Left Cardiac Structure Research Articles

THE INFLUENCE OF EXTREME DIPPING PRESSURE ON LEFT VENTRICULAR HYPERTROPHY IN GENERAL POPULATION

Objective: Extreme dipping pressure, characterized by a nighttime decrease of over 20% compared to daytime levels, lacks consensus regarding its influence on cardiac structure and function. Particularly in the general population, there's limited research on this common blood pressure pattern. This study aims to investigate the relationship between extreme dipping pressure and cardiac structure and function in a general population. Design and method: We conducted 24-hour ambulatory blood pressure monitoring in 673 individuals without hypertension to assess blood pressure patterns. We analyzed the association between extreme dipping pressure and left cardiac structure, left ventricular hypertrophy (LVH), and left ventricular diastolic function. Results: Using a criterion of a nighttime decrease of over 20% in systolic and/or diastolic blood pressure, extreme dipping pressure was observed in 15.8% (107/673) of the general population. LVH prevalence in this study was 18.9% (127/673), with extreme dipping, non-dipping, and dipping patterns observed in 12.6%, 39.4%, and 48.0%, respectively, in the LVH group. In the non-LVH group, these patterns were observed in 16.5%, 47.8%, and 35.7%, respectively. A significant difference in distribution between different blood pressure patterns existed between the LVH and non-LVH groups (p=0.19). Univariate analysis indicated that, compared to the non-dipping pattern, extreme dipping was a protective factor for LVH occurrence (p=0.045, OR 0.173, 95%CI 0.031-0.959). Even after adjusting for factors such as gender, age, BMI, left ventricular size, interventricular septum thickness, left ventricular posterior wall thickness, and overall blood pressure, extreme dipping remained a protective factor for LVH occurrence (p=0.019, OR 0.187, 95%CI 0.046-0.756). Conclusions: Our study indicates that extreme dipping pressure is relatively common in the general population and is closely associated with LVH occurrence. In the general population, extreme dipping independently reduces the occurrence of LVH.

Cardiac remodelling in non-alcoholic fatty liver disease in the general population.

Non-alcoholic fatty liver disease (NAFLD) is associated with increased risk for cardiovascular disease. Our study investigates the contribution of NAFLD to changes in cardiac structure and function in a general population. One thousand ninety-six adults (49.3% female) from the Study of Health in Pomerania underwent magnetic resonance imaging including cardiac and liver imaging. The presence of NAFLD by proton density fat fraction was related to left cardiac structure and function. Results were adjusted for clinical confounders using multivariable linear regression model. The prevalence for NAFLD was 35.9%. In adjusted multivariable linear regression models, NAFLD was positively associated with higher left ventricular mass index (β = 0.95; 95% confidence interval (CI): 0.45; 1.45), left ventricular concentricity (β = 0.043; 95% CI: 0.031; 0.056), left ventricular end-diastolic wall thickness (β = 0.29; 95% CI: 0.20; 0.38), left atrial end-diastolic volume index (β = 0.67; 95% CI: 0.01; 1.32) and inversely associated with left ventricular end-diastolic volume index (β = -0.78; 95% CI: -1.51; -0.05). When stratified by sex, we only found significant positive associations of NAFLD with left ventricular mass index, left atrial end-diastolic volume index, left ventricular cardiac output and an inverse association with global longitudinal strain in women. In contrast, men had an inverse association with left ventricular end-diastolic volume index and left ventricular stroke volume. Higher liver fat content was stronger associated with higher left ventricular mass index, left ventricular concentricity and left ventricular end-diastolic wall thickness. NAFLD is associated with cardiac remodelling in the general population showing sex specific patterns in cardiac structure and function.

The effect of sodium-glucose cotransporter 2 inhibitors on left cardiac remodelling in heart failure with reduced ejection fraction: Systematic review and meta-analysis.

