Concentric Left Ventricular Hypertrophy Research Articles

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.

Sport-related differences in QT dispersion and echocardiographic parameters in male athletes

The aim of this study was to compare QT dispersion (QTd) and echocardiographic parameters in male athletes competing across different sports (long-distance running, volleyball, football, powerlifting, and bodybuilding) and a control population. Significant moderate-strong differences (p < 0.001, {eta }_{p}^{2} = 0.52–0.71) were found in corrected QTd, intraventricular septal wall thickness (ISWT), posterior wall thickness (PWT), relative wall thickness (RWT) and LV (left ventricular) index between groups. Corrected QTd, ISWT, PWT, and RWT were significantly (p < 0.001) higher in powerlifters and bodybuilders compared to other athlete groups and controls. While all athlete groups displayed a significantly higher LV index (p < 0.05) compared to controls, corrected QTd was significantly lower (p < 0.001) only in long-distance runners, volleyball athletes, and football athletes compared to controls. Normal or eccentric LV hypertrophy (LVH) was observed in most long-distance runners (58% and 33%), volleyball athletes (50% and 50%), and football athletes (56% and 41%). In contrast, concentric LVH was observed in most powerlifters (58%) and bodybuilders (54%). Advanced LVH, predominantly concentric in nature, appears to be accompanied with increased QTd in powerlifters and bodybuilders. On the other hand, runners, volleyball athletes, and football athletes experienced LVH toward the upper threshold of the normal reference range alongside reduced QTd compared to other groups.

A teenager with adenoviral myocarditis mimicking hypertrophic cardiomyopathy.

A 14-year-old previously healthy female presented with chest pain and dyspnoea for 2 days in the setting of a recent upper respiratory infection. She had elevated inflammatory markers and troponin, resulting in the diagnosis of acute myocarditis. Transthoracic echocardiography demonstrated mild systolic dysfunction and a moderate pericardial effusion. Additionally, her echocardiogram showed concentric left ventricular hypertrophy raising concern for hypertrophic cardiomyopathy. She was treated with intravenous immunoglobulin. Serial echocardiograms revealed rapid resolution of her ventricular hypertrophy. Cardiac magnetic resonance confirmed the diagnosis of myocarditis.

Clinical Correlation of Left Ventricular Geometric Patterns at King Abdulaziz Hospital Al-Ahsa Eastern Province

Objective: Exploring the prevalence of alteration in left ventricular (LV) geometry by echocardiography and their correlation with cardiovascular (CV) risk factors and cardiovascular diseases (CVD). Background: Alterations in LV geometry, by echocardiography, is an important prognostic determinant of CVD morbidity and mortality. Yet it is an underutilized tool and has yet to be established in laboratories. Methods: Left ventricular mass index (LVMI) and relative wall thickness (RWT) were calculated by M-mode echocardiography. Patients were classified into four groups based on RWT and LVMI: normal geometry, concentric remodeling (CR), eccentric left ventricular hypertrophy (eLVH), and concentric left ventricular hypertrophy (cLVH). Results: LV geometry patterns revealed normal geometry prevalence (43.46%), followed by CR (30.76%). The commonest CV risk factor was hypertension (HTN) (85%), followed by diabetes mellitus (DM) (72%). A strong association was identified between CVD and LV geometry changes (p-value &lt; 0.005). CVD prevalence among total patients was 66.5% within this group; coronary artery disease (CAD) prevalence was 55.5% (p-value &lt; 0.029), and heart failure (HF) prevalence was 29.6% (p-value &lt; 0.001). Conclusion: We strongly reinforce routine echocardiograms in determining LVM, RWT, and LV geometry patterns. It is an important, underutilized diagnostic and prognostic tool in risk stratification of patients with CVD and altered LV geometry and mass. Future studies for incorporating LVM and RWT in clinical decision algorithms are warranted.

