Increase In Left Ventricular Mass Index Research Articles

Prognostic value of left ventricular mass measured on coronary computed tomography angiography

BackgroundLeft ventricular (LV) mass is a well-established prognostic indicator for cardiovascular risk. Measurement of LV mass on coronary computed tomography angiography (CCTA) is considered optional. We aimed to assess for associations between LV mass measured on CCTA with all-cause mortality (ACM) risk and to determine age- and sex-specific distributions. MethodsWe evaluated patients without known coronary artery disease (CAD) who underwent CCTA at a single center. We assessed age- and sex-specific distributions (10th, 25th, 50th, 75th, and 90th percentiles) of LV mass index. ACM, the primary endpoint, was recorded over a median period of 5.1 [interquartile range: 1.4–8.4] years. The association between LV mass and mortality risk was assessed using multivariable Cox models adjusted for age, sex, medical history, coronary artery calcium (CAC) score and CCTA stenosis. Results4187 patients (mean age: 61.9 ​± ​11.7, 63 ​% male) were included. Male sex, African American ethnicity, Hypertension, CAC>400, and smoking were independent predictors of increased LV mass index. During the median 5.1 years of study follow, 265 (6.3 ​%) deaths occurred. Increased LV mass index percentiles were associated with increased risk of ACM. The addition of LV mass index percentiles improved discrimination and reclassification for mortality prediction over a model with age, sex, conventional risk factors, CAC score and CCTA stenosis severity (X2 improvement: 22.68, NRI: 28 ​%, both p ​< ​0.001). ConclusionIn a large sample of patients without known CAD who underwent CCTA, increased LV mass index provided independent and incremental prognostic value for all-cause mortality. Assessment of LV mass by CCTA, considering age and gender distribution, can be utilized clinically to identify patients with high myocardial mass.

Echocardiographic and clinical features of patients developing prosthesis-patient mismatch after TAVI: insights from an international multicenter registry

Abstract Background The impact of prosthesis-patient mismatch (PPM) after transcatheter aortic valve implantation (TAVI) is controversial. Purpose Our study aims to evaluate the impact of PPM on mortality and clinical-echocardiographic progression of cardiac damage in a "real world" cohort of patients at intermediate and low surgical risk and to characterize its main predictors. Methods 963 patients who underwent TAVI procedure between 2017 and 2021, from an international multicenter observational registry, were included in this analysis. Multiparametric echocardiographic data were analyzed at 1-year follow-up (FU). Clinical and echocardiographic features were stratified by presence of PPM and PPM severity, as per the most current international recommendations (VARC-3 criteria). Results 18% of patients developed post-TAVI PPM, (7.7% of the whole cohort severe). At baseline, 50.3% of patients with PPM were male (vs 46.2% in the cohort without PPM, p=0.33), aged 82y (interquartile range (IQR) 79-85y) vs 82y (IQR 78-86y; p=0.46), and 55.6% had Balloon-Expandable valves implanted (vs 46.8% of patients without PPM, p=0.04); they had smaller left ventricular outflow tract (LVOT) diameter (20mm, IQR 19-21 vs 20mm, IQR 20-22, p=0.02), reduced Stroke Volume index (SVi) (34.2 vs 38 ml/m2, p&amp;lt;0.01) and transaortic flow rate (190.6 vs 211 ml/s, p&amp;lt;0.01). At pre-discharge FU patients with PPM had more paravalvular aortic regurgitation (AR) (moderate/severe AR 15.8% vs 9.2%, p&amp;lt;0.01). At a median FU of 1.46 years (IQR 1-4), there was no evidence of a significant impact of PPM on overall mortality (15.3% vs 13.1%, p=0.46) nor on rehospitalization rate for heart failure (4.3% vs 8.0%, p=0.10). At 1-year FU, maladaptive alterations of left ventricular parameters were found in patients with PPM, with a significant increase in endsystolic diameter (ESD) (33 vs 28mm, p=0.03) and a statistically non-significant increase in LV mass index (121 vs 106g/m2, p=0.07). Interestingly, trajectory parameters of patients with PPM from baseline to 1-year FU showed a reduced cardiac remodeling compared to patients without PPM, including no LVEF improvement (p=0.88), absent reduction of LV end-diastolic volume (p=0.70), indexed LV mass (p=0.31), ESD (p=0.48) and pulmonary artery systolic pressure (p=0.82), and an increase of basal RV diameter (p&amp;lt;0.001). Patients with moderate/severe PPM had worse NYHA functional class at 1 year (NYHA III-IV 13% vs 7.8%, p=0.03). Independent predictor of PPM at multivariable logistic regression was male gender (OR=1.93, p=0.04); while SVi (OR=0.86, p&amp;lt;0.001), prosthetic size &amp;gt;23mm (OR=0.62, p=0.03) and LVOT diameter (OR=0.79, p=0.02) had protective effect. Conclusions There was no evidence of a short- or medium-term impact of PPM on mortality. However, clinical-echocardiographic evaluations demonstrated a PPM-related pattern of early ventricular maladaptive alterations associated with a significant deterioration in NYHA class at 1 year.

