Increase In Myocardial Mass Research Articles

Investigating the Link Between Left Ventricular Hypertrophy and Anemia in End-Stage Renal Disease

Background:ESRD significantly burdens healthcare systems worldwide. Its related complications, such as LVH and anemia, lead to increased morbidity and mortality. Left Ventricular Hypertrophy (LVH), which mirrors an increase in myocardial mass and wall thickness, is easily identified in patients with ESRD. Anemia, a state of low hemoglobin, increases cardiac work Aims and Objective: To explore anemia and its association with LVH in ESRD patients on maintenance hemodialysis by detailed echocardiographic assessment and comprehensive blood analysis. Methodology: This comparative study was carried out at a teaching hospital, namely Ghurki Teaching Hospital and a tertiary care hospital, Mayo Hospital, Lahore, Pakistan from March 2023 to April 2024. A purposive sample of 200 adults on maintenance hemodialysis with ESRD was obtained through stratified random sampling techniques and the participants were grouped based on anemia status: anemic; (hemoglobin <13g/dL in males, <12g/dL in females) or non-anemic. The data were analyzed using SPSS software (Version 26) by employing independent t-test to compare the means, chi-squared test for categorical variables, A p-value < 0. 05 was considered significant. Results:In patients with anemia, the LVMI was significantly (P≤0.05) higher than in patients without anemia. Anemia was found to be a significant (P≤0.05) predictor of an increase in LVMI over time, indicating its role in the development of LVH. Conclusion:The findings of present research indicated that, as shown by echocardiography, there is a substantial correlation between LVH and anemia in patients on maintenance of hemodialysis.

Condition of the cardiovascular system in Wistar rats with experimental renal dysfunction

The aim: to evaluate functional and structural changes in blood vessels and myocardium in Wistar rats at different stages of the formation of experimental kidney dysfunction.Materials and Methods. Four groups of animals were studied. The first two groups consisted of rats subjected to 5/6 nephrectomy (NE). The period after NE is 2 or 4 months. The third and fourth groups included sham-operated (SO) animals of a similar observation period. After the end of the experiment, blood pressure was measured in rats, the left ventricular mass index (LVMI) was calculated, a biochemical blood test, histological, immunohistochemical and electron microscopic examination of the myocardium were performed, and the contractile activity of the portal vein was recorded for a period of 2 months (in vitro).Results. 2 months after NE, an increase in blood pressure, LVMI, and a decrease in the autorhythmic contractile activity of the portal vein were detected in rats. At the histological level, thickening of cardiomyocytes and arterial vessel walls and the presence of perivascular fibrosis were noted. After 4 months, in rats with NE, the increase in blood pressure, cardiomyocyte hypertrophy and perivascular fibrosis progressed. The thickness of cardiomyocytes was 14.1±3.11 μm, which was significantly greater than in the group with NE for 2 months (12.5±1.5 μm; p=0.008). At this period of observation, electron microscopic examination revealed deintegration of myofibrils, disruption of myofibril stacking and z-disk structure, and changes in the shape of mitochondria. 2 months after NE, an increase in the area of open capillaries was detected in rats (1902.8±202.9 μm²) compared to the corresponding LO animals (730.4±58.2 μm²; p=0.000). As renal dysfunction develops, the capillary area tends to increase (2139.1±396.5 μm²; p =0.120).Conclusion. In Wistar rats with renal dysfunction, changes were detected not only in the level of blood pressure, but also in the functional activity of the intravenous fluid, as well as in the structural components of the myocardium – cardiomyocytes, stroma and blood vessels. The increase in myocardial mass at the histological level was manifested by a significant increase in the thickness of cardiomyocytes, the volume of connective tissue, and the thickness of the wall of arterial vessels, reaching a maximum value at a longer period after NE.

Multidisciplinary approach in the differential diagnosis of left ventricular hypertrophy: a case report

Left ventricular (LV) hypertrophy implies structural cardiac changes and, as a consequence, an increase in myocardial mass. Currently, there are many causes of this condition as follows: hypertension, aortic stenosis, hypertrophic cardiomyopathy, exercise, storage diseases (AL, ATTR amyloidosis, Danon disease, Anderson-­Fabry disease, etc.), metabolic disorders. Despite the currently existing diagnostic algorithms for LV hypertrophy, establishing a correct diagnosis can take a long time, and controversial research results can lead to false conclusions. This article presents a case report of a patient with LV hypertrophy, an atypical clinical performance and ambiguous paraclinical data, which led to certain diagnostic difficulties.