Anaesthesia management for aneurysm clipping surgery in patients with severe aortic stenosis with regurgitation: A case report

Coexistence of both intracranial aneurysm and aortic stenosis is quiet rare but it may complicate management of either disease. Managing it is like tug of war, but a good case manager can find that delicate balance. We recently managed patient with severe aortic stenosis presented with anterior communicating aneurysmal.Case-52year old female with complaints of severe headache and vomiting episodes since 10 days. With known case of hypertension and hypothyroid since 4 years on irregular medications posted for aneurysmal clipping. On pre assessment check-up we found pansystolic murmur on auscultation. On investigations it revealed concentric LVH with severe AS with moderate AR maintaining 60% ejection fraction. Other routine investigation were normal. Case was successfully conducted under general anaesthesia with endotracheal tube intubation with pre induction arterial line insertion. Anaesthesia management was tailored keeping in mind hemodynamic stability throughout procedure. With all standard ASA monitoring.

Relationship Between Left Ventricular Hypertrophy and Diabetes Is Likely Bidirectional: A Temporality Analysis.

Background The temporal relationship between type 2 diabetes (T2DM) and left ventricular hypertrophy (LVH) is not well established. This study aims to examine the temporal sequence between T2DM and LVH/cardiac geometry patterns in middle-aged adults. Methods and Results The longitudinal cohort consisted of 1000 adults (682 White individuals and 318 Black individuals; 41.1% men; mean age, 36.2 years at baseline) who had data on fasting glucose/T2DM, left ventricular mass index (LVMI), and relative wall thickness collected twice at baseline and follow-up over 9.4 years on average. The cross-lagged path analysis model in 905 adults who did not take antidiabetic medications and the longitudinal prediction model in 1000 adults were used to examine the temporal relationships of glucose/T2DM with LVMI, LVH, relative wall thickness, and remodeling patterns. After adjustment for age, race, sex, smoking, alcohol drinking, body mass index, heart rate, hypertension, and follow-up years, the path coefficient from baseline LVMI to follow-up glucose was 0.088 (P=0.005); the path from baseline glucose to follow-up LVMI was -0.009 (P=0.758). The 2 paths between glucose and relative wall thickness were not significant. The path analysis parameters did not differ significantly between race, sex, and follow-up duration subgroups. Incidence of T2DM was higher in the baseline LVH group than in the normal LVMI group (24.8% versus 8.8%; P=0.017 for difference). Incidence of LVH and concentric LVH was higher in the baseline T2DM group than in the group without T2DM (50.0% versus 18.2% for LVH [P=0.005 for difference]; 41.7% versus 12.6% for concentric LVH [P=0.004 for difference]), with adjustment for covariates. Conclusions This study suggests that the temporal relationship between T2DM and LVH is likely bidirectional. The path from LVMI/LVH to glucose/T2DM is stronger than the path from glucose/T2DM to LVMI/LVH.

Relationship between Oxidative Stress and Left Ventricle Markers in Patients with Chronic Heart Failure

Oxidative stress is proposed in the literature as an important player in the development of CHF and correlates with left ventricle (LV) dysfunction and hypertrophy in the failing heart. In this study, we aimed to verify if the serum oxidative stress markers differ in chronic heart failure (CHF) patients' groups depending on the LV geometry and function. Patients were stratified into two groups according to left ventricular ejection fraction (LVEF) values: HFrEF (<40% (n = 27)) and HFpEF (≥40% (n = 33)). Additionally, patients were stratified into four groups according to LV geometry: NG-normal left ventricle geometry (n = 7), CR-concentric remodeling (n = 14), cLVH-concentric LV hypertrophy (n = 16), and eLVF-eccentric LV hypertrophy (n = 23). We measured protein (protein carbonyl (PC), nitrotyrosine (NT-Tyr), dityrosine), lipid (malondialdehyde (MDA), oxidizes (HDL) oxidation and antioxidant (catalase activity, total plasma antioxidant capacity (TAC) markers in serum. Transthoracic echocardiogram analysis and lipidogram were also performed. We found that oxidative (NT-Tyr, dityrosine, PC, MDA, oxHDL) and antioxidative (TAC, catalase) stress marker levels did not differ between the groups according to LVEF or LV geometry. NT-Tyr correlated with PC (rs = 0.482, p = 0.000098), and oxHDL (rs = 0.278, p = 0.0314). MDA correlated with total (rs = 0.337, p = 0.008), LDL (rs = 0.295, p = 0.022) and non-HDL (rs = 0.301, p = 0.019) cholesterol. NT-Tyr negatively correlated with HDL cholesterol (rs = -0.285, p = 0.027). LV parameters did not correlate with oxidative/antioxidative stress markers. Significant negative correlations were found between the end-diastolic volume of the LV and the end-systolic volume of the LV and HDL-cholesterol (rs = -0.935, p < 0.0001; rs = -0.906, p < 0.0001, respectively). Significant positive correlations between both the thickness of the interventricular septum and the thickness of the LV wall and the levels of triacylglycerol in serum (rs = 0.346, p = 0.007; rs = 0.329, p = 0.010, respectively) were found. In conclusions, we did not find a difference in serum concentrations of both oxidant (NT-Tyr, PC, MDA) and antioxidant (TAC and catalase) concentrations in CHF patients' groups according to LV function and geometry was found. The geometry of the LV could be related to lipid metabolism in CHF patients, and no correlation between oxidative/antioxidant and LV markers in CHF patients was found.