The therapeutic mechanism of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on left cardiac remodelling in patients with heart failure with reduced ejection fraction (HFrEF) is not well-established. This study meta-analysed the impact of SGLT2i on left cardiac structure and function in patients with HFrEF. Online databases were queried up to April 2023 for trials reporting indicators of left cardiac structure and function in patients with HFrEF treated with SGLT2i. Data from studies were pooled using a random-effects model to derive weighted mean differences (WMDs) and 95% confidence intervals (CIs). Six trials were included (n = 555). Compared with control, SGLT2i significantly improved left ventricular end-diastolic volume (LVEDV; WMD: -17.07 ml [-23.84, -10.31]; p < 0.001), LVEDV index (WMD: -5.62 ml/m2 [-10.28, -0.97]; p = 0.02), left ventricular end-systolic volume (LVESV; WMD: -15.63 ml [-26.15, -5.12]; p = 0.004), LVESV index (WMD: -6.90 ml/m2 [-10.68, -3.11]; p = 0.001), left ventricular ejection fraction (WMD: 2.71% [0.70, 4.72]; p = 0.008), and left atrial volume index (WMD: -2.19 ml/m2 [-4.26, -0.11]; p = 0.04) in patients with HFrEF. SGLT2i use was associated with a non-significant trend towards a reduction in left ventricular mass index (WMD: -6.25 g/m2 [-12.79, 0.28]; p = 0.06). No significant impact on left ventricular global longitudinal strain was noted (WMD: 0.21% [-0.25, 0.67]; p = 0.38). Sodium-glucose cotransporter 2 inhibitors improve cardiac structure and function in patients with HFrEF.

Echocardiographic assessment of left cardiac structure and function in antiretroviral therapy (ART)-naïve people living with HIV/AIDS.

Patients with human immunodeficiency virus (HIV) are at a significantly higher risk of cardiovascular disease (CVD) compared to HIV-negative people. Left heart dysfunction is the most common cardiac complication in people living with HIV/acquired immune deficiency syndrome (PLWHA), and diastolic dysfunction is an important predictor of cardiovascular events. The aims of this study were (1) to detect changes in left cardiac structure and function in antiretroviral therapy (ART)-naive PLWHA using echocardiography; and (2) to investigate the risk factors for the development of left ventricular diastolic dysfunction (LVDD) in ART-naive PLWHA. We retrospectively included 105 ART-naïve PLWHA and included 90 healthy subjects as controls to compare the differences in left heart structure and function between the two groups. Univariate and multifactorial logistic regression were employed to explore the risk factors of the development of LVDD in ART-naive PLWHA. The left ventricular end-diastolic internal diameter (LVEDD), left ventricular mass index (LVMI), and left atrial volume index (LAVI) were significantly greater in PLWHA than in controls (p < .05). The E/A ratio, lateral e' velocity, and mitral deceleration time were significantly lower in PLWHA than in controls (p < .05). Average E/e' ratio was significantly higher in PLWHA than in controls (p < .05). Left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) were not significantly different between PLWHA and controls (p > .05). Multifactorial logistic regression analysis showed that age, body mass index (BMI), and CD4+ count <200 cells/μL were independent risk factors for LVDD in ART-naive PLWHA (OR = 1.781, 1.228, 3.683, p < .05). Left ventricular systolic function did not differ between PLWHA and controls, and left ventricular diastolic function was lower in PLWHA than in controls. Age, BMI, and CD4+ count were independent factors affecting LVDD in ART-naive PLWHA.

Exercise Training Does Not Attenuate Cardiac Atrophy or Loss of Function in Individuals With Acute Spinal Cord Injury: A Pilot Study

ObjectiveTo investigate the effects of 2 modes of exercise training, upper-body alone, and the addition of electrical stimulation of the lower body, to attenuate cardiac atrophy and loss of function in individuals with acute spinal cord injury (SCI). DesignRandomized controlled trial. SettingRehabilitation Hospital. ParticipantsVolunteers (N=27; 5 women, 22 men) who were <24 months post SCI. InterventionsVolunteers completed either 6 months of no structured exercise (Control), arm rowing (AO), or a combination of arm rowing with electrical stimulation of lower body paralyzed muscle (functional electrical stimulation [FES] rowing). Main Outcome MeasuresTransthoracic echocardiography was performed on each subject prior to and 6 months after the intervention. The relations between time since injury and exercise type to cardiac structure and function were assessed via 2-way repeated-measures analysis of variance and with multilevel linear regression. ResultsTime since injury was significantly associated with a continuous decline in cardiac structure and systolic function, specifically, a reduction in left ventricular mass (0.197 g/month; P=.049), internal diameter during systole (0.255 mm/month; P<.001), and diastole (0.217 mm/month; P=.019), as well as cardiac output (0.048 L/month, P=.019), and left ventricular percent shortening (0.256 %/month; P=.027). These associations were not differentially affected by exercise (Control vs AO vs FES, P>.05). ConclusionsThese results indicate that within the subacute phase of recovery from SCI there is a linear loss of left ventricular cardiac structure and systolic function that is not attenuated by current rehabilitative aerobic exercise practices. Reductions in cardiac structure and function may increase the risk of cardiovascular disease in individuals with SCI and warrants further interventions to prevent cardiac decline.