The Relative Apical Sparing Strain Pattern in Severe Aortic Valve Stenosis: A Marker of Adverse Cardiac Remodeling.

The presence of a relative apical sparing (RAS) echocardiographic strain pattern raises a suspicion of underlying cardiac amyloidosis (CA). However, it is also increasingly observed in patients with aortic stenosis (AS). We aimed to evaluate the prevalence, dynamics, and clinical characteristics of the RAS strain pattern in severe AS patients who had been referred for surgical aortic valve replacement (SAVR). A total of 77 patients with severe AS and without CA were included with a mean age of 70 (62-73) years, 58% female, a mean aortic valve area index of 0.45 ± 0.1 cm2/m2, and a mean gradient of 54.9 (45-70) mmHg. An RAS strain pattern was detected in 14 (18%) patients. RAS-positive patients had a significantly higher LV mass index (125 ± 28 g/m2 vs. 91 ± 32, p = 0.001), a lower LV ejection fraction (62 ± 12 vs. 68 ± 13, p = 0.040), and lower global longitudinal strain (-14.9 ± 3 vs. -18.7 ± 5%, p = 0.002). RAS strain pattern-positive patients also had higher B-type natriuretic peptide (409 (161-961) vs. 119 (66-245) pg/L, p = 0.032) and high-sensitivity troponin I (15 (13-29) vs. 9 (5-18) pg/L, p = 0.026) levels. Detection of an RAS strain pattern was strongly associated with increased LV mass index (OR 1.03, 95% CI 1.01-1.06, p < 0.001). The RAS strain pattern had resolved in all patients by 3 months after SAVR. Our findings suggest that the RAS strain pattern can be present in patients with severe AS without evidence of CA. The presence of an RAS strain pattern is associated with adverse LV remodeling, and it resolves after SAVR.

Left Ventricular Hypertrophy After Renal Transplantation: Systematic Review and Meta-analysis.

Left ventricular hypertrophy (LVH) in patients with end stage renal disease undergoing renal replacement is linked to an increased risk for cardiovascular diseases. Dialysis does not completely prevent or correct this abnormality, and the evidence for kidney transplantation (KT) varies. This analysis aims to explore the relationship between KT and LVH. MEDLINE and Scopus were systematically searched in October 2023. All cross-sectional and longitudinal studies that fulfilled our inclusion criteria were included. Outcome was left ventricular mass index (LVMI) changes. We conducted a meta-analysis using a random effects model. Meta-regression was applied to examine the LVMI changes dependent on various covariates. Sensitivity analysis was used to handle outlying or influential studies and address publication bias. From 7416 records, 46 studies met the inclusion criteria with 4122 included participants in total. Longitudinal studies demonstrated an improvement of LVMI after KT -0.44 g/m2 (-0.60 to -0.28). Blood pressure was identified as a predictor of LVMI change. A younger age at the time of KT and well-controlled anemia were also associated with regression of LVH. In studies longitudinally comparing patients on dialysis and renal transplant recipients, no difference was detected -0.09 g/m2 (-0.33 to 0.16). Meta-regression using changes of systolic blood pressure as a covariate showed an association between higher blood pressure and an increase in LVMI, regardless of the modality of renal replacement treatment. In conclusion, our results indicated a potential cardiovascular benefit, defined as the regression of LVH, after KT. This benefit was primarily attributed to improved blood pressure control rather than the transplantation itself.

HYPERTENSION-SPECIFIC ASSOCIATION OF CARDIO-ANKLE VASCULAR INDEX WITH SUBCLINICAL LEFT VENTRICULAR FUNCTION IN A CHINESE POPULATION: DANYANG STUDY

Objective: The association of arterial stiffness, as measured by cardio-ankle vascular index (CAVI), with subclinical cardiac dysfunction in hypertensive patients is unclear. Our study aims to examine their relationship in hypertensive patients compared with that in normotensive subjects. Design and method: Our study included 1887 subjects who were enrolled from Danyang between 2018 and 2019. CAVI was measured using VaSera VS-1500A device. We performed conventional echocardiography to measure ejection fraction (EF) and E/A, tissue Doppler to measure mitral annular early diastolic velocities (e’), and speckle tracking to estimate left ventricular (LV) global longitudinal strain (GLS). Results: Increased LV mass index (76.3, 80.0, and 84.0 g/m2), decreased GLS (21.1, 21.0, and 20.4%), lower E/A (1.2, 1.0, and 0.8) and e’ velocity (11.2, 9.4, and 8.2 cm/s), and higher E/e’ (7.6, 8.2, and 8.8) were significantly associated with higher CAVI on unadjusted analyses (P &lt; 0.001). After adjustment for covariates, GLS, E/A, and e’ were still significantly decreased from tertiles 1 to 3 of CAVI (P &lt; 0.04). Further sensitive analyses revealed similar association pattern for diastolic function. However, the relationship of higher CAVI to worse GLS was stronger in hypertensives (P = 0.008) but not normotensives (P = 0.167) (Figure 1). Compared with lowest tertile, subjects with top tertile of CAVI were at higher risk of subclinical LV systolic dysfunction in hypertensive patients (OR = 2.61; P = 0.005). Conclusions: Increased CAVI is associated with worse subclinical diastolic function. However, this relationship of CAVI to subclinical systolic function was more prominent in hypertensive patients.