Management of severe hypothermia and pulsus alternans in an anaesthetised cat

AbstractAn 8‐year‐old, domestic, shorthair cat was presented for management of a significant degloving injury. After initial wound management, the cat was scheduled for anaesthesia to allow a free skin and pad graft to the affected foot. During anaesthesia, temperature rapidly dropped to a nidus of 28.0°C. Associated with this, the cat developed bradycardia and a marked pulsus alternans. The presumed ventricular myocardial dysfunction was treated with pimobendan (0.15 mg/kg intravenously). Within 5 minutes, the pulses equalised in amplitude. Additional active rewarming measures were initiated, which raised the temperature to 36.4°C before recovery in an incubator. A urinary catheter was placed to monitor for cold diuresis, and fluid therapy was altered to match urine output for 12 hours. A post‐anaesthetic echocardiogram revealed mild left ventricular concentric hypertrophy and dynamic right ventricular outflow tract obstruction indicating mild hypertrophic cardiomyopathy. The cat was discharged following 3 weeks of successful intensive wound and graft management.

Static cutoffs or tables for the diagnosis of hypertension? Effect on identification of organ damage in youths with obesity

Background and aimRecently, the European Society of Cardiology task force released a Consensus document (ESC-CD) on pediatric hypertension (HTN) supporting the use of normative tables (age range 6–16 years) for the diagnosis of HTN, while the Hypertension Canada Guidelines (HTN-CGs) proposed static cutoffs. We aimed to assess the prevalence of HTN by ESC-CD or HTN-CGs and their association with glomerular function and left ventricular (LV) geometry in youths with overweight/obesity (OW/OB). Methods and resultsData of 3446 youths were analyzed. HTN by was defined using normative tables (ESC-CD) or static cutoffs of BP ≥ 120/80 in children (age <12 years) and ≥130/85 mmHg in adolescents (age ≥12 years) (HTN-CGs). Mildly reduced glomerular filtration rate was defined by GFR <90 ≥ 60 mL/min/1.73 m2. Concentric LV hypertrophy (cLVH) was assessed in 500 youths and defined by LVH and high relative wall thickness as proposed by ESC-CD. Prevalence of HTN was 27.9% by ESC-CD and 22.7% by HTN-CGs. The association with mildly reduced glomerular filtration rate was significant only in hypertensive adolescents classified by HTN-CGs [Odds Ratio (OR), 95%Cl] 2.16 (1.44–3.24), whereas the association with cLVH was significant using both criteria: children OR 2.18 (1.29–3.67) by ESC-CD and 2.27 (1.32–3.89) by HTN-CGs; adolescents OR 2.62 (1.17–5.84) by ESC-CD and 2.83 (1.14–7.02) by HTN-CGs. ConclusionAlthough static cutoffs may represent a simplification for HTN identification, tables by ESC-CD detect a higher number of hypertensive youths before a clear appearance of glomerular impairment, which offers advantages in terms of primary cardiovascular prevention.

Serum amyloidosis: a cardiac amyloidosis.