Ethnic differences in right ventricular structure and function in urbanized hypertensive patients in the Gornaya Shoriya region

Aim of this study was to compare right ventricular echocardiography parameters in urbanized hypertensive patients of the Shor and non-indigenous ethnic groups in the Mountain Shoria region. The study included patients with arterial hypertension: 58 Shors and 50 non-indigenous urbanized residents, comparable in age, and divided by ethnicity and gender into 4 groups: Shors men (n = 20), Shors women (n = 38) , non-indigenous men (n = 15) and non-indigenous women (n = 35). All underwent echocardiographic examination, and the right heart parameters were studied. Shor men with arterial hypertension had the lowest values ​​of the pulmonary artery index (p = 0.05), the right atrium dimensions (p = 0.04), and the highest values ​​of the blood flow velocity in the right ventricle, et' (p = 0.05) and st' (p = 0.05) in comparison with non-indigenous men. Shor women have the lowest values Et/At ratios (p = 0.05). RV diastolic dysfunction was detected mainly in women compared with men (23.1% and 1.9%, p = 0.0014), somewhat more often in Shors. Ethnicity was one of the factors associated with the right ventricular diastolic dysfunction presence (p = 0.002). Among the factors associated with the RV diastolic dysfunction were risk factors (smoking, obesity), blood pressure, gender, ethnicity, and left ventricular parameters (diastolic dysfunction and the myocardial mass increase). Thus, our study established the influence of ethnic differences on the right heart echocardiographic parameters in Shors and Caucasians with arterial hypertension. The effect of sex on RV diastolic dysfunction was a lot bigger compared to the effect of ethnicity. The revealed differences should improve the assessment of the right heart structure and function in patients with arterial hypertension from small ethnic groups, which will help to improve the diagnosis and treatment of such patients.

February 2021 at a glance: focus on amyloidosis, myocarditis and cardiomyopathy

Cardiac amyloidosis (CA) is emerging as a major cause of heart failure (HF).1-3 Castiglione et al.4 reviewed the role of circulating biomarkers as tools to guide diagnosis, prognostic stratification, and therapy in CA. The independent prognostic role of cardiopulmonary exercise testing in patients with light chain or transthyretin CA (TTR-CA) was shown by Nicol et al.5 in a multicentre study. Both peak oxygen consumption (VO2) ≤13 mL/kg/min and N-terminal pro B-type natriuretic peptide (NT-proBNP) ≥1800 ng/L had independent prognostic value with a hazard ratio (HR) of 2.7 [95% confidence interval (CI) 1.6–4.8] and 2.2 (95% CI 1.1–4.3), respectively. No events occurred in patients with peak VO2 >13 mL/kg/min and NT-proBNP <1800 ng/L during a median follow-up of 20 months, despite overall 25% mortality and 29% hospitalization rates. Amyloidosis may be present in patients with severe aortic stenosis.2, 6 TTR-CA was detected in 13% of patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. It had no impact on mortality but was associated with a higher HF hospitalization rate during a 3-year follow-up.3 Tafamidis has emerged as an effective treatment option to improve prognosis in patients with TTR-CA.7, 8 A single-centre study in 648 real-world patients with TTR-CA matching the inclusion criteria of the Tafamidis in Transthyretin Cardiomyopathy Clinical Trial (ATTR-ACT) showed a significant benefit of tafamidis on major cardiovascular outcomes (HR after propensity score matching 0.546, P = 0.0132).9 In an analysis of the long-term extension of ATTR-ACT, both tafamidis 80 mg and 20 mg reduced all-cause mortality and cardiovascular hospitalizations at 30 months compared with placebo, with the higher dose associated with better outcomes without safety issues in the long-term extension.10 Sinagra et al.11 reviewed data about the role of viral detection for immunomodulation in acute lymphocytic myocarditis, highlighting current limitations of this approach and providing a framework for future dedicated studies. The Authors pointed out that the value of viral presence to guide immunosuppressive treatment in lymphocytic myocarditis requires more evidence and remains a subject of debate. As a further support, intravenous immunoglobulin did not improve cardiac systolic function or functional status in patients with chronic inflammatory cardiomyopathy, namely idiopathic dilated cardiomyopathy with parvovirus B19 persistence, in a randomized controlled trial.12 Over the last years, improvement in survival was observed in patients with dilated cardiomyopathy, with many patients with new-onset cardiomyopathy who may show reverse remodelling.13, 14 In TRED-HF, withdrawal of pharmacological treatment for HF in patients with recovered dilated cardiomyopathy was associated with relapses in 44% of patients.15 In a further analysis by cardiac magnetic resonance, treatment withdrawal resulted in early ventricular remodelling with an increase in myocardial mass and a reduction in global longitudinal strain. Interestingly, these changes may also occur in patients who do not show clinical deterioration.16 Shorter left ventricular systolic ejection time has been identified as a marker of worse prognosis among patients with HF with reduced ejection fraction (HFrEF).17 Alhakak et al.18 confirmed the prognostic impact of left ventricular systolic ejection time on mortality in a large HFrEF population (per 10 ms decrease: adjusted HR 1.06, 95% CI 1.01–1.11, P = 0.030), hence supporting its use to stratify patients' risk and to guide therapeutic response. Heightened chemosensitivity has a major role in the excessive ventilatory response to exercise and sleep breathing abnormalities in patients with HF. Buspirone, a 5HT1A receptor agonist that inhibits serotonergic chemoreceptor neuron firing, reduced carbon dioxide chemosensitivity and improved central apnoeas in patients with HF.19 A relatively large number of patients with advanced HF may benefit from long-term mechanical circulatory support.20 This indication might be further expanded if this device therapy may cause regression of myocardial fibrosis. Unfortunately, such hypothesis was not proven in a recent study in 125 patients.21

RELATIVE TELOMERE LENGTH OF PERIPHERAL BLOOD LYMPHOCYTES AND STRUCTURAL AND FUNCTIONAL STATE OF THE LEFT VENTRICLE MYOCARDIUM IN CLEAN-UP WORKERS OF THE CHORNOBYL ACCIDENT WHO SUFFERED FROM STENOTIC CORONARY ATHEROSCLEROSIS.