Association of long-term exposure to ambient air pollutants with cardiac structure and cardiovascular function in Chinese adults

Epidemiological evidence increasingly suggests that air pollutants are intimately associated with the incidence and mortality of cardiovascular diseases (CVDs). However, studies on the association between chronic exposure to air pollutants and changes in left cardiac function and structure are limited. In our cross-sectional study, 3145 participants were enrolled from 6 provinces to explore the relationship between long-term air pollutants, cardiac structure, and cardiovascular function (e.g., blood lipids, blood pressure and pulse) in Chinese adults. Our study showed that exposure to five pollutants (NO2, O3, PM1, PM2.5 and PM10) was associated with reduced left ventricular systolic function based on EF and SV parameters. These pollutants were also associated with increased pulses, where smaller particle sizes correlated significantly with pulses. Second, except for O3, four pollutants were associated with decreased left ventricular diastolic parameters LVIDd and EDV and increased cardiac structural parameter IVSd. In addition, exposures to NO2, O3 and PM10 were positively correlated with triglycerides in blood lipids. Overall, this study showed that chronic pollutant exposure is strongly associated with impaired left ventricular function in Chinese adults.

Monocyte to High-Density Lipoprotein Cholesterol Ratio Is Associated with Subclinical Left Cardiac Remodeling and Dysfunction in Type 2 Diabetes Mellitus

Chronic inflammation is involved in the development of heart failure (HF) in type 2 diabetes mellitus (T2DM). However, reliable and easily accessible biomarker of subclinical left cardiac remodeling and dysfunction remains a challenge.Overall, 1020 patients with T2DM without overt HF were enrolled from May 2019 to April 2020. Monocyte to high-density lipoprotein ratio (MHR) was calculated by blood monocyte count divided by high-density lipoprotein cholesterol. Left cardiac structure and function were assessed using transthoracic echocardiography. Univariate and multivariate linear regression analyses were used to estimate the association of MHR (Lg transferred) with echocardiographic parameters. We found that septal wall thickness (SWT), left ventricular internal end-diastole dimension (LVIDd), and left ventricular mass index (LVMI) raised with increasing MHR (P = 0.002 for SWT, P < 0.001 for LVIDd, and P = 0.001 for LVMI). Declined trends were shown in ejection fraction (EF) (P = 0.016), E velocity (P = 0.037), E/A ratio (P = 0.009), and tissue Doppler e' (P < 0.001), and elevating trend was observed in E/e' (P < 0.001). In multivariate regression analysis, MHR (Lg transferred) was positively associated with LVIDd (β = 0.031; P = 0.016), LVMI (β = 0.073; P = 0.014), and E/e' (β = 0.331; P < 0.001), whereas it was negatively associated with EF (β = -0.086; P = 0.007), E/A (β = -0.072; P = 0.009), and e' (β = -0.332; P < 0.001).MHR could be a practical biomarker for indicating subclinical cardiac remodeling and dysfunction in T2DM, due to low cost and easy availability.

Ethnic differences in childhood right and left cardiac structure and function assessed by cardiac magnetic resonance imaging