A 75-year old male with a history of membranoproliferative glomerulonephritis requiring kidney transplant, carpal tunnel, and peripheral neuropathy presented with new heart failure. An echocardiogram revealed moderate, concentric left ventricular hypertrophy (LVH) despite normal electrocardiographic voltage. To evaluate for the aetiology of unexplained LVH, a cardiac magnetic resonance (CMR) was performed which showed increased wall thickness with markedly increased T1 relaxation time and extensive, near-transmural late gadolinium enhancement throughout the myocardium (Panels A–C, green arrows), findings highly concerning for cardiac amyloidosis (CA). Despite this, a 21.5 mCi Tc-99 m pyrophosphate (Tc-PyP) scan and comprehensive serum (Panels D and E) and urine light chain analysis showed no evidence of transthyretin or immunoglobulin light chain CA, respectively. Despite these negative findings, the patient was referred for endomyocardial biopsy due to high clinical concern for CA. His biopsy revealed diffuse myocardial amyloid deposition (Panels E and F) which was ultimately identified as serum amyloid A (AA) protein on mass spectrometry. AA-CA is a rare form of cardiac amyloidosis caused by deposition of SAA protein—an acute phase reactant—in the myocardium. This disorder is most commonly observed in patients with longstanding chronic inflammatory conditions and is frequently missed by conventional light chain and Tc-PyP analysis. Renal dysfunction is a key feature of AA-CA and is present in a most cases. This case highlights the importance of having a low threshold to pursue further testing including invasive tissue biopsy when typical CA CMR features are present even in the absence of confirmatory non-invasive testing.

CORRELATION BETWEEN THE CHANGES IN HYPERTROPHIC GEOMETRIC MODELS OF THE LEFT VENTRICLE AND CLINICAL, ANTHROPOMETRIC, METABOLIC-HORMONAL PARAMETERS, AND MINERAL METABOLISM INDICATORS

Objective: to analyze the correlation between the changes in hypertrophic geometric patterns of the left ventricle and the changes in metabolic-hormonal parameters and indicators of mineral metabolism depending on the allelic state of the AGT (rs4762) and GNB3 genes in patients with essential arterial hypertension (EAH). Material and methods. The case-control study involved 100 patients with EAH stage II, 1–3 degrees of blood pressure (BP) elevation, high and very high cardiovascular risk. Among the patients, there were 21% (21) men and 79% (79) women. The mean age of patients was 59.86 ± 6.22y.o. The control group consisted of 60 apparently healthy individuals, matched on age (49.13 ± 6.28y.o.) and gender distribution (63% women, 37% men). The lipid panel parameters were measured in blood plasma, including TC (total cholesterol), ТG (triglycerides), LDL-C (low-density lipoprotein cholesterol), HDL-C (high-density lipoprotein cholesterol). All subjects were tested for serum levels of fasting glucose, ionized calcium, parathyroid (PTH) hormone, 25-hydroxyvitamin D (Vit D). Left ventricular hypertrophy (LVH) and LVH models were examined by echocardiography. Clinical and anthropometric examination methods were used in the study. Results. Eccentric left ventricular hypertrophy (ELVH) in patients with EAH was associated with higher blood pressure than concentric left ventricular hypertrophy (CLVH): systolic blood pressure and diastolic blood pressure were higher by 3.29% and 3.95%, respectively (р ≤ 0.05–0.04). ELHV was associated with higher body mass index and waist circumference (WC) in women – by 7.80% and 7.40% (р ≤ 0.05–0.048), respectively. In addition, the ELVH development was characterized by a lower level of ionized Ca2+ in the blood vs. CLVH (by 2.54%, р = 0.021), while the concentration of PTH in a compensatory manner was higher by 23.86% (р = 0.047), which indicated the calcium homeostasis intensity in EAH patients. The lipids, glucose serum concentration and Vit D level were not associated with any hypertrophic model of myocardium. Conclusions. Lipid profile, blood glucose, and Vit D concentration did not determine the development of any type of the LVH. ELVH was associated with a lower level of Ca2+ and consequently an elevated level of PTH. The formation of ELVH in patients with EAH was accompanied by a higher level of blood pressure and was also associated with higher BMI and WC.