LEFT VENTRICULAR GEOMETRIC PATTERNS AND TRIGLYCERIDE–GLUCOSE (TYG) INDEX

Objective: Background and aim of the study: the triglyceride–glucose (TyG) index, an indirect index of insulin resistance, has been found associated to the development of heart failure (HF). Left ventricular hypertrophy and concentric geometry are associated to the future risk of cardiovascular events, including heart failure Design and method: In 1070 patients undergoing an echocardiogram and laboratory examinations at an ESH Excellence Centre for workup for suspect arterial hypertension (age 56±14 years, 49% males, 75% hypertensives (HT), among them 79% treated) left ventricular mass (LVM) and geometry were assessed. Subjects were divided into 4 LV geometric patterns according to the presence of an increased LV mass index (LVM/h2.7&gt; 47 for females and and &gt; 50 for males) and/or an increased relative wall thickness (RWT&gt; 0.42). Results: After echocardiography subjects were classified as follows: 795(74%) with normal LV geometry (NG), 88 (8%) with concentric remodelling (CR), 143(13%) with eccentric hypertrophy (E_LVH) and 44 (4%) with concentric hypertrophy (C_LVH). The TyG was greater in males, in obese and in diabetic patients, and was significantly correlated with age, BMI, eGFR, systolic and diastolic blood pressure, LVM, LVMI and relative wall thickness. TyG remained significantly greater in patients with C_LVH as compared to both patients with NG and to patients with E_LVH, even after adjusting for multiple possible confounders (TyG: 8.5±0.6, 8.9±0.5, 8.6±0.6 and 9.0±0.7 and in patients with NG, CR, EH and CH respectively, ANOVA p &lt; 0.05). The results did not change after excluding diabetic patients Conclusions: Conclusion: the triglyceride–glucose (TyG) index, an indirect index of insulin resistance is significantly associated to concentric LVH, independently of several possible confounders. These findings can explain at least in part the association between TyG and the risk of cardiovascular events.

Association of major adverse cardiovascular events and all-cause mortality with left ventricular geometry in elderly

Abstract Objective To investigate the association of major adverse cardiovascular events and mortality with left ventricular geometry in elderly. Methods We prospectively recruited 3363 community-dwelling elderly (43.6% male, aged 71.1±5.9 years; 56.4% female, aged 71.1±6.1 years) from local community. Echocardiographic parameters were collected, left ventricular mass index (LVMi) above 115 g/m2 in male or 95 g/m2 in female, relative wall thickness (RWT) above 0.42 were considered as abnormal. Participants then were classified into 4 mutually exclusive groups as: normal geometry (normal LVMi and normal RWT), concentric remodeling (normal LVMi and increased RWT), eccentric hypertrophy (increased LVMi and normal RWT), concentric hypertrophy (increased LVMi and increased RWT). Cardiovascular death, non-fatal myocardial infarction including non-fatal ischemic stroke were recorded as incident MACE. Adjusted Cox regression models were used to evaluate the hazard ratios of MACE and all-cause mortality. Results Mean LVMi and RWT were 87.0 ± 28.4 g/m2 and 0.39 ± 0.08. During a median follow-up of 5.4 years, we identified 224 incident MACE cases and 233 deaths. All-cause mortality was significantly greater in participants with eccentric hypertrophy (adjusted hazard ratio [HR]: 1.649; 95% confidence interval [CI]: 1.143-2.379) compared with normal geometry in multivariate analyses after adjusting for baseline covariates. Incident MACE was significant both in concentric hypertrophy (HR:1.982; 95% CI: 1.239-3.170) and eccentric hypertrophy (HR:1.846; 95% CI: 1.266-2.692) but not in concentric remodeling (HR:1.101; 95% CI: 0.759-1.597). Baseline LVMi was a significant predictor of all-cause mortality (HR:1.047 per 10g/m2 increase in LVMi; 95% CI: 1.004-1.093). Similar results were observed with non-fatal myocardial infarction, non-fatal ischemic stroke and cardiovascular death. Conclusion Increased baseline LVMi and abnormal left ventricular geometry portend an increased risk for incident MACE and all-cause mortality in community dwelling elderly. From the pathophysiology point of view, per 10 g/m2 increase in LVMi add 5% risk for all-cause mortality.TablesFigures

Sex-Related Differences of Left Atrial Strain in Patients With Hypertension Using Cardiac Magnetic Resonance Feature Tracking.