Ethnic differences in cardiovascular risk factors and disease are well-known and may originate in early-life. We examined the ethnic differences in cardiac structure and function in children using cardiac magnetic resonance imaging in a European migrant population, and whether any difference was explained by early life factors. We used a prospective population-based cohort study among 2317 children in Rotterdam, the Netherlands. We compared children from Dutch (73%), Cape Verdean (3.5%), Dutch Antillean (3.3%), Moroccan (6.1%), Surinamese-Creoles (3.9%), Surinamese-Hindustani (3.4%), and Turkish (6.4%) background. Main outcomes were cMRI-measured cardiac structures and function. Cardiac outcomes were standardized on body surface area. Cape Verdean, Surinamese-Hindustani, and Turkish children had smaller right ventricular end-diastolic volume and left ventricular end-diastolic volume relative to their body size than Dutch children (p < 0.05). These results were not fully explained by fetal and childhood factors. Right ventricular ejection fraction and left ventricular ejection fraction did not differ between ethnicities after adjustment for fetal and childhood factors.Conclusion: Right ventricular end-diastolic volume and left ventricular end-diastolic volume differ between ethnic subgroups in childhood, without affecting ejection fraction. Follow-up studies are needed to investigate whether these differences lead to ethnic differences in cardiac disease in adulthood.What is Known:• Ethnic differences in cardiovascular risk factors and disease are well-known and may originate in early-life.• The prevalence of cardiovascular disease differs between ethnic groups.What is New:• We examined ethnic differences in left and right cardiac structure and function in children using cMRI.• Right and left cardiac dimensions differ between ethnic groups in childhood and are only partly explained by fetal and childhood factors.

Longitudinal changes of left and right cardiac structure and function in patients with end-stage renal disease on replacement therapy

BackgroundFew data are available regarding longitudinal changes of cardiac structure and function in end-stage chronic kidney disease (CKD). Aim of the present study is to describe serial echocardiographic findings in a cohort of dialyzed CKD patients. MethodsIn this retrospective longitudinal study, we included n = 120 dialyzed CKD patients who underwent at least 2 echocardiograms either 1, 2 or 3 years apart. After baseline echocardiogram, n = 112 had a further examination at year 1, n = 76 at year 2 and n = 45 at year 3. Echocardiographic examination included Tissue Doppler Imaging of both left (LV) and right (RV) ventricle. ResultsLV geometry and LV mass index did not significantly change over time. RV progressively dilated (mean change +1.3 mm, +1.1 mm and +3.1 mm at year 1, 2 and 3 respectively, p = 0.002, adjusted p = 0.003). Tissue Doppler parameters showed significant changes with regard to both LV (mean change of E/E’ +0.7, +1.3, +1.7 at year 1, 2 and 3 respectively p<0.001, adjusted p = 0.079) and RV (mean change of S wave (cm/sec) -1, -1.7, -2 at year 1, 2 and 3 respectively, p <0.001, adjusted p = 0.041). Decrease of RV S wave negatively correlated with E/E’ changes (r=-0.303, p = 0.002; r=-0.246, p = 0.049; r=-0.265, p = 0.089; at year 1, 2 and 3 respectively). LV ejection fraction (LVEF) progressively declined (p = 0.034, adjusted p = 0.140), albeit being significant lower against baseline only at year 3 (mean change -4.3%, p<0.05). ConclusionsIn dialyzed CKD patients we observed parallel worsening of LV diastolic and RV systolic function accompanied by RV dilation. LVEF decreased less sharply.

Metformin use in obese mothers is associated with improved cardiovascular profile in the offspring

Maternal obesity increases the risk for pregnancy complications and adverse neonatal outcome and has been associated with long-lasting adverse effects in the offspring, including increased body fat mass, insulin resistance, and increased risk for premature cardiovascular disease. Lifestyle interventions in pregnancy have produced no or modest effects in the reduction of adverse pregnancy outcomes in obese mothers. The Metformin in Obese Pregnant Women trial was associated with reduced adverse pregnancy outcomes and had no effect on birthweight. However, the long-term implications of metformin on the health of offspring remain unknown. The purpose of this study was to assess whether prenatal exposure to metformin can improve the cardiovascular profile and body composition in the offspring of obese mothers. In 151 children from the Metformin in Obese Pregnant Women trial, body composition, peripheral blood pressure, and arterial pulse wave velocity were measured. Central hemodynamics (central blood pressure and augmentation index) were estimated with the use of an oscillometric device. Left ventricular cardiac function and structure were assessed by echocardiography. Children were 3.9±1.0 years old, and 77 of them had been exposed to metformin prenatally. There was no significant difference in peripheral blood pressure, arterial stiffness, and body composition apart from gluteal and tricep circumferences, which were lower in the metformin group (P<.05). The metformin group, compared with the placebo group,had lower central hemodynamics (mean adjusted decrease, -0.707mmHg for aortic systolic blood pressure, -1.65 mm Hg for aortic pulse pressure, and -2.68% for augmentation index; P<.05 for all) and lower left ventricular diastolic function (adjusted difference in left atrial area, -0.525 cm2, in isovolumic relaxation time, -0.324 msec, and in pulmonary venous systolic wave, 2.97 cm/s; P<.05 for all). There were no significant differences in metabolic profile between the groups. Children of obese mothers who were exposed prenatally to metformin, compared with those who were exposed to placebo, had lower central hemodynamic and cardiac diastolic indices. These results suggest that the administration of metformin in obese pregnant women potentially may have a beneficial cardiovascular effect for their offspring.