Light-chain cardiac amyloidosis, a condition to consider in daily practice

AL-Amyloidosis is caused by a dysregulated plasma cell clone that produces light chains with a propensity to misfolding and deposition in the target organs. Cardiac involvement in AL amyloidosis is present in up to 70% of cases. We present the case of a 76-year-old woman with a history of surgery for bilateral carpal tunnel syndrome, who presented to the emergency department with a clinical picture of decompensated heart failure. The electrocardiogram showed a low voltage in the limb leads discordant with left-ventricular concentric hypertrophy on the transthoracic echocardiography (TTE). Additionally, TTE demonstrated signs of diastolic dysfunction, mild pericardial effusion, as well as apical sparing on the peak longitudinal strain polar map. The ejection fraction was at 53%. A diagnosis of cardiac amyloidosis was suspected. Serum Kappa and lambda free light chains were elevated with a ratio of 0,02. On nuclear scintigraphy and SPECT, there was no myocardial uptake of the radiotracer Tc99th HMDP. Given the presence of renal involvement consisting of a nephrotic syndrom, the kidney was our biopsy site of choice. The anatomopathological study of the renal biopsy confirmed the diagnosis of AL-amyloidosis. A bone marrow aspirate ruled out concomitant multiple myeloma. For management, the patient received guideline directed medical therapy for HFpEF, along with disease specific therapy consisting of chemotherapy with bortezomib, cyclophosphamide and dexamethasone. Our case highlights the importance of integrating cardiac and extracardiac signs in raising the suspicion of cardiac amyloidosis and prompting specific investigations.

PS-C14-5: ECHOCARDIOGRAPHIC PHENOTYPES OF HYPERTENSIVE IN NORTH CENTRAL NIGERIA

Objective: To describe the cardiac morphologic phynotypes in hypertensives as seen on echocardiography . Design and Methods: All patients presenting for echocardiography at the echocardiography lab were evaluated and documented alongside there biodata and anthropometry. The study was a cross sectional descriptive study done from 2019 t0 2022. Criteria for inclusion was hypertension and hypertension related cardiac morbidity. Data obtained was analyzed using SPSS version 16. Quantitative variables were presented as mean and standard deviation while qualitative variables were presented as frequencies and percentages. Level of significance p was at 0.05 Results: Five hundred and eighteen patients were included consisting of 50.6% male and 49.4% female with mean age of 55.08 ± 12.62 years. Majority (54.97%) of patients were between 50 -70 years of age. The mean age and BMI of males and females were significantly different at p values of 0.029 and 0.0001 respectively. Most patients had hypertensive heart disease ((96.0%), preserved EF(80.04%), grade 1 diastolic dysfunction(76.64%) and normal RV systolic function(90.98%). The mean LVEF, LAD, LVID, IVSd and LVPWd for males and females were significantly different at p value of 0.0001. The predominant LV geometry was concentric LV hypertrophy (45.8%) and 14% of patients had a dilated cardiomyopathy. Conclusions: Echocardiographic findings in hypertensives showed predominant abnormal morphologies with significant differences between male and females. This calls for management of hypertension beyond the numbers

PS-BPR02-6: NOT FOR THE FAINT OF HEART: A CASE REPORT OF BRADYCARDIA INDUCED HYPERTENSION

Background: Bradycardia is an underreported and often overlooked contributor to resistant hypertension. We present a case of refractory hypertension and bradycardia with atrial fibrillation and marked improvement in BP control following pacemaker implantation. Case Presentation: A 66-year-old asymptomatic Chinese male with a past history of hypertension with unilateral adrenalectomy (no hyperaldosteronism), remote myocardial infarction, treated obstructive sleep apnea, and type 2 diabetes presented with gradually increasing blood pressure (BP) and decreasing heart rate (HR). From 2019 to 2020, his 24-hour ambulatory BP average increased from 140/49 mmHg to 188/66 mmHg with a decrease in HR from 55 to 43 bpm; there was no significant nocturnal dipping. Home and office BPs were similar. Daily medications included candesartan 64 mg, amlodipine 20 mg, chlorthalidone 50 mg, spironolactone 50 mg, doxazosin 8 mg, hydralazine 300 mg, nitropatch 0.8 mg/hour, and kayexalate for persistent hyperkalemia. Medication adherence was confirmed by a pharmacy database review. Secondary hypertension workup was negative for Cushing's Disease, pheochromocytoma, and renal artery stenosis. Plasma aldosterone was undetectable and plasma renin activity was 1.95 (normal 0.10–1.10ng/L/s) while taking the above medications. Serial 24-hour Holter monitors captured sinus bradycardia without pauses. Echocardiogram revealed concentric left ventricular (LV) hypertrophy, left atrial enlargement, and LV ejection fraction of 55%. Subsequent 2-week Holter monitoring revealed atrial fibrillation with average HR of 44 bpm and multiple prolonged ventricular pauses (longest 5.1 seconds). Following pacemaker insertion, BP normalized to an average of 130/80 mmHg with only 3 agents. Conclusion: There is a paucity of literature on severe bradycardia resulting in resistant hypertension; the English language PubMed database documents 3 reported cases. Severe bradycardia may impair cerebral and renal blood flow, increase LV filling pressures through prolonged diastole causing greater ventricular stretch and increased force of contraction, and may alter arterial stiffness. This case demonstrates a rare but important phenomenon of refractory hypertension and bradycardia with marked improvement in BP control following pacemaker insertion. It is important that physicians are aware of this potential phenomenon when evaluating patients with resistant hypertension and bradycardia.