Previous studies demonstrated the impact of sex on left ventricular (LV) strain in patients with essential hypertension. However, little is known about the effect of sex on left atrial (LA) strain in patients with hypertension. This study aimed to explore the sex-related differences of LA strain by using cardiac magnetic resonance feature tracking in patients with hypertension and preserved LV ejection fraction. One hundred and fifty hypertensive patients (100 men and 50 women) and 105 age-matched and sex-matched normotensive controls (70 men and 35 women) were retrospectively enrolled and underwent cardiac magnetic resonance examination. LA strain parameters included LA reservoir strain (εs), conduit strain (εe), pump strain (εa), and their corresponding strain rate (SRs, SRe, and SRa). Men had significantly higher LV mass index, lower εs and εe than women in both patients and controls (all P <0.05). LA strain and strain rate were significantly reduced in hypertensive patients compared with controls, both in men and women (all P <0.05). In men, hypertension and its interaction were associated with increased LV mass index and decreased εs and εe. In multivariable analysis, men, LV ejection fraction, and LA minimum volume index remained independent determinants of εs and εe in all hypertensive patients (all P <0.05). LA strain was significantly impaired in hypertensive patients, and men had more impaired LA strain than women. These findings further emphasize the sex-related differences in the response of LA strain to hypertension in the early stage.

Effect of Metformin on Oxidative Stress and Left Ventricular Geometry in Nondiabetic Heart Failure Patients: A Randomized Controlled Trial.

Introduction: There is an increasing interest in using metformin in cardiovascular diseases and its potential new roles. Only two randomized controlled trials investigated the effect of metformin in nondiabetic heart failure (HF) patients. However, none of these studies assess the role of metformin in reducing oxidative stress. We hypothesized that metformin might improve oxidative stress and left ventricular remodeling in nondiabetic HF patients with reduced ejection fraction (HFrEF). Methods and Methods: Seventy HFrEF patients (EF 37% ± 8%; median age 66 years) were randomized to metformin (n = 35) or standard of care (SOC) for HF (n = 35) for 6 months in addition to standard therapy. Outcomes included the difference in the change (Δ) in total antioxidant capacity (TAC) and malondialdehyde (MDA), both assessed colorimetrically and left ventricular mass index (LVMI) assessed through transthoracic echocardiography. Results: Compared with the SOC, metformin treatment increased TAC [Δ = 0.12 mmol/L, confidence intervals (95% CIs): 0.03-0.21; P = 0.007]. TAC increased significantly only in the metformin group (0.90 ± 0.08 mmol/L at baseline vs. 1.04 ± 0.99 mmol/L at 6 months, P < 0.05). Metformin therapy preserved LVMI (Δ = -23 g/m2, 95% CI: -42.91 to -4.92; P = 0.014) and reduced fasting plasma glucose (Δ = -6.16, 95% CI: -12.31 to -0.02, P = 0.047) compared with the SOC. Results did not change after adjusting for baseline values. Changes in MDA left ventricular ejection fraction (LVEF) and blood pressure were not significantly different between groups. Conclusion: Metformin treatment in HF patients with reduced LVEF improved TAC and prevented the increase in LVMI compared with the SOC. These effects of metformin warrant further research in HF patients without diabetes to explore the potential benefits of metformin. Trial Registration Number: This protocol was registered in ClinicalTrials.gov under the number NCT05177588.

Repurposing the β3-Adrenergic Receptor Agonist Mirabegron in Patients With Structural Cardiac Disease

Left ventricular (LV) hypertrophy contributes to the onset and progression of heart failure (HF), particularly for patients with pre-HF (stage B) for whom no treatment has yet proven effective to prevent transition to overt HF (stage C). The β3-adrenergic receptors (β3ARs) may represent a new target, as their activation attenuates LV remodeling. To determine whether activation of β3ARs by repurposing a β3AR agonist, mirabegron, is safe and effective in preventing progression of LV hypertrophy and diastolic dysfunction among patients with pre- or mild HF. The Beta3-LVH prospective, triple-blind, placebo-controlled phase 2b randomized clinical trial enrolled patients between September 12, 2016, and February 26, 2021, with a follow-up of 12 months. The trial was conducted at 10 academic hospitals in 8 countries across Europe (Germany, Poland, France, Belgium, Italy, Portugal, Greece, and the UK). Patients aged 18 years or older with or without HF symptoms (maximum New York Heart Association class II) were screened for the presence of LV hypertrophy (increased LV mass index [LVMI] of ≥95 g/m2 for women or ≥115 g/m2 for men) or maximum wall thickness of 13 mm or greater using echocardiography. Data analysis was performed in August 2022. Participants were randomly assigned (1:1) to mirabegron (50 mg/d) or placebo, stratified by the presence of atrial fibrillation and/or type 2 diabetes, for 12 months. The primary end points were LVMI determined using cardiac magnetic resonance imaging and LV diastolic function (early diastolic tissue Doppler velocity [E/e'] ratio assessed using Doppler echocardiography) at 12 months. Patients with at least 1 valid measurement of either primary end point were included in the primary analysis. Safety was assessed for all patients who received at least 1 dose of study medication. Of the 380 patients screened, 296 were enrolled in the trial. There were 147 patients randomized to mirabegron (116 men [79%]; mean [SD] age, 64.0 [10.2] years) and 149 to placebo (112 men [75%]; mean [SD] age, 62.2 [10.9] years). All patients were included in the primary intention-to-treat analysis. At 12 months, the baseline and covariate-adjusted differences between groups included a 1.3-g/m2 increase in LVMI (95% CI, -0.15 to 2.74; P = .08) and a -0.15 decrease in E/e' (95% CI, -0.69 to 0.4; P = .60). A total of 213 adverse events (AEs) occurred in 82 mirabegron-treated patients (including 31 serious AEs in 19 patients) and 215 AEs occurred in 88 placebo-treated patients (including 30 serious AEs in 22 patients). No deaths occurred during the trial. In this study, mirabegron therapy had a neutral effect on LV mass or diastolic function over 12 months among patients who had structural heart disease with no or mild HF symptoms. ClinicalTrials.gov Identifier: NCT02599480.

