Left Ventricular Hypertrophy Index Research Articles

Comparison of reproducibility of conventional and signal-averaged electrocardiography

Objective. The aim of our study was to compare the reproducibility of signal-averaged and conventional electrocardiogram (ECG). Design and methods. The study group included 20 young healthy volunteers (10 men and 10 women, aged 18–25 years) examined twice with one-week interval. Twelve-lead and Frank’s orthogonal system ECG recordings were acquired during 5 minutes using computerized ECG device at each examination; conventional and averaged ECG analyses were performed. Mathematical processing to get averaged ECG in each lead was performed using original program «HR ECG». The sum of P wave, PQ interval, and QRS durations and the sum of P, Q, R, S, T waves amplitudes (amplitudes) in lead I of 12‑lead ECG and in lead Y in Frank’s lead system and left ventricular hypertrophy (LVH) indices (Sokolow-Lyon, Cornell voltage, Cornell product) were used for the evaluation of reproducibility. Results. Variation coefficients of durations between two evaluations of conventional and signal-averaged ECG were 13,1 % versus 4,8 % (p < 0,01) for lead I and 16 % versus 4,8 % (p < 0,01) for lead Y, respectively. Variation coefficients of amplitudes between two examinations of conventional and signal-averaged ECG were 12,2 % versus 7,2 % (p < 0,01) for lead I and 10,3 % versus 6,7 % for lead Y (p < 0,05), respectively. Variation coefficients of Sokolow-Lyon index, Cornell voltage and Cornell product were 12,3; 16,9 и 12,8 % versus 8,0; 14,2 и 10,1 %, respectively (p < 0,05 for all variables). Conclusions . The reproducibility of the signalaveraged ECG is significantly higher than the conventional one for interval duration, wave amplitude, as well as for LVH indices. The use of this method in clinical practice will increase the reliability of individual evaluation of myocardial changes at single examination and during follow-up. In studies with ECG control it may contribute to the decrease in study duration or group size required to reach statistically significant differences.

Heritabilities, proportions of heritabilities explained by GWAS findings, and implications of cross-phenotype effects on PR interval.

Electrocardiogram (ECG) measurements are a powerful tool for evaluating cardiac function and are widely used for the diagnosis and prediction of a variety of conditions, including myocardial infarction, cardiac arrhythmias, and sudden cardiac death. Recently, genome-wide association studies (GWASs) identified a large number of genes related to ECG parameter variability, specifically for the QT, QRS, and PR intervals. The aims of this study were to establish the heritability of ECG traits, including indices of left ventricular hypertrophy, and to directly assess the proportion of those heritabilities explained by GWAS variants. These analyses were conducted in a large, Dutch family-based cohort study, the Erasmus Rucphen Family study using variance component methods implemented in the SOLAR (Sequential Oligogenic Linkage Analysis Routines) software package. Heritability estimates ranged from 34 % for QRS and Cornell voltage product to 49 % for 12-lead sum. Trait-specific GWAS findings for each trait explained a fraction of their heritability (17 % for QRS, 4 % for QT, 2 % for PR, 3 % for Sokolow–Lyon index, and 4 % for 12-lead sum). The inclusion of all ECG-associated single nucleotide polymorphisms explained an additional 6 % of the heritability of PR. In conclusion, this study shows that, although GWAS explain a portion of ECG trait variability, a large amount of heritability remains to be explained. In addition, larger GWAS for PR are likely to detect loci already identified, particularly those observed for QRS and 12-lead sum.Electronic supplementary materialThe online version of this article (doi:10.1007/s00439-015-1595-9) contains supplementary material, which is available to authorized users.