PS-R04-7: UNSOLVED CASE OF RESISTANT HYPERTENSION: A CHALLENGING ISSUE IN A DEVELOPING COUNTRY

Introduction: It is difficult to find a definite etiology of resistant hypertension (RH) in developing countries due to limited resources. We present a case report and discuss RH's diagnosis and treatment approaches, which we suspected owing to Obstructive Sleep Apnea (OSA) after extensive assessment, including nuclear imaging and renal arteriography. Case presentation: A 58-year-old female was referred to Hasan Sadikin General Hospital for RH assessment. Having conducted ambulatory blood pressure monitoring and echocardiography, which suggested hypertensive heart disease, we confirmed the diagnosis of RH in this patient. The patient has a 4-year history of hypertension, accompanied by throbbing headaches and snores. She underwent percutaneous coronary intervention two years ago due to angina. During the physical examination, she was fully alert with a blood pressure of 170/90 mmHg and a heart rate of 62 times/minute, mild exophthalmos, and cardiomegaly. Her renal (including proteinuria), and thyroid function were within normal limits. Echocardiography revealed concentric left ventricular (LV) hypertrophy with normal LV systolic function. An abdominal Computed Tomography indicated pheochromocytoma or adrenal tumor. Metanephrines examination was not feasible due to cost issues. Using metaiodobenzylguanidine scan (Tc-99 and I-131), nuclear imaging failed to establish diagnosis of pheochromocytoma. Renal artery ultrasonography increased the suspicion of renal artery stenosis; however, renal arteriography showed mild renal artery stenosis. We referred the patient to a neurologist for OSA screening, from STOP-Bang questionnaire result indicated that the patient was likely to have OSA. Unfortunately, the diagnosis was inconclusive due to unavailability of polysomnography facility. The unavailability of minoxidil, renal denervation and continuous positive airway pressure (CPAP) hinders the optimal treatment in this patient. The blood pressure target remains unachievable despite Amlodipine 1x10 mg, candesartan 2x16 mg, bisoprolol 1x10 mg, tamsulosin 1x400 mg, spironolactone 1x50 mg, dan isosorbide mononitrate 2x2.5 mg consumption. The unavailability of chromatography-mass spectrometry for evaluation of medication adherence was also a significant limitation. Conclusion: This case showed that the blood pressure remains uncontrolled despite six different medications, which may be due to the untreated etiology of secondary hypertension. Furthermore, although extensive examinations have been performed, a definite diagnosis could not be made due to cost/facility issues for other diagnostic approach. To further complicate matters, the evaluation of medication adherence and optimal treatment were not available. Therefore, RH remains a challenging issue in developing countries.

PS-P05-2: THE CORRELATION OF HYPERTENSION WITH LENGTH OF STAY OF ADHF IN CVCU OF SAIFUL ANWAR GENERAL HOSPITAL, MALANG, INDONESIA

Background: Long-term hypertension eventually leads to heart failure (HF), and therefore, most patients with HF have a history of hypertension. Conversely, the absence of hypertension in midlife was associated with a lower risk of new-onset heart failure later in life. Cardiac remodeling with major pressure overload includes diastolic dysfunction and concentric left ventricular (LV) hypertrophy. If pressure overload persists, diastolic dysfunction progresses and concentrically remodeled left ventricular filling decreases, followed by heart failure with preserved ejection fraction. Objectives: The aim of this study was to ascertain the correlation of pre-existence hypertension with the length of stay (LOS) of acute decompensated heart failure (ADHF) patients admitted in CVCU of Dr. Saiful Anwar General Hospital, Malang. Method: The study was a retrospective analytic in ADHF patients in CVCU of Dr. Saiful Anwar General Hospital Malang in August 2021 to April 2022. The presence of pre-existence hypertension in admission were compared with non-hypertensive group. Result: A total of 86 patients met study criteria in August 2021 to April 2022, respectively. The prevalence of hypertensive group ADHF patients was 61.6% (53 of 86), with comparable rates for men (74.4% [64 of 86]) and women (25.6% [22 of 86]). The LOS rate was higher in hypertensive group (11 days in average) than non-hypertensive group ADHF patients (8 days in average). Conclusion: The prevalence of hypertension as comorbid of heart failure patients is higher than the non-hypertensive heart failure group in CVCU of Dr. Saiful Anwar Malang in August 2021 to April 2022. Based on admission vital signs, patients with longer LOS have hypertension as pre-exsistence comorbid.