Electrocardiographic Markers of Adverse Left Ventricular Remodeling and Myocardial Fibrosis in Severe Aortic Stenosis.

The optimal timing for aortic valve replacement (AVR) in aortic stenosis (AS) is still controversial and may be guided by markers of adverse left ventricular (LV) remodeling. We aim to assess electrocardiographic (ECG) strain in relation to LV remodeling and myocardial fibrosis. 83 severe AS patients underwent surgical AVR, with preoperative 12-lead ECG, cardiovascular magnetic resonance with T1 mapping and echocardiography with global longitudinal strain analysis. Collagen volume fraction (CVF) was measured in myocardial biopsies sampled during AVR. Patients with ECG strain had more severe AS, more advanced LV remodeling and evidence of heart failure. Patients with ECG strain had more diffuse fibrosis, as evident by higher mean native T1 values (974.8 ± 34 ms vs. 946.5 ± 28 ms, p < 0.001). ECG strain was the only predictor of increased LV mass index on multivariate regression analysis (OR = 7.10, 95% CI 1.46-34.48, p = 0.02). Patients with persistent ECG strain at 1 year following AVR had more advanced LV remodeling and more histological fibrosis (CVF 12.5% vs. 7.3%, p = 0.009) at baseline assessment. Therefore, ECG strain is a marker of adverse LV remodeling and interstitial myocardial fibrosis. Lack of improvement in ECG strain following AVR indicates more advanced baseline LV injury and higher levels of myocardial fibrosis.

Right and left ventricular mass development in early infancy: Correlation of electrocardiographic changes with echocardiographic measurements

BackgroundRight ventricular mass indexed to body surface area (RVMI) decreases and left ventricular mass index (LVMI) increases rapidly and substantially during early infancy. The relationship between these sizeable mass transformations and simultaneous electrocardiographic changes have not been previously delineated. MethodsNormal term infants (#45 initially enrolled) were prospectively evaluated at 2 days and at 2-week, 2-month, and 4-month clinic visits. Ventricular masses were estimated with 2D echocardiographic methods. QRS voltages were measured in leads V1, V6, I and aVF. ResultsMean QRS axis shifted from 135 (95%CI 124, 146) to 65 degrees (95%CI 49, 81) and correlated with both RVMI decrease and LVMI increase (R = 0.46⁎ vs. 0.25†, respectively. *p < 0.01, †p < 0.05). As RVMI decreased from mean 28.1 (95%CI 27.1, 29.1) to 23.3 g/m2 (95%CI 21.4, 25.2) so did V1R and V6S voltages. RVMI changes correlated with V1R, V6S, and V1R + V6S voltages (R = 0.29*, 0.23† and 0.35*, respectively. *p < 0.01, †p < 0.05) but not with V1R/S ratio. As LVMI increased from 44.6 (95%CI 42.9, 46.3) to 55.4 g/m2 (95%CI 52.3, 58.5) V6R and V6Q increased but V1S voltage did not. LVMI changes correlated with V6R, V6R-S, and V6(Q + R)-S voltages (R = 0.31*, 0.34*, and 0.38* respectively. *p < 0.01) but not with V1S or V6R/S (R = 0.01 and 0.18 respectively, p = NS). Conclusions: During early infancy the RVMI decrease correlates best with the QRS axis shift and V1R + V6S voltage, and the LVMI increase correlates best with V6R-S and V6(Q + R)-S voltages

ASSOCIATION OF MAJOR ADVERSE CARDIOVASCULAR EVENTS AND ALL-CAUSE MORTALITY WITH LEFT VENTRICULAR GEOMETRY IN ELDERLY: THE NORTHERN SHANGHAI STUDY