Left ventricular remodeling and dysfunction in obstructive sleep apnea : Systematic review and meta-analysis.

BackgroundObstructive sleep apnea syndrome (OSAS) is associated with cardiovascular mortality and morbidity. Several studies have reported that it affects the left ventricle; however, large randomized controlled trials are lacking. The current study aimed to summarize the association between OSAS and left ventricular (LV) structure and function.MethodsElectronic databases (PubMed, Embase, and Cochrane) and references were searched for articles published until March 2018. A systematic review and meta-analysis were performed to assess LV structure and function in OSAS patients based on echocardiography.ResultsIn total, 17 studies with 747 OSAS patients and 426 control participants were included. Patients with OSAS showed an increase in LV diastolic diameter (weighted mean difference [WMD], 95% CI: 1.24 [0.68, 1.80]; p < 0.001), LV systolic diameter (WMD, 95% CI: 1.14 [0.47, 1.81]; p = 0.001), and LV mass (WMD, 95% CI: 35.34 [20.67, 50.00]; p < 0.001). In addition, left ventricular ejection fraction (LVEF) significantly decreased in the OSAS group compared with the controls (WMD, 95% CIs: −1.82 [−2.76, −0.87]; p < 0.001), and the reduction in LVEF was consistent with the severity of OSAS. The OSAS group also showed an increase in left atrial diameter (WMD, 95% CI: 2.13 [1.48, 2.77]; p < 0.001) and left atrial diameter volume index (WMD, 95% CIs: 3.96 [3.32, 4.61]; p < 0.001).ConclusionObstructive sleep apnea syndrome leads to atrial dilatation, left ventricular hypertrophy, enlargement, mass increase and reduction of systolic function. Treatments for OSAS might be beneficial for the preservation of left cardiac structure and function.Electronic supplementary materialThe online version of this article (10.1007/s00059-019-04850-w) contains supplementary material, which is available to authorized users.

Visit-to-visit fasting plasma glucose variability is an important risk factor for long-term changes in left cardiac structure and function in patients with type 2 diabetes

BackgroundTo investigate the effect of visit-to-visit fasting plasma glucose (FPG) variability on the left cardiac structure and function in patients with type 2 diabetes mellitus (T2DM).MethodsIn this prospective cohort study, 455 T2DM patients were included and follow-up for a median of 4.7 years. FPG measured on every hospital visit was collected. FPG variability was calculated by its coefficient of variation (CV-FPG). Left cardiac structure and function were assessed using echocardiography at baseline and after follow-up. Multivariable linear regression analyses were used to estimate the effect of FPG variability on the annualized changes in left cardiac structure and function. Subgroup analysis stratified by mean HbA1c levels (< 7% and ≥ 7%) were also performed.ResultIn multivariable regression analyses, CV-FPG was independently associated with the annualized changes in left ventricle (β = 0.137; P = 0.031), interventricular septum (β = 0.215; P = 0.001), left ventricular posterior wall thickness (β = 0.129; P = 0.048), left ventricular mass index (β = 0.227; P < 0.001), and left ventricular ejection fraction (β = − 0.132; P = 0.030). After additionally stratified by mean HbA1c levels, CV-FPG was still independently associated with the annualized changes in the above parameters in patients with HbA1c ≥ 7%, while not in patients with HbA1c < 7%.ConclusionsVisit-to-visit variability in FPG could be a novel risk factor for the long-term adverse changes in left cardiac structure and systolic function in patients with type 2 diabetes.Trial registration ClinicalTrials.gov (NCT02587741), October 27, 2015, retrospectively registered.