PS-BPB02-8: CURCUMIN, AN INHIBITOR OF P300-HAT ACTIVITY, PREVENTS HYPERTENSION-INDUCED CARDIAC HYPERTROPHY WITH PRESERVED SYSTOLIC FUNCTION IN DAHL RATS

Background: Hypertension causes left ventricular hypertrophy (LVH) with a preserved systolic function. While LVH might be a compensatory process, its presence of LVH is associated with an increased incidence of cardiovascular events and heart failure. Recently, we found that curcumin, a major curcuminoid isolated from Curcuma longa, inhibits the histone acetyltransferase (HAT) activity of p300 as well as the p300-induced acetylation of histones and a hypertrophy-responsive transcription factor, GATA-4, in cultured cardiomyocytes. Furthermore, curcumin prevents deterioration of the systolic function in rat heart failure models in vivo. However, whether curcumin prevents the development of hypertension-induced LVH at an early stage of hypertension is unclear. Objective: To solve this problem, we have utilized a salt-sensitive Dahl rat (DS) model of hypertension. Methods: We randomized 6-week-old DS (n = 19) and control salt-resistant Dahl rats (DR, n = 10) to curcumin or the vehicle group. Then, these rats were given a high-salt diet and subjected to daily oral treatment with 50 mg/kg/day of curcumin or its vehicle (1% Gum arabic) for 6 weeks. Results: There were no differences between curcumin and vehicle in any data examined before treatment (6 weeks of age). The high-salt diet-induced a similar degree of hypertension in these two groups of DS compared with DR. At 12 weeks of age, transthoracic echocardiography in the vehicle group showed that the LV wall thickness, LV mass, and LV fractional shortening were significantly higher in DS compared with DR, and the LV systolic and diastolic dimensions were significantly smaller in DS than DR. Curcumin treatment significantly (p &lt; 0.01) decreased the LV wall thickness in DS but not DR. Curcumin also significantly (p &lt; 0.01) decreased the LV mass in DS, but not in DR. However, LV fractional shortening in DS was similar between the two groups. Curcumin also prevented the increases in hypertension-induced myocardial cell hypertrophy and perivascular fibrosis. Furthermore, curcumin significantly attenuated the up-regulation of hypertrophy-response gene transcriptions as well as acetylation of GATA4 but not phosphorylation of ERK1/2 and GATA4 in the heart. Conclusions: The natural compound, curcumin, inhibits the development of hypertension-induced concentric LVH without affecting the systolic function through inhibition of GATA4-acetylation. Thus, this compound might be applicable to patients with early-stages hypertensive heart diseases.

Serum aldosterone effect on left ventricular structure and diastolic function in essential hypertension

Aldosterone has hypertrophic and profibrotic effects on the heart. This study aims to determine the relationship between serum aldosterone concentration (SAC) and aldosterone-to-renin ratio (ARR) with left ventricular (LV) geometry and diastolic function in essential hypertension (EH). We investigated 213 EH patients (50.3±12.6 years; 57.7% male). SAC, ARR measurements, and echocardiographic analysis were performed for participants. Overall, stepwise multiple regression analysis showed significant associations between SAC and interventricular septum, LV posterior wall thickness, LV amass, LV mass index, e' velocity, a' velocity, and E/e' ratio after adjustment of potentially confounding covariates. When patients were divided into three SAC tertiles, multivariate-adjusted analysis of covariance (ANCOVA) demonstrated a significant increase in LV mass (P ˂ 0.001), LV mass index (P ˂ 0.001), relative wall thickness (P=0.003), interventricular septum (P=0.001), LV posterior wall thickness (P=0.001) and E/e' ratio (P ˂ 0.001), but a decrease in e' velocity (P=0.002) from the first to third tertile of SAC. In logistic regression analysis, increased SAC was independently associated with concentric LV hypertrophy [OR: 1.21, 95% CI: 1.11-1.33, P ˂ 0.001]. No significant associations were found between ARR and echocardiographic parameters of LV structure or diastolic function. In conclusion, SAC, but not ARR, is independently associated with echocardiographic indices of LV structure and diastolic function and is also related to concentric LV hypertrophy. Our findings suggest that aldosterone's pro-hypertrophic and myocardial fibrosis effects contribute to alterations in LV structure and diastolic function in EH beyond blood pressure.