Hypertrophic and antihypertrophic microRNA levels in peripheral blood mononuclear cells and their relationship to left ventricular hypertrophy in patients with essential hypertension

MicroRNAs regulate several aspects of physiological and pathologic cardiac hypertrophy, and they represent promising therapeutic targets in cardiovascular disease. We assessed the expression levels of the microRNAs miR-1, miR-133a, miR-26b, miR-208b, miR-499, and miR-21, in 102 patients with essential hypertension and 30 healthy individuals. All patients underwent two-dimensional echocardiography. MicroRNA expression levels in peripheral blood mononuclear cells were quantified by real-time reverse transcription polymerase chain reaction. Hypertensive patients showed significantly lower miR-133a (5.06 ± 0.50 vs. 13.20 ± 2.15, P < .001) and miR-26b (6.76 ± 0.53 vs. 9.36 ± 1.40, P = .037) and higher miR-1 (25.99 ± 3.07 vs. 12.28 ± 2.06, P = .019), miR-208b (22.29 ± 2.96 vs. 8.73 ± 1.59, P = .016), miR-499 (10.06 ± 1.05 vs. 5.70 ± 0.91, P = .033), and miR-21 (2.75 ± 0.15 vs. 1.82 ± 0.20, P = .002) expression levels compared with healthy controls. In hypertensive patients, we observed significant negative correlations of miR-1 (r = −0.374, P < .001) and miR-133a (r = −0.431, P < .001) and significant positive correlations of miR-26b (r = 0.302, P = .002), miR-208b (r = 0.426, P < .001), miR-499 (r = 0.433, P < .001) and miR-21 (r = 0.498, P < .001) expression levels with left ventricular mass index. Our data reveal that miR-1, miR-133a, miR-26b, miR-208b, miR-499, and miR-21 show distinct expression profiles in hypertensive patients relative to healthy individuals and they are associated with clinical indices of left ventricular hypertrophy in hypertensive patients. Thus, they may be related to heart hypertrophy in hypertensive patients and are possibly candidate therapeutic targets in hypertensive heart disease.

Short-term beat-to-beat variability of the QT interval is increased and correlates with parameters of left ventricular hypertrophy in patients with hypertrophic cardiomyopathy.

Stratification models for the prediction of sudden cardiac death (SCD) are inappropriate in patients with hypertrophic cardiomyopathy (HCM). We investigated conventional electrocardiogram (ECG) repolarization parameters and the beat-to-beat short-term QT interval variability (QT-STV), a new parameter of proarrhythmic risk, in 37 patients with HCM (21 males, average age 48 ± 15 years). Resting ECGs were recorded for 5 min and the frequency corrected QT interval (QTc), QT dispersion (QTd), beat-to-beat short-term variability of QT interval (QT-STV), and the duration of terminal part of T waves (Tpeak-Tend) were calculated. While all repolarization parameters were significantly increased in patients with HCM compared with the controls (QTc, 488 ± 61 vs. 434 ± 23 ms, p < 0.0001; QT-STV, 4.5 ± 2 vs. 3.2 ± 1 ms, p = 0.0002; Tpeak-Tend duration, 107 ± 27 vs. 91 ± 10 ms, p = 0.0015; QTd, 47 ± 17 vs. 34 ± 9 ms, p = 0.0002), QT-STV had the highest relative increase (+41%). QT-STV also showed the best correlation with indices of left ventricular (LV) hypertrophy, i.e., maximal LV wall thickness normalized for body surface area (BSA; r = 0.461, p = 0.004) or LV mass (determined by cardiac magnetic resonance imaging) normalized for BSA (r = 0.455, p = 0.015). In summary, beat-to-beat QT-STV showed the most marked increase in patients with HCM and may represent a novel marker that merits further testing for increased SCD risk in HCM.

PP.10.10

Objective: Increased short-term blood pressure variability (BPV) has been known to be related with target organ damages independent of blood pressure (BP) level. However, the effect of age on the relationship between BPV and left ventricular hypertrophy (LVH) has not been evaluated. We aimed to investigate the relationships between age, BPV, and LVH in a cross sectional study. Design and method: Among the 3,762 participants of the Korean ambulatory BP (KOR-ABP) registry, we assessed the data of 1,606 (42.7%) participants who had the record of echocardiography. As an index for 24-hour BPV, the average real variability (ARV) of systolic and diastolic BP was analyzed. We used left ventricular mass index (LVMI, LV mass divided by body surface area) as an index for LVH (LVH; > 95 g/m2 in women, > 115 g/m2 in men). Results: Mean age was 57.2 (SD 14.2) years, 857 (53.4%) were men, and 953 (59.3%) had hypertension (BP >140/90 mmHg or taking antihypertensive medications). Age was not associated with 24-hour average systolic BP (B = 0.037, P = 0.211), but associated with 24-hour average diastolic BP (B = -0.18, P < 0.001) by linear regression analysis. However, age was associated with both 24-hour ARV of systolic (B = 0.06, P < 0.001) and diastolic (B = 0.03, P = 0.014) BP. There were significant relationships of age and BPV on the presence of LVH, thus the older participants with increased BPV showed higher risk of having LVH.Conclusions: In KOR-ABP registry, age was associated with short-term BPV. Furthermore, there exist significant interactive effects of age and BPV on left ventricular hypertrophy.

