Increase In Left Ventricular Mass Index Research Articles

Prevalence of diastolic dysfunction in normotensive, asymptomatic patients with well-controlled type 2 diabetes mellitus

To evaluate the prevalence of left ventricular (LV) diastolic dysfunction in patients with type 2 diabetes mellitus free of cardiovascular disease, we studied 86 normotensive men and women (mean age 46 ± 6 years) with Doppler echocardiography. All subjects were asymptomatic for ischemic heart disease or heart failure. The traditional transmitral filling patterns were used to characterize diastolic physiology. The Valsalva maneuver was used to differentiate normal from pseudonormal LV filling pattern. All patients had a normal electrocardiogram at rest and a negative result on exercise echocardiography for inducible wall motion abnormalities. Global LV systolic function was normal (mean LV ejection fraction 58%, range 53% to 76%). Diastolic dysfunction was found in 41 subjects (47%) of which 26 (30%) had impaired relaxation and 15 (17%) had a pseudonormal filling pattern. The mean LV mass index was 101 g/m 2 (range 86 to 122). All patients with a normal-filling physiology had gender-adjusted normal LV mass index (mean 93 ± 11 g/m 2), whereas 62% of those with either abnormal relaxation (mean 103 ± 12 g/m 2, p <0.001) or a pseudonormal pattern (mean 110 ± 12 g/m 2, p <0.001) had increased LV mass index. No subject in this cohort had restrictive diastolic physiology. In conclusion, diastolic dysfunction in type 2 diabetes mellitus patients is often found despite adequate metabolic control and freedom from clinically detectable heart disease. The Valsalva maneuver can unmask an additional 17% of patients with subclinical abnormal LV filling pattern, who otherwise would be classified as having a normal diastolic physiology. Increased LV mass index is closely associated with abnormal LV filling characteristics.

Spot urinary albumin–creatinine ratio predicts left ventricular hypertrophy in young hypertensive African-American men

Hypertensive patients with target organ damage are at increased cardiovascular risk, and should be treated most aggressively. The association between urinary albumin excretion and left ventricular hypertrophy (LVH) in prior studies is inconsistent, and has not been described using a single, random spot urine specimen. Therefore, we evaluated the association between the urinary albumin creatinine ratio (ACR) and left ventricular (LV) mass and also tested the hypothesis that a simple random, single-void urine ACR would identify high risk young, hypertensive, African-American men. We measured echocardiographic LV mass and a random spot urinary ACR in 109 untreated, hypertensive, young, inner city, African-American men. The mean age was 41 ± 6 years and the mean blood pressure (BP) was 157 ± 19/107 ± 13 mm Hg. Microalbuminuria (ACR 30 to 300 mg/g) was present in 22% of subjects. The ACR is higher in the men with LVH than in the men without LVH ( P < .05). Increased ACR is a predictor of increased LV mass index ( P < .003) using multiple linear regression. An ACR >30 mg/g has a sensitivity of 33% and a specificity of 82% for the diagnosis of echocardiographic LVH. In conclusion, elevated random spot ACR is a marker of increased LV mass, independent of BP, in young urban African-American men with hypertension, and may help to determine the aggressiveness of antihypertensive therapy in this high-risk group.

Pulsed Doppler tissue imaging in endurance athletes: relation between left ventricular preload and myocardial regional diastolic function

The aim of this study was to assess the effects of endurance training on myocardial regional systolic and diastolic function by pulsed Doppler tissue imaging (DTI). Twenty male water polo players and 20 male control subjects underwent standard Doppler echocardiography and pulsed DTI, performed in apical views by placing a sample volume on left ventricular (LV) basal septal and inferior walls. Age, body surface area, and blood pressure were comparable between the 2 groups, with lower heart rate in athletes (p <0.001). They had significantly increased LV mass index (due to both higher wall thickness and end-diastolic diameter), greater endocardial fractional shortening, higher transmitral early/atrial (E/A) peak velocities ratio. In athletes, DTI analysis showed significantly prolonged myocardial deceleration time and greater myocardial E/A peak velocity ratio of septal and inferior walls, whereas myocardial early peak velocity was increased (p <0.01) only at the inferior wall. In the overall group, we found univariate relations of septal and inferior E/A peak velocity ratio and myocardial deceleration time with LV mass levels, and, in particular, with the sum of wall thickness. By separate multivariate analyses, however, these relations disappeared, being dependent on heart rate degree. Another association found between LV end-diastolic diameter and myocardial early diastolic wave peak velocity of the inferior wall (r = 0.68, p <0.0001) remained significant (standardized β coefficient 0.60, p <0.00001), even after adjusting for heart rate, body surface area, age, and stroke volume (R 2 = 0.71, p <0.00001). In conclusion, DTI is a useful tool for detecting regional changes in myocardial function induced by training, because athletes present with an improvement in diastolic passive properties of myocardium. The higher early diastolic velocity of the inferior wall and its relation to increased preload may represent an indicator of aerobic training, allowing quantification of the degree of LV adaptation to endurance exercise.