There were examined 60 male EW who operated at the Chornobyl nuclear power plant at1986 and 25 male non-irradiated persons (control group - CG) with coronary heart disease (CHD). Everyone EW andCG patients were almost healthy before the accident. During the period 2016-2021, they underwent a comprehen-sive clinical and laboratory examination, echodopplercardiographic examination and determination of RTL by fluo-rescent hybridization in situ using laser flow cytometry. EW almost did not differ from CG according to its clinical characteristics, the presence of risk factors,indices of systolic and diastolic heart functions, as well as RTL. The analysis of variance showed that RTL was influ-enced by the fact of irradiation in combination with obesity (p = 0.020). At normal body weight, RTL average valuein CG was significantly higher than in EW (p = 0.023). According to the results of hierarchical cluster analysis of twovariables as RTL and end-diastolic volume normalized by body surface area (EDV/BSA), EW and CG patients togeth-er were divided into two subgroups. The first subgroup (1st cluster) differed from the second (2nd cluster) by signi-ficantly larger average values of left ventricle (LV) EDV and end-systolic volume (ESV) as well as EDV/BSA andESV/BSA, LV myocardial mass (MM) and MM/BSA, reduced ejection fraction (EF). In patients of the 1st cluster telom-eres were significantly shorter than in the 2nd one (10,3 ± 1.7 vs. 14.3 ± 2.0 at p = 0.000). The increase of myocar-dial mass and LV wall thickness caused the development of its hypertrophy. The number of people with hypertrophyLV was significantly higher among patients of the 1st cluster (91.6 vs. 67.2 %, p < 0.001) due to eccentric hypertro-phy LV. Accordingly, concentric hypertrophy LV was more common among patients in the 2nd cluster (24.6 vs. 4.2 %at p < 0.01). Patients of the 1st cluster was characterized by a more severe course of heart failure. In patients who suffered from CHD with stenotic atherosclerosis of the coronary arteries and wereexposed to radiation 30-35 years earlier, having normal body weight, there was a reduction in telomere. Hierarchicalcluster analysis proved to be a good tool that allows by the value of RTL and EDV/BSA to separate the group ofpatients with the most severe clinical course of CHD and LV systolic dysfunction among patients with the samepathology.

Cardiomyopathies: echocardiographic profiles based on principal component factor analysis in men and women

Aim. To determine echocardiographic profiles and their prognostic value using factor analysis in men and women with various types of cardiomyopathies (CMP).Material and methods. The study involved 100 people with CMP — 69 men with a median age of 53 years and 31 women with a median age of 58 years. Among the subjects, six nosological types corresponding to ICD 10 classification were revealed: dilated CMP (DCM), ischemic CMP (ICM), alcoholic CMP, mixed CMP, hypertrophic CMP (HCM) and myocarditis. All persons underwent an echocardiography. Echocardiography results as variables were included in factor analysis. The resulting two factors are presented as the first and second echocardiographic profiles.Results. The first echocardiographic profile was characterized as the degree of myocardial contractile function reduction. A strong association of the first profile with DCM, alcoholic CMP and myocarditis in men (p=0,001) and DCM in women (p=0,05) was obtained. In some individuals with ICM and mixed CMP, there was no association with the first profile. The second echocardiographic profile reflected the degree of myocardial mass increase and had significant differences only in women (p=0,04). A strong correlation with the second profile was observed in HCM, in the majority of women with ICM and in some persons with mixed CMP. Fatal outcomes in men were recorded in patients with ICM (66,7%), alcoholic CMP and myocarditis, and in women with mixed CMP (11,1%).Conclusion. For patients with DCM, myocarditis, and alcoholic CMP, the first echocardiographic profile with a risk of death is characteristic. The second echocardiographic profile was inherent in HCM and was associated with a protective effect in women with ICM. The revealed echocardiographic profiles can be extrapolated to nosological types of CMP in men and women in order to verify the diagnosis and prognosis.

Handling confounding variables in statistical shape analysis - application to cardiac remodelling.

Statistical shape analysis is a powerful tool to assess organ morphologies and find shape changes associated to a particular disease. However, imbalance in confounding factors, such as demographics might invalidate the analysis if not taken into consideration. Despite the methodological advances in the field, providing new methods that are able to capture complex and regional shape differences, the relationship between non-imaging information and shape variability has been overlooked. We present a linear statistical shape analysis framework that finds shape differences unassociated to a controlled set of confounding variables. It includes two confounding correction methods: confounding deflation and adjustment. We applied our framework to a cardiac magnetic resonance imaging dataset, consisting of the cardiac ventricles of 89 triathletes and 77 controls, to identify cardiac remodelling due to the practice of endurance exercise. To test robustness to confounders, subsets of this dataset were generated by randomly removing controls with low body mass index, thus introducing imbalance. The analysis of the whole dataset indicates an increase of ventricular volumes and myocardial mass in athletes, which is consistent with the clinical literature. However, when confounders are not taken into consideration no increase of myocardial mass is found. Using the downsampled datasets, we find that confounder adjustment methods are needed to find the real remodelling patterns in imbalanced datasets.