R Wave in aVL Lead is a Robust Index of Left Ventricular Hypertrophy: A Cardiac MRI Study.

In patients free from overt cardiac disease, R wave in aVL lead (RaVL) is strongly correlated with left ventricular mass index (LVMI) assessed by transthoracic echocardiography. The aim of the present study was to extend this finding to other settings (cardiomyopathy or conduction disorders), by comparing ECG criteria of left ventricular hypertrophy (LVH) to cardiac MRI (CMR). In 501 patients, CMR and ECG were performed within a median-period of 5 days. CMR LVH cut-offs used were 83 g/m2 in men and 67 g/m2 in women. RaVL was independently correlated with LVMI in patients with or without myocardial infarction (MI) (N = 300 and N = 201, respectively). SV3 was independently correlated with LVMI and LV enlargement only in patients without MI. In the whole cohort, RaVL had area under receiver-operating characteristic curve of 0.729 (specificity 98.3%, sensitivity 19.6%, optimal cut-off 1.1 mV). The performance of RaVL was remarkable in women, in Caucasians, and in the presence of right bundle branch block. It decreased in case of MI. Overall, it is proposed that below 0.5 mV and above 1.0 mV, RaVL is sufficient to exclude or establish LVH. Between 0.5 and 1 mV, composite indices (Cornell voltage or product) should be used. Using this algorithm allowed classifying appropriately 85% of the patients. Our results showed that RaVL is a good index of LVH with a univocal threshold of 1.0 mV in various clinical conditions. SV3 may be combined to RaVL in some conditions, namely LV enlargement to increase its performance.

0352: R wave in AVL lead is a robust index of left ventricular hypertrophy: a cardiac MRI study

in patient free from overt cardiac disease and conduction disorders, R wave in aVL lead (RaVL) is better correlated than other ECG indexes with left ventricular mass index (LVMI) assessed with transthoracic echocardiography. The aim of this study was to validate RaVL as an index of left ventricular hypertrophy (LVH) using cardiac MRI (CMR) in different conditions. In a cohort of 501 patients, CMR and ECG were performed within a median-period of 5 days. The CMR LVH cut-offs used were 83g/m 2 in men and 67g/m 2 in women. In mutivariable analysis (adjusted for age, left ventricular volume, blood pressure, age and gender), RaVL was correlated with LVMI in the whole cohort and also in patients with or without myocardial infarction (MI): β=0.037, p<0.001; β=0.053, p<0.001; β=0.039, p=0.010, respectively. In the whole cohort, area under ROC curve (AUC) was 0.729 (specificity 98.3%, sensitivity 19.6%, optimal cut-off 1.1 mV, 75.8% correctly classified). In the subgroup without MI (N=300), an optimal value of 1.0 mV classified correctly 80.7% of patients (AUC 0.781, specificity 95.5%, sensitivity 35.5%). In the subgroup with MI (N=201), RaVL had a lower diagnostic performance (AUC 0.673, specificity 97.7%, sensitivity 13.2%, optimal threshold 1.1 mV). We observed the same diagnostic performance of RaVL in women and in men without MI (optimal threshold 1.0 mV, AUC 0.788 and 0.778 respectively).The diagnostic value of RaVL was lower in patients with left bundle branch block (BBB) or left deviation axis in comparison with those having right BBB (optimal threshold 1.0 mV for all, AUC 0.556, 0.753 and 0.933 respectively). Using the gold standard to assess LVMI, our results demonstrated thar RaVL is a good index of LVH with a threshold around 1.0 mV independently of various clinical conditions.