Cardiometabolic Follow Up of the Offspring From the Metformin in Obese Non-Diabetic Pregnant (MOP) Women Trial

Background: Maternal obesity is associated with adverse cardiometabolic outcome in the offspring. We aimed to assess whether prenatal exposure to metformin can improve the cardiovascular profile and body composition in the offspring of obese mothers. Methods: In 151 children from the MOP trial we measured body composition, peripheral blood pressure and arterial pulse wave velocity. Central haemodynamics (central blood pressure and augmentation index) were estimated using the Vicorder device. Left ventricular cardiac function and structure were assessed by echocardiography. In 39 children from each group the metabolic profile was assessed. Findings: Children were 3.9±1.0 years of age and 77 were exposed to metformin prenatally. There was no significant difference in peripheral blood pressure, arterial stiffness and body composition apart from gluteal and tricep circumferences which were lower in the metformin group (p<0.05). The metformin, compared to the placebo group, had lower central haemodynamics (mean adjusted decrease -0.707mmHg for aortic systolic blood pressure, -1.65mmHg for aortic pulse pressure and -2.68% for augmentation index, p<0.05 for all) and improved left ventricular diastolic function (adjusted difference in left atrial area -0.525cm2, in isovolumic relaxation time -0.324msec and in pulmonary venous systolic wave 2.97cm/s, p<0.05 for all). There were no significant differences in metabolic profile between the groups. Interpretation: Children of obese mothers who were prenatally exposed to metformin, compared to those exposed to placebo, have improved central haemodynamic and cardiac diastolic indices. These results suggest that administration of metformin in obese pregnant women may reduce the cardiovascular risk for their offspring. Funding Statement: The study was supported by a grant from the Fetal Medicine Foundation (Charity No: 1037116). MC acknowledges financial support from the Department of Health through the National Institute for Health Research (NIHR) Healthcare Technology Co-operative for Cardiovascular Diseases at Guy’s and St Thomas’ NHS Foundation Trust. Declaration of Interests: The authors state: None. Ethics Approval Statement: Ethical approval for the study was obtained from the London-Surrey Borders Research Ethics Committee (REC no 08/H0806/80). Signed informed consent was obtained from the parents and assent from the child when possible.

Growth Hormone Improves Cardiopulmonary Capacity and Body Composition in Children With Growth Hormone Deficiency.

Growth hormone deficiency (GHD) in children may be associated with early cardiovascular risk factors and alterations in left ventricular (LV) structure and function; data on cardiopulmonary functional capacity are lacking. Aim of the study was to evaluate the effect of GHD and growth hormone (GH) therapy on cardiopulmonary functional capacity, left and right cardiac structure and function, and body composition in children and adolescents. Prospective, case-control study. Twenty-one untrained GHD children (11.3 ± 0.8 years) underwent cardiopulmonary exercise testing, echocardiography and dual-energy x-ray absorptiometry, before and after 12 months of GH therapy. Twenty-one controls matched for sex, pubertal status, body mass index, and physical activity (PA) were evaluated at baseline and after 1 year. At baseline, GHD patients showed reduced LV mass (LVM; 63.32 ± 7.80 vs 80.44 ± 26.29 g/m2, P = 0.006), peak oxygen consumption (VO2peak; 22.92 ± 4.80 vs 27.48 ± 6.71 mL/Kg/min, P = 0.02), peak workload (80.62 ± 29.32 vs 103.76 ± 36.20 W, P = 0.02), and O2 pulse (4.93 ± 1.30 vs 7.67 ± 2.93 mL/beat, P = 0.0003), compared with controls. GHD patients also exhibited lower lean body mass (LBM 65.36 ± 7.84% vs 76.13 ± 8.23%, P < 0.001), and higher fat mass (FM 30.84 ± 7.92% vs 22.19 ± 8.18%, P = 0.001) than controls. GH therapy resulted in a significant increase of LVM (72.01 ± 15.88, P = 0.03), VO2peak (26.80 ± 4.97; P = 0.01), peak workload (103.67 ± 32.24, P = 0.001), O2 pulse (6.64 ± 1.68, P = 0.0007), and LBM (75.36 ± 7.59%, P = 0.0001), with a reduction in FM (22.62 ± 7.73%, P = 0.001). No difference was found in either left or right ventricular function. Our results suggest that cardiac structure, body composition and cardiopulmonary functional capacity are impaired in children with untreated GHD and can be restored after short-term GH replacement therapy.