Genetics of feline hypertrophic cardiomyopathy.

Hypertrophic cardiomyopathy (HCM) is characterized by an abnormal increase in myocardial mass that affects cardiac structure and function. HCM is the most common inherited cardiovascular disease in humans (0.2%) and the most common cardiovascular disease in cats (14.7%). Feline HCM phenotype is very similar to the phenotype found in humans, but the time frame for the development of the disease is significantly shorter. Similar therapeutic agents are used in its treatment and it has the same complications, such as heart failure, thromboembolism and sudden cardiac death. In contrast to humans, in whom thousands of genetic variants have been identified, genetic studies in cats have been limited to fragment analysis of two sarcomeric genes identifying two variants in MYBPC3 and one in MYH7. Two of these variants have also been associated with human disease. The high prevalence of the reported variants in non-affected cats hinders the assumption of their pathogenicity in heterozygotes. An in-depth review of the literature about genetic studies on feline HCM in comparison with the same disease in humans is presented here. The close similarity in the phenotype and genotype between cats and humans makes the cat an excellent model for the pathophysiological study of the disease and future therapeutic agents.

ВЗАИМОСВЯЗЬ МЕЖДУ АНЕМИЕЙ И ПОРАЖЕНИЕМ СЕРДЦА У ПАЦИЕНТОВ С РЕВМАТОИДНЫМ АРТРИТОМ

Objective: To determine the impact of anemia on the structural-geometrical condition of the heart in patients with rheumatoid arthritis (RA). Methods: 154 patients with RA were included in the study: 37 patients with anemia (1st group) and 117 – without systemic manifestations of RA (2nd group). All patients underwent echocardiography. Results: Both groups were comparable in age, sex, ratio of seropositive and seronegative patients. A comparative analysis of both groups revealed that in 1st group DAS28 was higher than in 2nd group (p&lt;0.05). The left ventricular myocardial mass index was higher in 1st group than in the 2nd group (p&lt;0.05). The same applies to the left ventricular end-diastolic diameter: in patients with anemia, it was more than in patients without it (p&lt;0.05). Our results suggest that patients with anemia often have a violation of diastolic myocardial function, which is accompanied by an increase in myocardial mass. The correlation analysis in both groups revealed a direct relationship between age and left ventricular mass index (r=0.62, p&lt;0.0005), inverse relationship between age and E/a parameter of mitral valve (r=-0.71, p&lt;0.00001). In addition, in 1st group we revealed the inverse relationship between DAS28 and E/a parameter of tricuspid valve (r=-0.43, p&lt;0.05). Conclusion: Thus, regardless of the presence of anemia, the patients with RA observed dependence of structural and functional changes in the heart of age: a violation of diastolic function of the left ventricle, an increase of the left ventricular myocardial mass index. However, in patients with anemia, an increase in the activity of the disease is accompanied by diastolic dysfunction of the right ventricle that requires correction in patient management process. Keywords: Rheumatoid arthritis, anemia, echocardiography, diastolic dysfunction.

Micro‐RNA‐205 Regulates Heart Size Through Direct Modulation of the Hippo Pathway

During fetal development, the mammalian myocardium undergoes a period of hyperplastic growth, which establishes the number of cardiomyocytes in the adult heart. After birth, cardiomyocytes proceed through a final round of cell division in the absence cytokinesis that results in binucleation of &gt;95% of adult cardiomyocytes. Nearly all subsequent increase in myocardial mass is due to myocardial hypertrophy, with extremely low number of new cardiomyocytes being produced throughout post‐natal life. Despite the importance of this phenomenon, little is known about the molecular/genetic basis, especially with regard to the role of micro‐RNAs, for the transition from hyperplastic to hypertrophic‐based myocardial growth.We hypothesize a specific perinatal heart micro‐RNA‐mediated gene program is necessary for the normal transition from a fetal heart to an adult heart gene program.To identify the molecular mechanisms and genetic pathways involved in cardiac myocyte differentiation, RNA was isolated from E19, and 1, 3, 5, 7, 10 and 35‐day old mouse hearts (n=9 hearts/time point pooled). Cardiomyocyte micro‐RNA profiles (n=3 arrays/time point) were measured and bioinformatic analysis was used to identify genes that are transiently and significantly changing (p&lt;0.05, fold change &gt;1.5) during the perinatal period.Our analysis identified microRNA‐205 as a candidate for playing a role in the cardiac transitional program. Previous studies have shown a global knockout of miR‐205 to be neonatally lethal. We observe a transient 20‐fold increase in miR‐205 expression between day 1 and day 5 of post‐natal life, with levels returning to baseline by day 10. In‐situ hybridization revealed miR‐205 expression to be restricted to the epicardium of the heart.Mice harbouring a cardiomyocyte‐specific deletion of miR‐205 using αMHC‐Cre are born healthy with expected Mendelian ratios, and develop through the neonatal period normally. Hearts collected from adult mice show signs of abnormal growth and hypertrophy, up to 50% larger than controls. Previous studies demonstrated that miR‐205 directly targets YAP within the evolutionarily conserved hippo pathway that controls organ size. Hearts lacking miR‐205 exhibit a substantial increase in YAP protein expression. Increased cardiac size has been demonstrated in a constitutively active YAP transgenic mouse model. We conclude that miR‐205 plays a direct role in regulating post‐natal heart size through direct modulation of the Hippo pathway.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