0367: Significance of different ECG indices for left ventricular enlargement assessment: a cardiac MRI study

Numerous ECG indices have been developed to diagnose left ventricular (LV) hypertrophy but ECG indexes assessing LV enlargement are lacking. The aim of the present study was to address the capacity of different ECG parameters to predict LV enlargement in different conditions, including myocardial infarction (MI), using cardiac MRI (CMR). In a cohort of 501 patients with various clinical conditions, CMR and ECG were performed within a median period of 5 days. LV enlargement was defined by a LV end-diastolic volume indexed to body surface area (LVEDVI) >92 ml/m 2 . In the whole cohort, amplitudes of RaVL, SV3, SV1 and QRS duration correlated in univariate analysis with LVEDVI (R=0.108, 0.304, 0161 and 0.256 respectively, p<0.01 for all). In multivariable analysis (adjusted for age, BMI, LV mass index, systolic blood pressure and gender), only QRS duration and SV3 remained associated with LVEDVI (β=0.130, p<0.001; β=0.057, p<0.001, respectively). Areas under ROC curves (AUC) demonstrate that SV3 had the best performance to predict LV enlargement (AUC 0.701, specificity 96.9%, sensitivity 19.1%, optimal threshold 2.2 mV, see figure). In patients without MI (N=300), SV3 and QRS duration were independently correlated with LEVDVI (β =0.051, p<0.001; β=0.273, p<0.001, respectively), while in patient with MI only SV3 remained independently correlated with LEVDVI (β =0.051, p<0.001). AUC for SV3 were lower in patients with MI than those without (0.681 vs. 0.708), in women than in men (0.673 vs. 0.706) and in patients with QRS duration <120ms than those without (0.685 vs. 0.787). The optimal threshold of SV3 varies from 1.7 to 2.2 mV according to different subgroups of patients. Using the gold standard to assess LV volume, our results demonstrated that SV3 had a good specificity to detect LV enlargement. Abstract 0367 - Figure: ROC curves to predict left ventricular enlargement

Dependence of the index of left ventricular hypertrophy in hypertensive patients on Arg389Gly polymorphism of β1-adrenoceptor gene and T393C of α-subunit of G-protein gene

Aim. Left ventricular hypertrophy (LVH) is an independent risk factor for cardiovascular complications. Every year the number of publications written concerning the genetic determinism of its progression is increasing. To determine the dependence of LVH on Arg389Gly polymorphisms of β1-adrenoceptor gene (ADRβ1) and T393C of α-subunit of G-protein gene (GNAS1) the echocardiography and polymerase chain reaction were performed in 166 patients with hypertension.Methods and results. It was found that in men, who had T393T genotype, higher levels of left ventricular myocardium mass and index of left ventricular myocardium mass were observed comparing to patients with T393C and C393C genotype of GNAS1 gene.Conclusion. The dependence of these parameters on Arg389Gly polymorphism of ADRβ1 gene was not found.

Evidence of a hyperkinetic state in children with elevated blood pressure

Background: Left ventricular hypertrophy (LVH) and elevated left ventricular mass index (LVMI) are important predictors of cardiovascular morbidity and mortality in adults. Children with hypertension and pre-hypertension demonstrate LVH and greater LVMI compared to normotensive children. The impact of blood pressure (BP) on early changes in left ventricular properties provides an opportunity to understand and identify cardiovascular risk early in childhood.Aim: The aim of this study was to assess left ventricular structural and functional properties in a sample of children across a wide range of BP values.Subjects and methods: Children aged 11–14-years were divided into BP groups: hypertensives (HTN; ≥95th percentile; n = 21) and normotensives (NTN; <90th percentile; n = 85) based on BP measures taken at two time points. Resting supine heart rate (HR), cardiac output (CO) and total peripheral resistance (TPR) were collected along with left ventricular structural and functional properties using ultrasound sonography. Results: LVMI and TPR were not different between groups. CO, HR and left ventricular end-diastolic and end-systolic volumes were elevated in the HTN group. Furthermore, HR and body mass index were found to be independent predictors of BP group status in children.Conclusion: These findings show that children with elevated BP are characterized by high HR and CO and normal TPR. Also, the results identify HR as a predictor of BP group status in early childhood.