O10 Beneficial effect of Phyllanthus amarus (Euphorbiaceae) on DOCA-salt-induced left ventricle cardiac hypertrophy and endothelial dysfunction in rats

Introduction Phyllanthus amarus is used in African traditional medicine to treat cardiovascular disorders such as hypertension. This study has evaluated the effect of an aqueous extract of Phyllanthus amarus (AEPA) on blood pressure, cardiac and endothelial function in the deoxycorticosterone acetate and high salt diet (DOCA-salt)-induced hypertensive rats. Methods Male Wistar rats were assigned into five groups including control, AEPA (100 mg/kg), DOCA-salt (50 mg/kg), and DOCA-salt + AEPA(100 or 300 mg/kg). Systolic blood pressure (SBP) was determined by tail-cuff plethysmography, left ventricle cardiac structure and function by echocardiography, vascular reactivity of main mesenteric artery rings using organ chambers, the vascular level of oxidative stress using dihydroethidine staining, and the level of proteins by immunofluorescence methods. Results After 5 weeks, the AEPA treatments (100 or 300 mg/kg/day) significantly lowered SBP in DOCA-salt hypertensive rats by about 24 and 21 mmHg, respectively. Echocardiography indicated that AEPA affected slightly cardiac function and reduced significantly the increased posterior and septum diastolic wall thickness and the left ventricle mass in hypertensive rats. AEPA improved the DOCA-salt-induced endothelial dysfunction, and the blunted nitric oxide- and endothelium-dependent hyperpolarization-mediated relaxations in mesenteric artery rings. AEPA treatments reduced the level of vascular oxidative stress and the expression level of target proteins (eNOS, COX-2, p22 phox ) in DOCA-salt rats. Conclusion The Phyllanthus amarus aqueous extract induced an antihypertensive effect associated with an improved cardiac structure and endothelial dysfunction in DOCA-salt hypertensive rats. Such a beneficial effect might involve the normalization of the level of vascular oxidative stress.

Correlation of vitamin D with essential hypertension and its target organ damages in the elderly

Objective To investigate the correlation of vitamin D with essential hypertension and its target organ damages in the elderly. Methods In the retrospective study, 365 elderly participants aged ≥ 60 years hospitalized in our department during January 2013 to February 2014 were involved, including 247 patients with confirmed essential hypertension(HT)and 118 patients without HT.Serum 25-hydroxy vitamin D[25(OH)D]levels were measured and compared between HT and non-HT group, and binary regression analysis was used to discuss potential influencing factors of HT.The damage index of vitamin D target organ was compared between vitamin D deficiency group(n=198)and vitamin D non deficiency group(n=49). Results The median serum 25(OH)D level of participants is 35.3 nmol/L, 77.5%(283 cases)were in the insufficient vitamin D status.The level of 25(OH)D was significantly lower in HT group than in non-HT group(34.0 vs.38.7 nmol/L, P 0.05)in albumin/creatinine ratio, serum creatinine, estimated glomerular filtration rate, ankle-brachial index, pulse wave velocity, intima media thickness of carotid artery, Sokolow-Lyon index, cornell index and left ventricular mass index.The serum 25(OH)D level was significantly lower in CHD plus HT group than non-CHD(P<0.05). The 25(OH)D level was negatively correlated with coronary heart disease(B=-0.021, P=0.019). The serum 25(OH)D level was significantly lower in groups with double-and triple-vessel coronary artery disease than in non-CHD group(P<0.01). Conclusions Vitamin D insufficiency is common in the elderly.The serum 25(OH)D level is significantly lower in old patients with HT especially with stage 3 HT than in non-HT ones.The 25(OH)D level is lower in HT patients with comorbid CHD, and more obvious in HT patients with multi-vessel coronary artery disease.An insufficient vitamin D status is not correlated with hypertensive target organ damages including kidney, peripheral vascular and left ventricular cardiac structure. Key words: Vitamin D; Hypertension; Coronary artery disease

Variational Reconstruction of Left Cardiac Structure from CMR Images.