Left ventricular mass index increase in early renal disease: impact of decline in hemoglobin.

Cardiovascular disease occurs in patients with progressive renal disease both before and after the initiation of dialysis. Left ventricular hypertrophy (LVH) is an independent predictor of morbidity and mortality in dialysis populations and is common in the renal insufficiency population. LVH is associated with numerous modifiable risk factors, but little is known about LV growth (LVG) in mild-to-moderate renal insufficiency. This prospective multicenter Canadian cohort study identifies factors associated with LVG, measured using two-dimensional-targeted M-mode echocardiography. Eight centers enrolled 446 patients, 318 of whom had protocol-mandated clinical, laboratory, and echocardiographic measurements recorded. We report 246 patients with assessable echocardiograms at both baseline and 12 months with an overall prevalence of LVH of 36%. LV mass index (LVMI) increased significantly (>20% of baseline or >20 g/m2) from baseline to 12 months in 25% of the population. Other than baseline LVMI, no differences in baseline variables were noted between patients with and without LVG. However, there were significant differences in decline of Hgb level (-0.854 v -0.108 g/dL; P = 0.0001) and change in systolic blood pressure (+6.50 v -1.09 mm Hg; P = 0.03) between the groups with and without LVG. Multivariate analysis showed the independent contribution of decrease in Hgb level (odds ratio [OR], 1.32 for each 0.5-g/dL decrease; P = 0.004), increase in systolic blood pressure (OR, 1.11 for each 5-mm Hg increase; P = 0.01), and lower baseline LVMI (OR, 0.85 for each 10-g/m2; P = 0.011) in predicting LVG. Thus, after adjusting for baseline LVMI, Hgb level and systolic blood pressure remain independently important predictors of LVG. We defined the important modifiable risk factors. There remains a critical need to establish optimal therapeutic strategies and targets to improve clinical outcomes.

Pharmacological modulation of pressure-overload cardiac hypertrophy: changes in ventricular function, extracellular matrix, and gene expression.

Appropriate cardiac hypertrophy (CH) is necessary in several clinical settings, such as pulmonary artery banding in the two-stage arterial switch operation for transposition of the great arteries. Pressure-overload CH, however, produces ventricular dysfunction due to structural and molecular changes. The beta2-adrenergic receptor agonist clenbuterol has been shown to induce CH without such adverse effects to the rat heart. This study was performed to determine its effects on left ventricular (LV) function, structure, and gene expression in pressure-overload CH. Sprague-Dawley rats were assigned to one of four groups: 1, sham-operated (n=15); 2, banding of ascending aorta (n=22); 3, banding+clenbuterol (n=18); and 4, banding+thyroxine (n= 17). At the end of 3 weeks, groups 2, 3, and 4 showed an increase in LV mass index of 49.7+/-5.1%, 66.1+/-3.8%, and 47.6+/-4.6%, respectively, relative to group 1. A subgroup with severe CH (>50%) in group 2 was found to have significantly impaired developed pressure and diastolic relaxation and an increase in passive stiffness, with significantly reduced LV expression of sarcoplasmic reticulum Ca2+-ATPase2a (SERCA2a) mRNA and increased LV collagen concentration. In comparison, similarly hypertrophied animals in groups 3 and 4 demonstrated improved developed pressure, normal relaxation and diastolic stiffness with normal collagen concentration, and a greater abundance of SERCA2a mRNA. Clenbuterol administration in conjunction with pressure overload produces a specific type of CH with preserved LV function. In addition, an increase in LV mass was associated with less fibrosis and greater expression of SERCA2a mRNA than banding alone.

Systolic function in hypertensive men with concentric remodeling.