Normal values of the electrocardiogram for ages 16–90 years

IntroductionTo establish an up-to-date and comprehensive set of normal values for the clinically current measurements in the adult ECG, covering all ages for both sexes. MethodsThe study population included 13,354 individuals, taken from four population studies in The Netherlands, ranging in age from 16 to 90years (55% men) and cardiologically healthy by commonly accepted criteria. Standard 12-lead ECGs were available for all participants. The ECGs were processed by a well-validated computer program. Normal limits were taken as the 2nd and 98th percentiles of the measurement distribution per age group. ResultsOur study corroborates many findings of previous studies, but also provides more differentiated results, in particular for the older age groups. Age trends were apparent for the QTc interval, QRS axis, and indices of left ventricular hypertrophy. Amplitudes in the left precordial leads showed a substantial increase in the older age groups for women, but not for men. Sex-dependent differences were apparent for most ECG parameters. All results are available on the Website www.normalecg.org, both in tabular and in graphical format. ConclusionsWe determined age- and sex-dependent normal values of the adult ECG. Our study distinguishes itself from other studies by the large size of the study population, comprising both sexes, the broad range of ages, and the exhaustive set of measurements. Our results emphasize that most diagnostic ECG criteria should be age- and sex-specific.

Dénervation rénale dans le traitement de l’hypertension artérielle résistante : expérience du CHU de Lyon

AimWe report the first experience of Lyon's university hospital regarding renal denervation to treat patients with resistant essential hypertension. Patients and methodsOver a one-year period, 17 patients were treated (12 men, 5 women) with renal denervation. Baseline characteristics were as follows: age 56.5±11.5 years, BMI 33±5kg/m2 and ambulatory blood pressure 157±16/87±13mmHg with 4.2±1.5 anti-hypertensive treatment. ResultsWe did not observe per procedural and early complications. After a median follow-up of 3 months and with the same anti-hypertensive treatment, office systolic blood pressure (SBP) and diastolic blood pressure (DBP) decrease respectively of 20±15 (P<0.001) and 10±13mmHg (P=0.014) (n=17). After six months of follow-up, ambulatory blood pressure (ABPM) decrease of 17.5±14.9mmHg (P=0.027) for SBP and of 10.5±9.6mmHg (P=0.029) for DBP (n=6). Among these patients, five of them were controlled (ABPM inferior to 130/80mmHg) and electrical left ventricular hypertrophy indexes decreased: R wave in aVL lead of 4±3mm (P=0.031), Sokolow index of 3±3mm (P=0.205), Cornell voltage criterion of 9±7mm (P=0.027) and Cornell product of 1310±1104 (P=0.027). ConclusionOur results are in accordance with data from other centers. On average blood pressure decreases significantly but important inter individual variations are observed. The procedure seems safe.

Noninvasive Risk Stratification of Patients With Transthyretin Amyloidosis

We sought to evaluate noninvasive parameters by electrocardiography, echocardiography, technetium-99m-3,3-diphosphono-1,2-propanodicarboxylic acid ((99m)Tc-DPD) scintigraphy, and cardiac magnetic resonance for the prediction of all-cause mortality in patients with cardiac transthyretin amyloidosis (ATTR). ATTR may present with highly variable symptoms, including polyneuropathy and cardiomyopathy, the latter being associated with a poor outcome. However, data on noninvasive risk stratification of ATTR are limited. A total of 70 patients with ATTR were evaluated by echocardiography, cardiac biomarkers, and (99m)Tc-DPD scintigraphy. Cardiac magnetic resonance was performed in 30 patients. Echocardiographic findings and plasma levels of biomarkers were correlated with results of quantitative analysis of scintigraphy using a region-of-interest technique (whole-body as well as heart tracer retention). Receiver-operating characteristic (ROC) analysis was performed to calculate a cutoff value of (99m)Tc-DPD scintigraphy for heart retention for the diagnosis of cardiac amyloid involvement with the highest sensitivity and specificity. Univariate and multivariate analyses were performed in patients with cardiac involvement (n= 60) to determine noninvasive predictors of all-cause mortality. Scintigraphy findings correlated with morphological (interventricular septum thickness, left ventricular hypertrophy index) as well as functional (mitral annular systolic velocity, mitral/tricuspid annular plane systolic excursion) findings, cardiac biomarkers, renal function, and late gadolinium enhancement. The ROC-derived cutoff for the detection of cardiac amyloidosis by scintigraphic heart tracer retention was 4.8%. Univariate Cox regression revealed N-terminal pro-B-type natriuretic peptide, troponin T, mitral annular plane systolic excursion, and left ventricular hypertrophy index as predictors of all-cause mortality. However, on multivariate analysis, troponin T remained the only independent predictor of survival. The ROC-derived cutoff value of troponin T predicting all-cause mortality with the highest sensitivity (80.0%) and specificity (68.7%) was 0.0375 ng/l. Quantitative analysis of tracer retention is capable of characterizing the severity of cardiac involvement in ATTR. By multivariate analysis, troponin T remained the only independent predictor of survival.