MORPHOLOGICAL AND FUNCTIONAL MYOCARDIAL ABNORMALITIES IN THE CHORNOBYL NPP ACCIDENT CLEAN-UP WORKERS OF «IODINE» PERIOD HAVING GOT TYPE 2 DIABETES MELLITUS.

Evaluation of morphological and functional myocardial abnormalities in the Chornobyl NPP (ChNPP)accident clean-up workers (ACUW) of the «iodine» period exposed to ionizing radiation at a young age and havinggot the type 2 diabetes mellitus (T2DM). The ChNPP ACUW of «iodine» period (n=111) exposed to ionizing radiation (IR) at a young age(18-35 years) were involved in the study. Subjects having got the T2DM were included in study Group I (n = 66), per-sons with normal glucose challenge test were selected as a comparison Group II (n = 45). External radiation doses (ERD)ranged from 10 to 860 mSv. The Group III (clinical control) included persons having got the T2DM with no radiationexposure in a history (n=20). Group IV was the normative one. There was no statistical difference between the groups inage, sociodemographic characteristics and level of education. Echocardiography and cardiac Doppler sonography wereperformed in one- and two-dimensional regimens according to the recommendations of the European Association ofEchocardiography. Total adiponectin and proinflammatory cytokine (TNF-α and IL-6) concentrations were assayed by theimmunoenzyme method. Statistical processing of data was carried out using the Microsoft® Exel 2002 software. Myocardial remodeling in the ChNPP ACUW of a «iodine» period having the T2DM occurred through a sig-nificant increase of its linear parameters. Volumetric parameters (EDV, ESV and their indexes) were within maximumpermissible limits significantly exceeding however the values in the Group IV. There was aт increase in myocardialmass of the left ventricle and its indices with the formation of structural-geometric abnormalities, mainly in theform of concentric hypertrophy with a decrease in the myocardial contractile capacity. There was no differences ofthe vast majority of key morphometric parameters of myocardium in the dose subgroups, while in persons with ERD> 500 mSv the incidence of serious left ventricular hypertrophy (LVMMI > 149 g/m2) significantly exceeded thisvalue in individuals with lower ERD. At a maximum ERD the more intense fibroplastic processes were observed inmyocardium [a significant increase in the interstitial collagen volumetric fraction (ICVF)] as compared to the caseswith ERD up to 50 mSv. Intensification of myocardial fibroblastic processes occurred in the comparizin group andgroup off clinical control. In combination with concentric myocardial hypertrophy this may lead to an increased riskof cardiovascular complications. Strong negative correlation was revealed between the parameters of left ventricu-lar structure in diastole and adiponectin level in the ChNPP ACUW of a «iodine» period with diagnosed T2DM, high-lighting its cardioprotective effect. At the same time, the content of FNP-α and IL-6 proinflammatory cytokines hada positive correlation with the main parameters of abnormal myocardial remodeling, indicating the possibility oftheir role in unfavorable cardiovascular modifications. The decreased adiponectin level and elevated levels of TNF-α and IL-6 in the ChNPP ACUW of a«iodine» period having got the T2DM are the meaningful factors in progression of LV geometric remodeling. Togetherwith fibroplastic processes (a significant increase in ICVF) this may be a basis for the development of myocardialremodeling processes, namely a concentric hypertrophy, which is a prerequisite for the development of complica-tions in cardiovascular system.

THE INFLUENCE OF DYNAMIC AND STATIC PHYSICAL EXERCISES ON THE PARAMETERS OF INTRACARDIAC HEMODYNAMICS AND PHYSICAL ENDURANCE IN HIGHER-LEVEL SPORTSMEN