Hypertensive patients with concentric remodeling (relative wall thickness > or = 0.45 and normal left ventricular [LV] mass index) may have poor outcomes. It is unclear whether systolic function abnormalities, shown to be present in some patients with concentric LV hypertrophy (increased LV mass index and relative wall thickness > or = 0.45), are also present in patients with concentric remodeling. To assess LV pump, chamber, and myocardial function in hypertensive men with concentric remodeling, clinical and echocardiographic data of 118 hypertensive men with concentric remodeling were compared with data from 104 hypertensive men with normal relative wall thickness and normal LV mass index. Chamber function was assessed by relating endocardial fractional shortening to end-systolic circumferential stress, myocardial function was assessed by relating midwall fractional shortening to circumferential stress, and pump performance was assessed by stroke volume (Teichholz method). Compared with hypertensive men with normal relative wall thickness, concentric-remodeling patients had lower stroke volume (84 +/- 20 versus 111 +/- 20 mL, P < .001). Endocardial shortening was no different between the two groups (38 +/- 7% versus 40 +/- 7%, P=NS), but midwall shortening was lower in patients with concentric remodeling (20 +/- 3% versus 22 +/- 3%, P < .001), despite lower end-systolic stress (81 +/- 25 versus 117 +/- 37 g/cm2, P < .001). Endocardial and midwall stress-shortening regression plots classified 28% and 42%, respectively, of the concentric remodeling patients below the fifth percentile of hypertensive patients with normal geometry. These data indicate that indexes of chamber and myocardial function are lower than those observed in hypertensive patients with normal geometry. Thus, indices of chamber, myocardial, and pump performance indicate potential abnormalities in systolic function in men with concentric remodeling.

High prevalence of concentric remodeling in elderly individuals with isolated systolic hypertension from a population survey.

Echocardiographic determination of left ventricular mass index (LVMI) is shown to be valuable in the assessment of cardiovascular risk. Determination of left ventricular geometry, including concentric remodeling, provides additional prognostic information. In isolated systolic hypertension (ISH), the few echocardiographic studies available show an increased LVMI, but criteria and patient populations differ. No comparison with diastolic hypertension (DH) has been made, nor has left ventricular geometry (with concentric remodeling) been evaluated. We compared both LVMI and left ventricular geometry of newly diagnosed ISH subjects with normotensive and DH subjects, all previously untreated and from the same population. The echocardiographic LVMI of 97 previously untreated ISH subjects (4 x systolic pressure > or = 160 mm Hg, diastolic pressure < 95 mm Hg) was clearly elevated compared with values in age- and sex-matched normotensive subjects (98 and 71 g/m2, respectively; P < .001). The geometric pattern was abnormal in most ISH subjects, with a high prevalence (43%) of concentric remodeling. Both LVMI and left ventricular geometry of ISH subjects did not differ significantly from values in DH subjects (LVMI, 92 g/m2; concentric remodeling, 56%). Sex differences in LV geometry in ISH were present only with the Framingham criteria, not with the Koren criteria. This study shows a high prevalence of concentric remodeling in elderly individuals with previously untreated ISH. The increase of LVMI and abnormality in left ventricular geometry are comparable with those in DH subjects, further defining the place of ISH as a cardiovascular risk factor in the elderly. Whether there are sex differences in cardiac adaptation in ISH and whether the geometric classification can be used to adjust treatment remain to be investigated.

Left Ventricular Morphology in Chronic Renal Failure by Echocardiography

M-mode, two-dimensional, and Doppler echocardiography were performed in 38 chronic renal failure (CRD) patients on conservative management, 35 patients on hemodialysis, and 36 matched controls. The controls were matched for age, sex, and comorbidities. The incidence of hypertension, left ventricular (LV) end diastolic volume, LV end systolic volume, and LV mass index were significantly higher in patients on hemodialysis compared to the controls. The LV parameters in the predialysis patients were not significantly different from the controls, except the LV end systolic internal dimensions were significantly higher in the CRF patients. Multiple regression analysis underscored the strong association between increase in LV mass index (LVMI) and hypertension. The diabetic patients with renal failure had large LV internal diameter and end diastolic volume compared to non-diabetics. Systolic function was well preserved even in hypertensive and diabetic patients with uremia. The incidence of diastolic dysfunction and asymmetrical septal hypertrophy were not significantly different in the three groups of patients.