Objective: To investigate the association of major adverse cardiovascular events and mortality with left ventricular geometry in elderly. Design and method: We prospectively recruited 3363 community-dwelling elderly (43.6% male, aged 71.1 ± 5.9 years; 56.4% female, aged 71.1 ± 6.1 years) from local community. Echocardiographic parameters were collected, left ventricular mass index (LVMi) above 115 g/m2 in male or 95 g/m2 in female, relative wall thickness (RWT) above 0.42 were considered as abnormal. Participants then were classified into 4 mutually exclusive groups as: normal geometry (normal LVMi and normal RWT), concentric remodeling (normal LVMi and increased RWT), eccentric hypertrophy (increased LVMi and normal RWT), concentric hypertrophy (increased LVMi and increased RWT). Cardiovascular death, non-fatal myocardial infarction including non-fatal ischemic stroke were recorded as incident MACE. Adjusted Cox regression models were used to evaluate the hazard ratios of MACE and all-cause mortality. Results: Mean LVMi and RWT were 87.0 ± 28.4 g/m2 and 0.39 ± 0.08. During a median follow-up of 5.4 years, we identified 224 incident MACE cases and 233 deaths. All-cause mortality was significantly greater in participants with eccentric hypertrophy (adjusted hazard ratio [HR]: 1.649; 95% confidence interval [CI]: 1.143-2.379) compared with normal geometry in multivariate analyses after adjusting for baseline covariates. Incident MACE was significant both in concentric hypertrophy (HR: 1.982; 95% CI: 1.239-3.170) and eccentric hypertrophy (HR: 1.846; 95% CI: 1.266-2.692) but not in concentric remodeling (HR:1.101; 95% CI: 0.759-1.597). Baseline LVMi was a significant predictor of all-cause mortality (HR: 1.047 per 10g/m2 increase in LVMi; 95% CI: 1.004-1.093). Similar results were observed with non-fatal myocardial infarction, non-fatal ischemic stroke and cardiovascular death. Conclusions: Increased baseline LVMi and abnormal left ventricular geometry portend an increased risk for incident MACE and all-cause mortality in community dwelling elderly. From the pathophysiology point of view, per 10 g/m2 increase in LVMi add 5% risk for all-cause mortality.

Blood pressure parameters affecting ventricular repolarization in obese children.

Ventricular repolarization (VR) increases the risk of sudden cardiac death due to ventricular arrhythmia. We aimed to evaluate the blood pressure (BP) parameters affecting VR in obese children. Obese (BMI ≥ 95p) and healthy children ≥ 120cm between January 2017 and June 2019 were included. Demographic and laboratory data, peripheral and central BPs evaluated by a device capable of ambulatory blood pressure monitoring (ABPM), and pulse wave analysis were assessed. Electrocardiographic ventricular repolarization indices, left ventricular mass index (LVMI), and relative wall thickness (RWT) were calculated. A total of 52 obese and 41 control patients were included. Uric acid, triglyceride, total cholesterol, LDL, and ALT values, systolic and diastolic office BPs, 24-h, daytime and nighttime systolic and mean arterial BPs, daytime diastolic BP SDS levels, daytime and nighttime systolic loads, daytime diastolic load, 24-h, daytime and nighttime central systolic and diastolic BPs, and pulse wave velocity values were significantly higher, whereas 24-h, daytime and nighttime AIx@75 were similar between the groups. fT4 levels of obese cases were significantly lower. QTcd and Tp-ed were higher in obese patients. Although RWT was higher in obese cases, LVMI values and cardiac geometry classifications were similar. The independent factors affecting VR in obese cases were younger age and higher diastolic load at night (B = - 2.83, p = 0.010; B = 0.257, p = 0.007, respectively). Obese patients have higher peripheral and central BP, arterial stiffness, and higher VR indices that develop before an increase in LVMI. It would be useful to prevent obesity from an early age and follow up nighttime diastolic load to control VR associated sudden cardiac death in obese children. A higher resolution version of the Graphical abstract is available as Supplementary information.

Relation of the left ventricular geometric patten to coronary artery disease in hypertensive patients using a 320-detector-row CT scanner

BackgroundIt was estimated that about 1.3 billion people were diagnosed to be hypertensive in 2015. All countries consistently show this high prevalence. Ischemic heart disease stands as the most common cause of systolic blood pressure-related deaths per year. Left ventricular hypertrophy determined by echocardiography can predict cardiovascular morbidity and mortality. The question of whether the LV geometric pattern has an additional prognostic value is still not clearly answered. Currently, coronary computed tomography is widely used in clinical practice with a great capability of simultaneous evaluation of the LV mass and the coronary arterial tree. Our study aims to examine the relationship between LV mass and geometry and coronary artery disease using an ECG-gated 320-detector- row CT scanner.ResultsTwo hundred ninety-eight hypertensive Egyptian individuals were enrolled in our study, the mean age was 57.5 ± 10.5, and males comprised 76.5% of the study population. The mean LV mass and LV mass index were 193 ± 60 gm and 95.2 ± 27.5 g/m2 respectively. One-fifth of the patient had CAD luminal stenosis ≥ 50%. Normal LV geometric pattern was observed in about 37% of the study population. About one-third of the patients showed concentric remodeling. Patients with increased LV mass index represented one-third of the study population with a greater percentage of the concentric hypertrophy pattern than the eccentric hypertrophy pattern. Patients with high CAD-RADS showed statistically significant higher LV mass, LV mass index, and septal wall thickness. Patients with high CAD-RADS showed a greater percentage of concentric and eccentric hypertrophy. The LV geometric pattern was the only independent predictor of the high CAD-RADS. The LV geometric patterns associated with high RADS ordered from the highest to the lowest, were concentric LVH, Eccentric LV, and concentric remodeling.ConclusionsLV geometric pattern is the only independent predictor of high CAD-RADS after adjustment for LV mass index and septal wall thickness. Among abnormal LV geometric patterns, concentric hypertrophy stands as the most important predictor of high CAD-RADS.