Abstract P253: Genome-Wide Association Study of Electrocardiographic Left Ventricular Hypertrophy among Persons of European Ancestry: the Kaiser Permanente/UCSF GERA Cohort

Electrocardiographic (ECG)-derived left ventricular hypertrophy (LVH) is a recognized phenotype of hypertensive target organ damage and an independent risk factor for cardiovascular disease morbidity and mortality, and has been shown to be 20 to 40% heritable. A major prior collaborative study (EchoGen) relied on echocardiography measurement of LVH. We report here the results of the first genome-wide association study of an ECG index of LVH, the Cornell voltage, in a large US, population-based cohort. The Kaiser Permanente/UCSF Genetic Epidemiology Research on Adult Health and Aging (GERA) Cohort enrolled 110,266 persons, of whom 84,760 (77%) were of European ancestry (EA). Twelve-lead ECGs (obtained as part of routine medical care) were available in 59% (n=52,423; 62% female, mean age ± SD, 62 ± 13 years) of EA members of the GERA cohort. For those with more than 1 ECG (75%), one was selected at random. We programmatically derived from the digital tracings the Cornell voltage as R in aVL plus S in V3 (in mV). Mean ± SD Cornell voltages were 1.39 ± 0.58 mV in men and 1.16 ± 0.55 mV in women. Genotypes were generated on 674,518 SNPs using a custom designed Affymetrix Axiom array, and imputation was conducted using the 1000 Genomes data as a reference set. We identified 10 genetic loci (nearest genes: NFIA, CRIM1, CCDC141, HAND1, VGLL2, CTNNA, TBX3, SIPA1L1, ZNF595, and PROCR) with genome-wide significant associations (p&lt;5*10 -8 ) with Cornell voltage as a continuous variable. Five of the loci (NFIA, CRIM1, HAND1, TBX3, and SIPA1L1) have previously been reported to influence QRS and PR intervals, while the other loci are novel. Interestingly, none of these loci were associated with left ventricular mass in the EchoGen consortium. Sex-specific analyses supported the association of these loci in both men and women; six loci were associated at a genome-wide significant level in these stratified analyses, including TBX3 and ZNF595 in both men and women, CCDC141, SIPA1L1, and PROCR in men, and VGLL2 in women, despite reduced sample sizes. These results may help elucidate both the biological and genetic basis of this clinically relevant phenotype.

Fabry disease: multidisciplinary evaluation after 10 years of treatment with agalsidase Beta.