1007-22 Cardiovascular Effects of Thyrotoxicosis and Thyroid Hormone Administration

Thyrotoxicosis results in a number of effects on the cardiovascular system including changes in blood pressure, peripheral vascular resistance and left ventricular mass. Whilst many of these are well documented, the reversibility of these changes with restoration of euthyroidism is less clear and may have prognostic implications. In addition, patients who have undergone thyroidectomy for thyroid carcinoma require chronic high-dose thyroid hormone therapy; the cardiovascular effects of this therapy have not been assessed with regard to long term risk. We studied 23 female patients with Graves’ hyperthyroidism (group 1) with no prior history of heart disease at presentation and after 1 and 2 months of carbimazole treatment and 11 female patients receiving doses of thyroxine sufficient to suppress thyroid stimulating hormone (TSH) to below normal values (group 2); data were compared to those from 25 normal female age matched controls. Cardiac dimensions and function were assessed by 2-dimensional and M-mode echocardiography, 24 hour blood pressure and heart rate by automatic ambulatory sphygmomanometer. At presentation, group 1 showed increases in mean 24 hour systolic blood pressure (124 ± 12.4 v 110 ± 6.7 mmHg, p &lt; 0.05) (mean ± SD), mean 24 hour heart rate (99.0 ± 14.4 v 77.0 ± 9.4/min, p &lt; 0.001) and left ventricular mass index (LVMI) (93.1 ± 12.2 v 78.9 ± 9.0 g/m 2 , p &lt; 0.03) compared to controls. Fractional shortening (FS) and ejection fraction (EF) were increased (FS: 39.7 ± 2.1 v 35.8 ± 1.9%, p &lt; 0.05) (EF: 69.8 ± 1.3 v 65.7 ± 1.5%, p &lt; 0.05). All of these indices had returned to normal, however, after 2 months of carbimazole treatment. In group 2, the only abnormality was a significant increase in LVMI compared to controls (100.3 ± 25.9 v 78.9 ± 9.0 g/m 2 p &lt; 0.05). Diurnal variation in systolic and diastolic blood pressure and heart rate were normal in both groups. There were no changes in either group in assessments of sympathetic activity (tilt testing, isometric forearm exercise, cold pressor test and Valsalva ratio) or in 24 hour urinary catecholamines compared with controls, or between presentation and 2 months in group 1. The cardiovascular effects of thyrotoxicosis are reversed rapidly in response to antithyroid treatment with carbimazole; despite the similarities between thyrotoxicosis and a hyperadrenergic state, our data show no objective evidence to suggest sympathetic overactivity. Patients receiving suppressive doses of thyroid hormones show evidence of increased left ventricular mass; this finding warrants long-term follow up to assess prognostic implications in terms of future cardiovascular risk.

Prognostic value of left ventricular mass in uncomplicated acute myocardial infarction and one-vessel coronary artery disease

This study assesses the relative prognostic value of increased left ventricular (LV) mass compared with residual ischemic myocardium and angiographic characteristics of the diseased vessel in 76 patients with uncomplicated acute myocardial infarction associated with 1-vessel coronary artery disease (CAD). All patients underwent symptom-limited treadmill exercise testing, resting and dipyridamole echocardiography and coronary angiography before discharge, and were followed-up for 32 ± 6 months. LV measurements were obtained in diastole according to the Penn convention. Measurements of LV mass were divided by body surface area to obtain LV mass index. A cut-off value of 135 g/m 2 body surface area for men and 112 g/m 2 for women was prospectively selected. The individual effects of clinical, stress testing and anglographic variables were evaluated by using the Cox regression model. Echocardiographic LV mass index was increased in 43 patients and normal in 33. There was no intergroup difference with respect to baseline clinical and angiographic variables, ejection fraction and prevalence of stress-induced ischemia. During follow-up there were 23 cardiac events in the 43 patients with increased LV mass index and only 5 in the 33 with normal LV :Mass index (p <0.001). No patient died or had nonfatal reirrfarction among patients with normal LV mass. Cox survival analysis identified an increased LV mass index as the only independent predictor of cardiac events (chisquare = 7.9; p < 0.005; RR = 5.4). Thus, these data suggest that LV mass is an important independent risk factor in patients with uncomplicated acute myocardial infarction associated with 1-vessel CAD.

Prediction of Progression of Left Ventricular Hypertrophy in Mild Hypertension: 5-Year Observations without Pharmacological Intervention.

We investigated the clinical implications of blood pressure changes after 20min of rest and during exercise in particular for predicting the progression of left ventricular hypertrophy (LVH) in unmedicated male subjects with borderline and mild hypertension. We studied 155 subjects who were enrolled in a hypertension management program that included routine annual physical check-ups and cardiovascular follow-up studies, including echocardiography and treadmill exercise stress testing, every 3 years. Sixty-nine subjects were followed for 5 years without pharmacological intervention. Left ventricular mass index (LVMI) was correlated with systolic pressure at peak exercise (max Ps) and 20-min resting systolic pressure in 155 subjects. Stepwise multiple linear regression analysis showed that the initial LVMI and max Ps had significantly higher percent explained variances in relation to the LVMI increase over the 5-year observation period compared with other variables. Hyper-responders, subjects with an initial max Ps above 200mmHg, showed a greater increase in LVMI than subjects with an initial max Ps below 200mmHg, although there was a small but significant increase in LVMI, without any increase in the blood pressure variables, even in those showing a normal response. In conclusion, max Ps appears to be a simple and reliable predictor of LVH progression. (Hypertens Res 1992; 15: 155-161)

Does Isovolumic Relaxation Time Reflect the Severity of Left Ventricular Hypertrophy in Patients with Essential Hypertension?