Aim. To assess the influence of dynamic and static exercises on the parameters of intracardiac hemodynamics and physical endurance in higher-level sportsmen. Material and methods. Totally, 136 sportsmen studied all males. Higher- level (qualified) sportsmen (groups of sports perfection and higher sports mastery) — 116 persons (mean age 22,07±4,10 y.; sports experience 5-15 years) depending on the type of activity were selected into groups as following: I (n=30) — wrestling, judo, II (n=27) — ski racing, biathlon, III (n=33) — powerlifting, IV (n=26)—volleyball. Group V (n=20) — controls (age 17,95±1,55 y.), with the experience not higher than 3 years. Investigation methods: electrocardiography, echocardiography (EchoCG), veloergometry. Results. By the data of ECG the parameters of intracardiac hemodynamics in sportsmen of all groups were in the normal range. There were significant differences found for the geometry of the heart between control group and higher-level sportsmen, and the controls had lower morphostructural parameters. In highly dynamic kinds of sports (ski racing, biathlon) the morphostructural changes are related to the increase of volumetric parameters of the left ventricle. Intensive static and low dynamic load in power kinds of sports (powerlifting) lead to the increase of myocardial mass, caused by thickness of the left ventricle walls. The highest values of the level of physical endurance and maximum oxygen consumption were in biathlon and ski racing sportsmen who train endurance. Conclusion. Study of the influence of dynamic and static physical exertion on the parameters of intracardiac hemodynamic, morphostructure of the heart and physical endurance is of definitive importance for the evaluation of cardiovascular adaptation potential in higher-level sportsmen. Depending on the type and intensity of the exertion adaptation mechanisms have their specifics. The obtained data can be used for on-time correction of the training regimens and for management of training-competition process in sportsmen of various kinds. That means, EchoCG and veloergometry must be included into the list of obligatory diagnostic methods that fulfill systemic dynamic control of cardiovascular system parameters in the highest achievement sportsmen, that has special significance for revealing of the signs of desadaptation and overtraining in longtime sports involvement.

ANATOMIC AND MORPHOLOGICAL SIGNS OF A DIFFUSE-GENERALIZED HYPERTROPHIC CARDIOMYOPATHY

Aim. Based on the instrumental, histological and genetic studies to show the role and significance of intracardial anomalies and morphological specifics of the special form of hypertrophic cardiomyopathy (HCM), that the authors name as diffuse-generalized. Material and methods. A clinical, instrumental, histological and molecular-genetic study was conducted with 16 enrolled patients with diffuse-generalized form of HCM, who underwent complex surgical interventions: by transaortal approach the extended myoectomy of interventricular sept, and by intraatrial approach — parietal resection of papillary muscles, and universal chordal-sparing mitral valve replacement. Results. There was no in-hospital mortality. The long-term results for up to 5 years show that all patients moved from the IV-III NYHA to I-II NYHA functional classes. Morphological study showed that in the base of myocardial mass increase in HCM there is neither hypertrophy, but hyperplasia of cardiomyocytes. All 16 patients showed significant signs of myxomatous mitral valve degeneration. Conclusion. Diffuse-generalized type of HCM is due to spread hyperplasia process in myocardium. The invented radical remodeling operation abolishes intraventricular severe changes of pressure and increases diastolic volume of the left ventricle, preventing diastolic dysfunction development.

The effect of raloxifene on left ventricular hypertrophy in postmenopausal women: A prospective, randomized, and controlled study.

Objective:In healthy women, there is a progressive age-related increase in myocardial mass that is not seen in their male counterparts and occurs primarily in postmenopausal women. Raloxifene is a selective estrogen receptor modulator that has estrogenic actions on bone and the cardiovascular system. The aim of this study was to investigate the effect of raloxifene on myocardial hypertrophy in postmenopausal patients.Methods:A total of 22 postmenopausal osteoporotic women were included in this open-label, randomized, prospective, controlled study. Patients were randomized into two groups: 11 of the patients (group 1) were treated with raloxifene 60 mg/day, and the other 11 patients (group 2) were defined as the control group. Quantitative 2-dimensional and M-mode echocardiographic examination was performed in all patients at the beginning and repeated at the end of the 6-month follow-up period. Left ventricle mass (LVM) and left ventricle mass index (LVMI) were calculated for all patients.Results:The mean age of the patients was 57.2±3.9 years, and baseline clinical characteristics and echocardiographic parameters were similar between the two groups. After 6 months of raloxifene treatment, there was no difference in echocardiographic parameters of LVM and LVMI compared with the control group (201.2±25.9 gr vs. 169.7±46.2 gr, p=0.14 and 120.4±25.9 gr/m2 vs. 105.5±26.3 gr/m2, p=0.195, respectively). There was also no significant difference in LVM and LVMI in the within-group analysis of both groups.Conclusion:Raloxifene therapy does not affect myocardial hypertrophy in postmenopausal women after 6 months of treatment.

Ремоделювання серця та зміни загальної гемодинаміки в підлітків з артеріальною гіпертензією