Left ventricular myocardial strain responding to chronic pressure overload in patients with resistant hypertension evaluated by feature-tracking CMR

ObjectivesThe study aimed to investigate the alterations of myocardial deformation responding to long-standing pressure overload and the effects of focal myocardial fibrosis using feature-tracking cardiac magnetic resonance (FT-CMR) in patients with resistant hypertension (RH).MethodsConsecutive RH patients were prospectively recruited and underwent CMR at a single institution. FT-CMR analyses based on cine images were applied to measure left ventricular (LV) peak systolic global longitudinal (GLS), radial (GRS), and circumferential strain (GCS). Functional and morphological CMR variables, and late gadolinium enhancement (LGE) imaging were also obtained.ResultsA total of 50 RH patients (63 ± 12 years, 32 men) and 18 normotensive controls (57 ± 8 years, 12 men) were studied. RH patients had a higher average systolic blood pressure than controls (166 ± 21 mmHg vs. 116 ± 8 mmHg, p < 0.001) with the intake of 5 ± 1 antihypertensive drugs. RH patients showed increased LV mass index (78 ± 15 g/m2 vs. 61 ± 9 g/m2, p < 0.001), decreased GLS (− 16 ± 3% vs. − 19 ± 2%, p = 0.001) and GRS (41 ± 12% vs. 48 ± 8%, p = 0.037), and GCS was reduced by trend (− 17 ± 4% vs. − 19 ± 4%, p = 0.078). Twenty-one (42%) RH patients demonstrated a LV focal myocardial fibrosis (LGE +). LGE + RH patients had higher LV mass index (85 ± 14 g/m2 vs. 73 ± 15 g/m2, p = 0.007) and attenuated GRS (37 ± 12% vs. 44 ± 12%, p = 0.048) compared to LGE − RH patients, whereas GLS (p = 0.146) and GCS (p = 0.961) were similar.ConclusionAttenuation of LV GLS and GRS, and GCS decline by tendency, might be adaptative changes responding to chronic pressure overload. There is a high incidence of focal myocardial fibrosis in RH patients, which is associated with reduced LV GRS.Clinical relevance statementFeature-tracking CMR-derived myocardial strain offers insights into the influence of long-standing pressure overload and of a myocardial fibrotic process on cardiac deformation in patients with resistant hypertension.Key Points• Variations of left ventricular strain are attributable to the degree of myocardial impairment in resistant hypertensive patients.• Focal myocardial fibrosis of the left ventricle is associated with attenuated global radial strain.• Feature-tracking CMR provides additional information on the attenuation of myocardial deformation responding to long-standing high blood pressure.

Abstract P665: Thoracic Aorta Calcification and Left Ventricular Structure and Function Relevant to Heart Failure: The Multi-Ethnic Study of Atherosclerosis (MESA)

Background: Aortic stiffness promotes left ventricular (LV) remodeling and dysfunction. Thoracic aorta calcification (TAC) contributes to aortic stiffness, but it remains unclear how TAC presence, volume, and density impact LV structure and function. We tested the hypothesis that TAC presence and higher volume is associated with increased LV mass index, decreased LV end-diastolic volume (LVEDV) index, and impaired mid-wall circumferential strain (Ecc). Methods: We evaluated 1,693 participants from the MESA who underwent chest CT and cardiac MRI from 2010 to 2012. We used linear regression models to determine cross-sectional associations between the presence, volume, and density of TAC with LV mass index, LVEDV index, and Ecc. Each pair of predictor and outcome variables underwent three model adjustments: (1) age, gender, and race/ethnicity; (2) Model 1 plus education level, height, weight, physical activity, sedentary behavior, smoking status, eGFR, SBP, DBP, anti-HTN medication use, total cholesterol/HDL ratio, statin use, and diabetes; (3) Model 2 plus coronary artery calcium (CAC) presence and volume. TAC volume and density were evaluated separately, then jointly in the same models. Results: The mean age was 69 years (SD 9) and 53% were female, while 39% were White, 26% Black, 21% Hispanic/Latino, 15% Chinese. TAC was present in 1,518 (90%) participants. TAC volume and density were highly correlated (r=0.75) with respective median 213 (25%ile, 75%ile: 36, 800) mm 3 and mean 350 (SD 110) Hounsfield Units. LV mass index, LVEDV index, and Ecc had respective means of 65 g/m 2 (SD 14), 120 mL/m 2 (SD 31), and -18.2% (SD 2.8). After full adjustment (Model 3 without density), a 10% increase in TAC volume was associated with a 1.8% multiplicative higher Ecc (i.e., less negative Ecc) (95% CI 0.2-3.4%, p=0.04) reflecting reduced LV systolic and diastolic function. Higher TAC volume was marginally associated with higher LV mass index: a 10% increase in TAC volume was associated with a 5.6% increase (-0.6-11.7%, p=0.08) in Model 2 without density, 13.9% (2.1-25.7%, p=0.03) in Model 2 with density, 3.9% (-2.5-10.4%, p=0.23) in Model 3 without density, and 11.3% (-1.0-23.7%, p=0.08) in Model 3 with density. After adjustments in Models 2 or 3, there were no other significant associations between TAC presence, volume, or density with the outcomes. Conclusions: Higher TAC volume is associated with impaired Ecc independent of CAC and marginally associated with higher LV mass index. These results suggest that the extent of TAC may influence LV remodeling and thus reduced function.