Fabry disease is an X linked disorder of metabolism due to deficient α-galactosidase A activity. Enzyme replacement therapy (ERT) with agalsidase Beta was approved by EMA in 2001 and FDA in 2003. Six patients were enrolled. Baseline data was measured for renal, cardiac, and cerebrovascular functioning. We compared baseline quality of life scales with the current results. These parameters were assessed during the 10years of follow-up period. Before ERT four patients showed normal eGFR, one stage 2 of CKD, and one hyperfiltration stage. All presented microalbuminuria and just two cases showed proteinuria. After 10years of ERT, no patient showed decrease in renal functioning. One patient decreased from proteinuria to microalbuminuria range. Before treatment one case showed left ventricular (LV) hypertrophy and LV Mass Index was abnormal in two female patients. After 10years echocardiographic values did not present progression to LVH and one female showed regression to normal values of LV posterior wall and interventricular septum. Brain MRI showed ischemic lesions in one female and vertebrobasilar dolichoectasia in one male. From baseline and during the follow-up period MRI did not progress to new ischemic lesions and there were no clinical signs of cerebrovascular damage. After 10years quality of life showed improvement in all domains measured. Early treatment of agalsidase Beta is related to a better outcome regarding stability and regression of signs and symptoms in Fabry disease. Our results in patients with mild organ involvement showed good outcomes and support an early and continuous ERT.

Left ventricular geometry and outcomes in patients with atrial fibrillation: The AFFIRM Trial

BackgroundEchocardiographically determined left ventricular hypertrophy (LVH) is a marker of cardiovascular disease related to prognosis and clinical outcomes. We sought to determine if LVH is a measure of outcomes in atrial fibrillation (AF) patients. MethodsWe performed a post-hoc analysis of patients with echocardiographic data enrolled in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Trial. Patients were stratified based on gender-adjusted echocardiography derived interventricular septal (IVS) thickness, relative wall thickness (RWT), gender-adjusted LV mass, and type of LV remodeling (normal LV geometry, concentric hypertrophy, eccentric hypertrophy, and concentric remodeling). ResultsOf 4060 patients in AFFIRM, echocardiographic data were available in 2433 patients (60%). Multivariate analysis revealed that LVH defined as moderately or severely abnormal IVS thickness was an independent predictor of both all cause mortality (HR 1.46, 95%CI 1.14–1.86, p=0.003) and stroke (HR 1.89, 95%CI 1.17–3.08, p=0.01). This association was confirmed when IVS thickness was assessed as continuous or categorical variable. Concentric LV hypertrophy was associated with the highest rates of all cause mortality (HR 1.53; 95%CI 1.11–2.12; p=0.009). ConclusionAn easily obtained echocardiographic index of LVH (IVS thickness) may enhance risk stratification of patients with AF, and raise the possibility that LVH regression should be a therapeutic target in this population.

Effect of Combined Systolic and Diastolic Functional Parameter Assessment for Differentiation of Cardiac Amyloidosis From Other Causes of Concentric Left Ventricular Hypertrophy

Differentiation of cardiac amyloidosis (CA) from other causes of concentric left ventricular hypertrophy remains a clinical challenge, especially in patients with preserved ejection fraction at the early disease stages. Consecutive hypertrophic patients with CA, isolated arterial hypertension, Fabry disease, and Friedreich ataxia (n=25 per group) were investigated; 25 healthy volunteers served as a control group. Standard echocardiography was performed, and segmental longitudinal peak systolic strain (LSsys) in the septum was assessed by 2-dimensional speckle tracking imaging. Indices of left ventricular hypertrophy and ejection fraction were similar among all patient groups. Deceleration time of early filling was significantly lower in patients with CA (147±46 milliseconds) compared with those with isolated arterial hypertension, Fabry disease, or control subjects (all P<0.0125). Septal basal LSsys (-6±2%) was significantly lower in patients with CA compared with those with isolated arterial hypertension (-14±6%), Fabry disease (-12±5%), Friedreich ataxia (-16±2%), or control subjects (-17±3%; all P<0.001), whereas septal apical LSsys was similar among all patient groups and control subjects (all P>0.05). A data-driven cutoff value for the ratio of septal apical to basal LSsys ratio >2.1 differentiated CA from other causes of left ventricular hypertrophy (sensitivity, 88%; specificity, 85%; positive predictive value, 67%; negative predictive value, 96%). The prevalence of septal apical to basal LSsys ratio >2.1 plus deceleration time of early filling <200 milliseconds was 88% in CA but 0% in all other groups. A systolic septal longitudinal base-to-apex strain gradient (septal apical to basal LSsys ratio >2.1), combined with a shortened diastolic deceleration time of early filling (deceleration time of early filling <200 milliseconds), aids in differentiating CA from other causes of concentric left ventricular hypertrophy.