To elucidate whether the isovolumic relaxation time (IRT) reflects the severity of left ventricular hypertrophy, IRT and left ventricular mass index (LVMI) were measured in 43 patients with essential hypertension and in 17 normotensive controls. The hypertensive patients were subdivided into three groups based on interventricular septal thickness (IVST) and left ventricular posterior wall thickness (PWT), determined echocardiographically, and clinical symptoms. IVST and PWT in group 1 patients (n = 10) were less than 10 mm, IVST and/or PWT in group 2 (n = 23) were 10 mm or greater, and the hypertensive patients in group 3 (n = 10) were in class III of the New York Heart Association Classification of hypertension. The IRT was prolonged in accordance with the increase in LVMI in groups 1 and 2. Though the LVMI showed no significant difference between normotensive controls and group 1, the IRT was significantly longer in group 1 patients (p < 0.05). The LVMI was markedly greater in group 3 than in group 2 (p < 0.01), but the IRT showed no significant difference. This finding indicates that there might be a limit of IRT prolongation associated with myocardial hypertrophy due to essential hypertension. In conclusion, IRT reflects the severity of left ventricular hypertrophy in patients with mild to moderate essential hypertension, but does not in advanced stages of hypertension.

Assessment of left ventricular systolic and diastolic function with Doppler echocardiography in hypertensive patients receiving intravenous medroxalol

Intravenous medroxalol, an α- and β-adrenergic blocking agent, causes an immediate hypotensive effect. In 14 subjects with mild-to-moderate hypertension, cardiac output (CO) and cardiac index (CI) were significantly decreased without significant changes in stroke volume, reflecting the fact that a reduced CO and CI were related to decreases in heart rate. The vasodilator effect of intravenous medroxalol was not apparent with the dosages used in this study. Transient changes noted in two Doppler diastolic velocity indexes—mitral early diastolic peak flow velocity (PFVE) and the ratio of mitral late-to-early diastolic peak flow velocity (PFVA/E)—are suggestive of an improvement in left ventricular (LV) diastolic filling during medroxalol infusion, possibly related to changes in loading conditions. Systolic and diastolic blood pressure did not correlate with any of the Doppler diastolic and systolic indexes in our patient population. Reduced aortic peak flow velocity, rate of aortic flow acceleration, and the rate of mitral early diastolic deceleration were noted with increasing LV mass index, independent of age or blood pressure. Doppler echocardiography may be a useful tool in the assessment and follow-up of LV systolic and diastolic function in patients undergoing pharmacologic interventions.

Different patterns of left ventricular filling in arterial hypertension

To determine whether left ventricular (LV) filling dynamics may be influenced by the type of LV morphological adaptation to arterial hypertension, pulsed Doppler mitral flow velocity recordings were performed in 30 hypertensive patients and in 18 normotensive subjects matched for age, body surface and heart rate. Peak early (E) and late (A) mitral flow velocity, A/E ratio (A/E), time to peak E (TP), acceleration (AHT) and deceleration half-time (DHT) of early mitral flow and isovolumic relaxation time (IRT) were measured. Compared with the control group, hypertensive patients showed prolonged IRT and DHT, increased A and A/E, whereas TP, AHT and E were unchanged. Hypertensive patients were classified into two subgroups on the basis of h/r ratio (h/r). Subgroup 1: 16 patients with normal h/r, less than 0.42, (five patients with increased LV mass index, greater than 129.2 g m-2, and 11 patients with normal LV mass index, less than 129.2 g m-2). Subgroup 2: 14 patients with increased h/r, greater than 0.42, (nine patients with increased LV mass index, greater than 129.2 g m-2 and five patients with normal LV mass index, less than 129.2 g m-2). In Subgroup 1 the cardiac output (CO) was increased and the total peripheral resistance (TPR) was unchanged in comparison with the control group. In Subgroup 2 the opposite haemodynamic profile was detected: normal CO and increased TPR.(ABSTRACT TRUNCATED AT 250 WORDS)