, aged 47 to 59 years (the mean age — (50.6 ± 5.2) years). All patients underwent general clinical laboratory and instrumental examinations. After the initial examination, all patients were prescribed a three‑component fixed combination (FC) of antihypertensive drugs: an angiotensin‑converting enzyme inhibitor (ACE inhibitor) perindopril, a thiazide‑like diuretic (TPD) indapamide and a long‑acting dihydropyridine calcium channel blocker (CCB) amlodipine in optimal daily doses, considering blood pressure levels. Atorvastatin was administered as a lipid‑lowering drug in a daily dose, defined depending on the initial blood levels of low‑density lipoprotein cholesterol (LDL cholesterol). Achievement of the target levels of blood pressure and LDL‑cholesterol was assessed after 6 and 12 weeks of the study. Doses of antihypertensive drugs and atorvastatin were adjusted during the study.&#x0D; Results. It has been established that 6 weeks of treatment of AH patients with AO in outpatient settings with the use of three‑component fixed combination of antihypertensive drugs (ACE inhibitors, TPD and CCBs of the dihydropyridine series) and statins’ lipid‑lowering therapy against the background of recommendations for lifestyle correction, resulted in the achievement of the target “office” BP levels of in only 57 % of patients and target levels of LDL‑cholesterol in only 32 %. Insufficient efficacy of antihypertensive therapy in the examined patients was associated with a greater severity of obesity, increased heart rate (HR) and a higher incidence of left ventricular hypertrophy (LVH), while the low efficacy of statin therapy was primarily associated with the low therapy compliance. The addition of nebivolol, cardioselective beta‑adrenoblocker (BAB) with a vasodilatory effect, to the fixed combination of ACE inhibitors, TPD and BCC significantly increased the effectiveness of antihypertensive therapy. At the same time, intensification of statin therapy did not result in the significant increase of the frequency of achieving target levels of LDL cholesterol in the blood.&#x0D; Conclusions. The standard three‑component fixed combination of antihypertensive drugs in combination with medium‑dose statin therapy and recommendations for the normalization of lifestyle was not enough effective in a significant part of AH patients with AO at the outpatient stage, which indicates the need for timely correction of drug therapy and implementation of healthy lifestyle.&#x0D;

Anemia and Left Ventricular Hypertrophy in Chronic Renal Failure

Summary Chronic renal failure (CRF) syndrome significantly alters patients’ quality of life. Anaemia, hypertension, and cardiovascular diseases are common complications of CRF. The study aimed to determine the incidence of arterial hypertension (AH), anaemia, and left ventricular hypertrophy (LVH) in patients with CRF and to analyze the relationship between them. The study included 212 patients with CRF, treated at the Clinic of Nephrology and Dialysis at the University Hospital “Dr. G. Stranski,” Pleven, during 2008-2020. The AH accounted for 88.2% of the patients with CRF. The incidence of AH is comparable to that in patients in the predialysis period – 88.6% and among patients on dialysis – 87.9%. LVH was diagnosed in 94.3% of patients with CRF. The incidence of LVH in the predialysis period was 94.3%, and among dialysis patients -94.4%. The incidence of LVH among hypertensive and normotensive patients was comparable. The incidence of anaemia among patients with CRF was 86.3%. Anaemia was present in 94.4% of the patients on dialysis and in 78.1% of the patients in the predialysis period. The difference was significant (p &lt;0.05). There was no correlation between anaemia and AH, nor between AH and LVH. A significant dependence of LVH on the duration of chronic renal failure and dialysis treatment was established.

Abstract 10188: Does Myocardial Contraction Fraction Predict Mortality in the Oldest Old

Background: People over the age of 85 are the world's most rapidly growing age group and have a high incidence of cardiovascular mortality. Ejection fraction (EF), the most commonly used index of systolic function, may be limited prognostically in this population given the high incidence of left ventricular hypertrophy and myocardial contraction fraction (MCF) may be more accurate. The objective of this longitudinal study was to assess the prognosis of MCF in an age-homogenous, community-dwelling population of subjects. Methods: Subjects were recruited from the Jerusalem Longitudinal Cohort Study. Echocardiography was performed with a portable echocardiograph at the subjects place of residence. Standard echocardiographic assessment of cardiac structure and function including MCF was performed. 5-year mortality was assessed via a centralized government database. Results: 418 subjects (197 males, 218 females) were enrolled in the study of whom 113 (27%) died at the time of 5-year follow-up. Subjects who died had significantly lower MCF (32 ± 14% vs. 36 ± 12%; p &lt; 0.004) and EF (51.6 ± 11.6% vs 56.3 ± 9.4%; p&lt; 0.0001) than survivors. On Kaplan-Meier analysis MCF was more significantly associated with mortality than EF (p&lt; 0.0005 vs p &lt; 0.04). The association between MCF and mortality remained significant on multivariate analysis as both a categorical and continuous variable while EF was only significant as a continous variable. Conclusions: MCF assessed by home echocardiography provides additional prognostic information to EF and may be a superior predictor of 5-year mortality in a community-dwelling population of the oldest old.

SEX DIFFERENCES IN THE ASSOCIATION BETWEEN FAT MASS AND ORGAN DAMAGE IN COMMUNITY-DWELLING ELDERLY CHINESE: THE NORTHERN SHANGHAI STUDY

Objective: Body fat mass (FM) is associated with multiple organ damage. However, the available data on the relationship between FM and different organ damage is inconsistent and differs according to gender. The present study aims to evaluate the relationship between FM and organ damage in elderly men and women in the Chinese community. Design and method: After excluding missing data, data from 3331 participants were included in this analysis. Based on age, height, weight, waist circumference, race, predicted FM was calculated. Organ damage includes arterial stiffness (AS), lower extremity atherosclerosis (LEA), left ventricular hypertrophy (LVH), micro-albuminuria, and chronic kidney disease (CKD). Results: Of the 3331 participants, 1881 (56.4%) were female. After adjusted for multiple risk factors, among women, participants with higher quantiles of FM had a significantly increased odds ratio (OR) for AS (OR = 1.63, 95% CI: 1.18–2.27, p for trend = 0.011), LEA (OR = 2.867, 95% CI: 1.73–4.74, p for trend &lt; 0.001), LVH (OR = 1.91, 95% CI: 1.40–2.60, p for trend &lt; 0.001), CKD (OR = 1.83, 95% CI: 1.12–3.00, p for trend = 0.008), but not for micro-albuminuria. In men, higher FM was only associated with an increased incidence of LVH (OR = 2.12, 95% CI: 1.34–3.36, p for trend &lt; 0.001). Conclusions: Elevated FM is associated with more organ damage in elderly women in the Chinese community. Therefore, in order to alleviate the occurrence of organ damage, elderly women should pay more attention to the management of body fat.