Advanced diffuse fibrosis is associated with mid-wall fibrosis in patients with aortic stenosis

Purpose: To determine the association between diffuse fibrosis by T1 mapping and mid-wall fibrosis (MwF) by delayed enhancement in patients with aortic stenosis (AS). Methods: In a prospective study, patients with AS and no myocardial infarction underwent cardiovascular magnetic resonance (CMR) at 3T. Using modified look-locker inversion sequences, T1 maps were generated pre- and 20 min post-contrast (gadobutrol, 0.1 mmol/kg). Contrast volume of distribution (Vd; ΔRmyocardium/ΔRbloodx[1-hematocrit], where ΔR=1/post-contrast T1–1/pre-contrast T1) was measured at the short-axis, mid-cavity level in patients without MwF. In patients with MwF, Vd was measured at the short-axis level of MwF, excluding regions of enhancement. AS severity was assessed with echocardiography [aortic valve area, mean pressure gradient, trans-aortic velocity (Vm)]. Indices of left ventricular hypertrophy were evaluated with CMR [indexed left ventricular mass (LVMi) and mass/volume ratio (M/V; LVM/end-diastolic volume)]. Logistic regression was used to determine the association between Vd and MwF, adjusting for potential confounders. Results: Sixty patients were studied (70% males; 71±9 years, Vm 3.6±0.9m/s). MwF was identified in 33%. Patients with MwF had higher LVMi (91±22 vs. 79±16g/m2, p=0.03), M/V (1.21±0.22 vs. 1.08±0.19, p=0.02), Vm (3.9±0.7 vs. 3.5±0.9m/s, p=0.04) and Vd (28.7±2.5 vs. 26.7±2.0%, p<0.01). After adjusting for age, gender, AS severity and left ventricular remodeling indices, Vd was independently associated with MwF (odds ratio 1.55, 95% confidence interval 1.04-2.32). ![Figure][1] Conclusions: MwF is independently associated with an increased level of diffuse fibrosis. Diffuse fibrosis by T1 mapping is an early marker of myocardial response to ventricular hypertrophy. [1]: pending:yes

GW24-e3975 Plasma brain natriuretic peptide lever between dynamic blood pressure and left ventricular hypertrophy in elderly hyperension

ObjectivesTo study the relationship between parameters of 24 hour dynamic blood pressure (BP) and plasma brain natriuretic peptide and left ventricular hypertrophy in elderly Hyperension patients.MethodsAmbulatory BP monitoring (ABPM) for...

The association of ankle brachial index with left ventricular hypertrophy and left ventricular mass index: the Dong-gu study

To investigate the association between ankle-brachial index (ABI), left ventricular hypertrophy (LVH) and left ventricular mass index (LVMI) in a general population. The study population consisted of 8,246 people aged 50 years and older who participated in the baseline survey of the Dong-gu Study conducted in Korea between 2007 and 2010. Trained research technicians measured LV mass using mode M ultrasound echocardiography and ABI using an oscillometric method. After adjustment for risk factors and common carotid artery intima-media thickness (CCA-IMT) and the number of plaques, higher ABIs (1.10 1.19, 1.20 - 1.29, and ≥ 1.30) were significantly and linearly associated with high LVMI (1.10 - 1.19 ABI: β, 3.33; 95 % CI, 1.72 - 4.93; 1.20 - 1.29 ABI: β, 6.51; 95 % CI, 4.02 - 9.00; ≥ 1.30 ABI: β, 14.83; 95 % CI, 6.18 - 23.48). An ABI of 1.10 - 1.19 and 1.20 - 1.29 ABI was significantly associated with LVH (1.10 - 1.19 ABI: OR, 1.35; 95 % CI, 1.19 - 1.53; 1.20 - 1.29 ABI: OR, 1.59; 95 % CI, 1.31 - 1.92) and ABI ≥ 1.30 was marginally associated with LVH (OR, 1.73; 95 % CI, 0.93 - 3.22, p = 0.078). After adjustment for other cardiovascular variables and CCA-IMT and the number of plaques, higher ABIs are associated with LVH and LVMI in Koreans aged 50 years and older.