Defining Biventricular Abnormalities by Cardiac Magnetic Resonance in Pre-Dialysis Patients with Chronic Kidney Disease.

The aim of the study was to investigate biventricular structural and functional abnormalities in pre-dialysis patients across stages of chronic kidney disease (CKD) by cardiac magnetic resonance (CMR). Fifty-one CKD patients with CMR exams were retrospectively analyzed. Patients were divided into three groups according to estimated glomerular filtration rate (eGFR): CKD 1 group (patients with normal eGFR≥90 mL/min/1.73 m2, n = 20), CKD 2-3 group (patients with eGFR< 90 to ≥30 mL/min/1.73 m2, n = 14), and CKD 4-5 group (patients with eGFR<30 mL/min/1.73 m2, n = 17). Twenty-one age- and sex-matched healthy controls (HC) were recruited. CMR-derived left ventricular (LV) and right ventricular (RV) structural and functional measures were compared. Association between CMR parameters and clinical measures was assessed. There was an increasing trend in RV mass index (RVMi) and LV mass index (LVMi) with the occurrence and development of CKD from HC group to CKD 4-5 group although no significant difference was observed between CKD 1 group and HC group. LV global radial strain and LV global circumferential strain dropped and native T1 value elevated significantly in CKD 4-5 group compared with the other three groups (all p < 0.05), while RV strain measures, RV ejection fraction, and LV ejection fraction showed no significant difference among 4 groups (all p > 0.05). Elevated LV end-diastolic volume index (β = 0.356, p = 0.016) and RV end-systolic volume index (β = 0.488, p = 0.001) were independently associated with RVMi. Increased systolic blood pressure (β = 0.309, p = 0.004), LV end-systolic volume index (β = 0.633, p < 0.001), and uric acid (β = 0.261, p = 0.013) were independently associated with LVMi. Meanwhile, serum phosphorus (β = 0.519, p = 0.001) was independently associated with native T1 value. In pre-dialysis CKD patients, left and right ventricular remolding has occurred. RVMi and LVMi were the first changed CMR indexes in the development of CKD when eGFR began to drop. Because fluid volume overload was the independent risk factor for RVMi and LVMi increase, reasonable controlling fluid volume overload may slow down the progression of biventricular remolding and may reduce related cardiovascular disease risk.

Young athlete’s growing heart: sex differences in cardiac adaptation to exercise training during adolescence

BackgroundAthlete’s heart is a condition of exercise-induced cardiac remodelling. Adult male endurance athletes more often remodel beyond reference values. The impact of sex on remodelling through adolescence remains unclear. Paediatric...

Prevalence of cardiac arrhythmias among patients undergoing chronic hemodialysis

Aim. To evaluate the prevalence of arrhythmias in patients undergoing chronic hemodialysis, to characterize the arrhythmia types in relation to the dialysis procedure and to determine their relationship with clinical findings and echocardiographic characteristics.Material and methods. The study involved 152 patients with kidney failure undergoing chronic hemodialysis. All patients underwent an assessment of dialysis parameters, collection of clinical data, and 48-hour Holter monitoring. In addition, 93 patients underwent an echocardiography with an assessment of left ventricular (LV) mass index, LV ejection fraction, left atrial (LA) volume index, E/e’, cardiac output and preload, which was defined as increased LV filling pressure (E/e’ &gt;12) and LA enlargement (LA volume index &gt;30 ml/m2).Results. Among the 152 examined patients, premature supraventricular and ventricular contractions (PVCs) were observed in almost all patients, while 41% had paroxysmal supraventricular tachycardia. Clinically significant arrhythmias included persistent atrial fibrillation (AF) in 8,6% of patients, paroxysmal AF in 3,9%, nonsustained ventricular tachycardia in 19,7%, bradycardia in 4,6%, second-degree atrioventricular block in 1,3% and third-degree atrioventricular block among 2,6%. PVCs were more common on dialysis days, while tachyarrhythmias were more common during dialysis and in the immediate post- dialysis period. Older age (odds ratio (OR) 10 years older, 1,53; 95% confidence interval (CI): 1,15-2,03; P=0,003), lower cardiac output (OR 1 L/min more, 0,66; 95% CI: 0,44-1,00; P=0,05) were independently associated with clinically relevant arrhythmias.Conclusion. In patients on chronic hemodialysis, older age, increased preload and lower cardiac output are independently associated with clinically relevant arrhythmias. In addition, a positive association between increased LV mass index and AF episodes has been demonstrated. Lower cardiac output had positive correlation with AF and ventricular arrhythmias.