Мета даного дослідження — встановлення особливостей ремоделювання серця та змін загальної гемодинаміки в підлітків з артеріальною гіпертензією залежно від маси тіла. Матеріали та методи. Проведено комплексне обстеження 102 юнаків 13–18 років з АГ, серед яких 32 підлітки з АГ та нормальною масою тіла, 23 — з АГ й надлишковою масою тіла (НМТ) та 47 — з АГ та ожирінням I–II ступеня. Фізичний розвиток дітей оцінювався з використанням антропометричних параметрів (зріст, маса тіла, окружність талії (ОТ) та стегон (ОС)) та обчисленням індексу маси тіла (ІМТ, кг/м2). ІМТ оцінювали за номограмами з урахуванням віку і статі. Нормальним вважався ІМТ, що знаходився на рівні між 15-м і 85-м перцентилем. Показники ІМТ між 85-м і 97-м перцентилем розцінювалися як надлишок маси тіла, а вище 97-го перцентиля — як ожиріння. Критерієм абдомінального ожиріння вважалася окружність талії, що дорівнювала 94 см і більше для юнаків віком понад 16 років і більше 90-го перцентиля для дітей до 15 років (IDF 2007). Функціональний стан серцево-судинної системи вивчався за допомогою ультразвукового дослідження серця в М- і В-режимах із використанням датчика 3,5 мГц на апараті Sonoline-SL1 фірми Siеmens за стандартною методикою, що рекомендована Асоціацією спеціалістів з ехокардіографії.Результати та їх обговорення. Єдиним антропометричним показником у підлітків виділених груп, за яким вони не розрізнялись між собою, був зріст. Середні значення ІМТ у пацієнтів з АГ і НМТ та АГ й ожирінням знаходилися в межах від 26,55 ± 0,35 кг/м2 до 31,98 ± 0,67 кг/м2 на відміну від хворих із АГ і нормальною масою тіла, у яких цей показник знаходився на рівні 22,21 ± 0,35 кг/м2 (р &lt; 0,001). Установлено статистично значущу відмінність середніх показників індексу ОТ/ОС у пацієнтів з АГ та ожирінням та у хворих з АГ та НМТ (р &lt; 0,001). Збільшення вище від норми показника ОТ понад 94 см для юнаків віком понад 16 років і більше 90-го перцентиля для дітей до 15 років виявлено у 20,0 ± 7,7 % випадків лише серед юнаків з АГ та ожирінням, ОТ в них знаходилася в межах від 93 до 128 см.При оцінці параметрів серця встановлено такі особливості: у групі юнаків з АГ та ожирінням порівняно з групою контролю відбувалось вірогідне збільшення діаметра кореня аорти (р &lt; 0,05), розширення лівого передсердя (р &lt; 0,05), дилатація порожнини лівого шлуночка (ЛШ) (р &lt; 0,05). Задня стінка лівого шлуночка (р &lt; 0,01) та міжшлуночкова перегородка (р &lt; 0,01) також були вірогідно товщими, унаслідок чого відбувався приріст маси міокарда ЛШ (р &lt; 0,05) та збільшення відносної товщини стінки лівого шлуночка (р &lt; 0,05). У групі підлітків з АГ та НМТ зареєстровано вірогідне потовщення міокарда лівого шлуночка, як задньої стінки лівого шлуночка (р &lt; 0,01), так і товщини міжшлуночкової перегородки (р &lt; 0,01), у результаті чого відбувалось збільшення індексу маси міокарда лівого шлуночка (р &lt; 0,1), вірогідний приріст відносної товщини стінки лівого шлуночка (р &lt; 0,01) та істотне збільшення діаметра аорти (р &lt; 0,05). Звертає на себе увагу розширення порожнини правого шлуночка як у групі з НМТ, так і в юнаків з ожирінням (р &lt; 0,01; р &lt; 0,01). У групі підлітків з АГ та нормальною масою тіла параметри серця мали лише тенденцію до збільшення, але не досягали рівня достовірності в порівнянні з групою контролю.При індивідуальній оцінці параметрів серця виявлено, що концентрична гіпертрофія лівого шлуночка зареєстрована в 1 (3,13 %) підлітка з АГ з нормальною масою тіла, у 4 (17,39 %) юнаків з АГ та НМТ та в 7 (14,89 %) — з АГ та ожирінням. Ексцентрична гіпертрофія лівого шлуночка виявлена у 3 (13,04 %) обстежених з АГ із НМТ та в 11 з АГ на тлі ожиріння (23,40 %). Дилатацію порожнини ЛШ виявлено в 9 (28,12 %) хворих з АГ з нормальною масою тіла, у 14 (60,88 %) — з АГ та НМТ та у 22 (46,80 %) юнаків з АГ на тлі ожиріння. Таким чином, у підлітків з АГ і НМТ відбувається бівентрикулярне ремоделювання серця з переважно концетричною гіпертрофією міокарда лівого шлуночка на відміну від підлітків з АГ і ожирінням, де ремоделювання серця відбувається з формуванням ексцентричної гіпертрофії, переважно за рахунок міжшлуночкової перегородки. Звертає на себе увагу формування в обох групах підлітків (із надмірною масою та ожирінням) ознак діастолічної дисфункції міокарда ЛШ та значна дилатація кореня аорти.

The Effect of Recombinant Human Growth Hormone Therapy on Left-Ventricular Chamber Size and Function in Children With Growth Hormone Deficiency

This study was designed to assess the effect of recombinant human growth hormone (rhGH) therapy on left-ventricular (LV) chamber size and function in children with idiopathic isolated growth hormone deficiency (GHD) using conventional echocardiography and tissue Doppler imaging (TDI). Thirty patients (19 boys and 11 girls) with idiopathic isolated GHD were followed-up for 12 months. Mean age of patients was 11.0 ± 2.6 years (range 6.3-15.5). At baseline and at 3, 6, and 12 months of treatment, the structure of the left ventricle was assessed by conventional echocardiography and myocardial rates and time intervals by TDI. There was a significant increase in LV mass (LVM) compared with pretreatment values. Like LVM, relative wall thickness (RWT) was also increased significantly. The significant increase in LVM indexed to body surface area and RWT became apparent at month 3 of treatment with a significant increase in LVM indexed to height(2.7) at treatment month 6. Normalized LVM increased as early month 3 of treatment, and a steady increase was observed until month 12. However, no patient had LVM > +2 standard deviation scores at month 12 of treatment. No significant differences were observed in functional parameters of the left ventricle and the interventricular septum. The results of this study showed that rhGH therapy causes an increase in myocardial mass without changing the geometry or function of the myocardium. Therefore, the increase in myocardial mass appears to be concentric, thus causing remodeling instead of hypertrophy.