Cardiovascular Disease (CVD), accounting for 17% of overall deaths in the USA, is the leading cause of death over the world. Advances in medical imaging techniques make the quantitative assessment of both the anatomy and function of heart possible. The cardiac modeling is an invariable prerequisite for quantitative analysis. In this study, a novel method is proposed to reconstruct the left cardiac structure from multi-planed cardiac magnetic resonance (CMR) images and contours. Routine CMR examination was performed to acquire both long axis and short axis images. Trained technologists delineated the endocardial contours. Multiple sets of two dimensional contours were projected into the three dimensional patient-based coordinate system and registered to each other. The union of the registered point sets was applied a variational surface reconstruction algorithm based on Delaunay triangulation and graph-cuts. The resulting triangulated surfaces were further post-processed. Quantitative evaluation on our method was performed via computing the overlapping ratio between the reconstructed model and the manually delineated long axis contours, which validates our method. We envisage that this method could be used by radiographers and cardiologists to diagnose and assess cardiac function in patients with diverse heart diseases.

Automatic localization of mitral valve orifice in three-dimensional left cardiac model.

This study proposes a novel method to localize the mitral valve orifice in the three-dimensional left cardiac model reconstructed from Cardiac Magnetic Resonance (CMR) images. After acquiring both short axis and long axis CMR images, endocardium contours were delineated on all images while additional six points were marked to identify the mitral valve orifice on three long axis images. Contours from long axis images were registered to the short axis contours. The resulting registration parameters were stored. A three-dimensional surface model of the left cardiac structure was then reconstructed from the short axis contours. The six points representing mitral valve orifice in long axis images were projected onto the surface model using the registration parameters. A variational method was then applied to localize the mitral valve orifice on the surface model via minimizing the geodesic distance. Numerical examples show the robustness and effectiveness of the proposed method. Automatic location of mitral annulus orifice with the computational time per data set (22 frames) of five minutes would hold clinical potential as a real-time mitral valve assessment tool.

Astragalosides Rescue Both Cardiac Function and Sarcoplasmic Reticulum Ca2+ Transport in Rats with Chronic Heart Failure

The study investigated the beneficial effects of astragalosides (AS) on cardiac performance in rats with chronic heart failure. Chronic heart failure was produced by left anterior descending coronary artery ligation, and the therapeutic efficacy of astragalosides at 10, 20 and 40 mg/kg was evaluated. Five weeks after the operation, cardiac function was deficient and sarcoplasmic reticulum Ca²⁺-ATPase (SERCA) activity was significantly reduced. Moreover, SERCA mRNA decreased, while expression of the SERCA down-regulator phospholamban (PLB) was significantly increased. Phosphorylated phospholamban (P-PLB), the form that does not inhibit SERCA, was also reduced by chronic heart failure. Treatment with AS improved left ventricle function and cardiac structure, reversed the depression of SERCA activity, and increased P-PLB. These results suggest that the cardioprotective effect of AS may be due to the increase in P-PLB protein, which disinhibits SERCA activity. Rescue of sarcoplasmic reticulum Ca²⁺ cycling by astragalosides could normalize excitation-contraction coupling and improve overall cardiac function.

Cardiac Structure and Apnea/Hypopnea Index in Patients with Arterial Hypertension and Excessive Weight

Background/Aims: Arterial hypertension is frequently associated with sleep apnea, excessive weight, and with changes in the echocardiographic characteristics of the left cardiac chambers. The present investigation was conducted in order to search for a possible relation between left cardiac structure and sleep apnea magnitude in patients with arterial hypertension and excessive weight. Methods: A group of 56 patients with arterial hypertension and mean body mass index of 30.6 ± 3.8 (weight in kilograms/height in meters squared) was studied by echocardiography, sleep study and electrocardiography. Results: A relatively high mean apnea-hypopnea index (AHI) was found (17.9 ± 17.2 episodes/h sleep), but this parameter was not found to be correlated with cardiac echocardiographic diameters. Patients with an AHI <5 episodes/h had smaller mean values for left atrial diameter, left ventricular mass index and left ventricular relative wall thickness, when compared to patients with an AHI value of ≧5. The mean corrected QT interval was found to be longer in female patients, whereas left ventricular end-diastolic diameter was smaller than in male patients. Conclusion: In patients with arterial hypertension and excessive weight, significant apnea seems to be very common. In such patients, left ventricle wall thickness, left ventricle mass index and the left atrium diameter may act as surrogate markers for significant sleep apnea. Thus, the hypothesis is raised that hypoxia may lead to changes in heart structure.