Effects of high-efficiency postdilution online hemodiafiltration and high-flux hemodialysis on serum phosphorus and cardiac structure and function in patients with end-stage renal disease

Cardiovascular disease is the leading cause of mortality in patients with chronic kidney disease and has a strong association with hyperphosphatemia. Dialysis is the major treatment tool for attaining serum phosphorus control. Phosphorus removal can be increased with hemodiafiltration. We compared the effect of hemodiafiltration and hemodialysis on serum phosphorus and phosphorus removal and changes in cardiovascular variables in a short-term follow-up. Adult patients with end-stage renal disease were randomized to receive hemodialysis or hemodiafiltration for 3 months. Clinical and biochemical variables were recorded monthly. Cardiac resonance was done at randomization and at the end of follow-up. A total of 24 patients were studied (10 in hemodialysis and 14 in hemodiafiltration) with a mean age of 34.7 ± 11.4 years. The two groups did not differ as for age and blood pressure control at baseline. Phosphorus removal was higher (1,099 ± 239 in hemodiafiltration vs. 864 ± 366 mmol/session in hemodialysis, p < 0.05) and serum phosphorus was lower in the hemodiafiltration group at the end of follow-up (3.4 ± 0.8 in hemodiafiltration vs. 4.5 ± 1.6 mg/dl in hemodialysis, p < 0.05). We found a significant increase in ejection fraction only in the hemodiafiltration group. There was a trend to smaller increase in myocardial mass and a decrease in left ventricular end-diastolic volume only in the hemodiafiltration group. The changes in cardiac variables were significantly associated with changes in serum phosphorus levels. Hemodiafiltration was associated with better control of serum phosphorus and improvement in left ventricular ejection fraction, compared with hemodialysis.

352 Perinatal Heart Development: Identification and Characterization of a Transitional Program That Controls Cell Cycle Arrest and Terminal Differentiation of the Heart

During fetal and early perinatal development the myocardium undergoes a period of hyperplastic growth, which results in an exponential increase in the number of cardiomyocytes that will constitute the adult heart. Soon after birth, cardiomyocytes proceed through a final round of cell division in the absence cytokinesis that results in binucleation of >95% of adult cardiomyocytes. All subsequent increase in myocardial mass is accomplished by myocardial hypertrophy. Fetal heart genes are re-activated with the onset of pathological hypertrophic or dilated cardiomyopathies, yet there is no evidence of cardiomyocyte re-entry into the cell cycle.

Correlation between ECG abnormalities and cardiac parameters in highly trained asymptomatic male endurance athletes: evaluation using cardiac magnetic resonance imaging

Intensive endurance training can induce abnormal ECG patterns at rest. These alterations are differentiated into minor, mildly or distinctly abnormal ECG patterns. Echocardiographic data imply a correlation between the extent of these alterations and cardiac parameters like cardiac volume or wall thickness. In comparison to echocardiography, cardiac magnetic resonance imaging (MRI) is characterized by high reproducibility and accuracy. The aim of this study was to investigate the correlation between ECG alterations and cardiac parameters in highly trained asymptomatic male endurance athletes as assessed using cardiac MRI. Forty-five asymptomatic male endurance athletes (mean age 40 ± 8.9 years., range 19-59 years., 13 ± 5 h of training per week) underwent a cardiac MRI examination in addition to a resting ECG. Based on the ECG patterns at rest, the athletes were divided into groups with normal or minor (group 1) and mild or distinct (group 2) alterations. Steady-state free-precession cine MRI was used to calculate left and right ventricular end-diastolic volume, end-systolic volume, stroke volume, ejection fraction, and myocardial mass (MM). Late enhancement imaging was used to exclude structural alterations or myocardial scarring. Athletes in group 1 and 2 did not differ significantly in terms of age, height, body weight, body mass index or hours of training per week. Athletes with mildly or distinctly abnormal ECG patterns showed a significantly higher MM than athletes with minor ECG alterations at rest or normal resting ECG values (156.4 ± 18.4 g vs. 140.5 ± 20.0 g; p = 0.0103). The differences persisted when the values were corrected for body surface area (80.0 ± 7.4 g/m² vs. 73.4 ± 8.3 g; p = 0.0093). All other assessed cardiac parameters did not differ between the two groups. Pathological myocardial enhancement was detected only in one patient with a minor abnormal ECG. Male asymptomatic endurance athletes with mildly or distinctly abnormal ECG patterns at rest are characterized by a higher myocardial mass than comparable athletes with minor alterations or normal ECG at rest. Thus, the extent of ECG-abnormalities seems to be mainly the result of an increase in myocardial mass. Additionally, the absence of mild or distinct ECG alterations does not exclude the presence of pathological late gadolinium enhancement.