Detection of left ventricular hypertrophy on the ECG through machine learning with a focus on obesity

Abstract Background Cardiac remodeling, an important aspect of cardiovascular disease (CVD) progression, is emerging as a significant therapeutic target. The electrocardiogram (ECG) is of paramount importance in the initial evaluation of a patient. However, the ECG is not a sensitive method of detecting left ventricular hypertrophy (LVH), and as far as we know, it cannot detect changes in left ventricular geometry (LVG) at early stages, especially before LVH is present. Its sensitivity is particularly low for obese patients. Purpose To use a machine learning (ML) classifier to detect abnormal LVG from ECG parameters/markers, even before it becomes LVH, and to propose some indicative markers useful for practitioners. We also looked at the results of our model for obese patients to test the markers in this population. Methods We enrolled consecutive subjects, aged 30 years or older (mean age: 61.6±12 years old) with and without essential hypertension and no indications of CVD. All patients underwent a full echocardiographic evaluation and were classified into 2 groups; those with normal geometry (NG) vs. those with concentric remodeling (CR) or LVH defined as concentric hypertrophy (CH) and eccentric hypertrophy (EH). Abnormal LVG was identified as increased relative wall thickness (RWT) and/or left ventricular mass index (LVMi). We analyzed the EKG waveforms deduced to single beat averages for each lead using custom software and extracted 70 markers. We then trained a Random Forest machine learning model to classify subjects with abnormal LVG and calculated SHAP values to perform feature importance and interaction. Results After screening 1120 individuals, we enrolled 594 subjects, aged 30 years or older (mean age: 61.6±12 years old). The percentage of women was 56.5%, while 71.3% of all patients were hypertensive. Hypertension, age, body mass index divided by the Sokolow-Lyon voltage (BMI/S-L), QRS-T angle, and QTc duration were among the most important parameters (Figure, left panel) identified by the model as being predictive of abnormal LVG (AUC/ROC = 0.84, sensitivity = 0.94, specificity 0.61). Specifically for obese patients, whose prevalence in our population was 60.3%, our model performed well (sensitivity = 0.71, specificity = 0.92. When we tried our model without the the BMI/S-L parameter, the specificity dropped to 0.88. We also found that a cut-off point of 18 for the BMI/S-L marker predicted the patients who were more probable to have developed abnormal LVG. Conclusions This study is the first to demonstrate the promising potential of ML modeling for the efficient and cost-effective diagnostic screening of abnormal LVG and cardiac remodeling through ECG. We found specific clinical and ECG parameters that can predict early pathological changes of LVG in patients without established CVD and detect the population who will benefit from a detailed echocardiographic evaluation. Funding Acknowledgement Type of funding sources: None.

1098 CHARACTERIZATION OF DIFFERENT TYPES OF LV REMODELING USING QUANTITATIVE INTRACARDIAC FLUID-DYNAMICS

Abstract Background Hyperdoppler is a novel advanced echocardiographic technique for the quantitative assessment of intracardiac fluid-dynamics. Recently, its use has been proven useful to complement traditional echocardiographic evaluation of cardiac function in Heart Failure. However, no specific data are available on its application to differentiate between different types of LV remodeling. Thus, our aim was to investigate whether quantitative changes in fluid dynamics might be able to characterize patients with different ventricular geometry. Methods We enrolled 100 consecutive patients with one of the following: LV concentric hypertrophy (CH), eccentric hypertrophy (EH), concentric remodeling, normal LV geometry (CTRL). They underwent a complete echocardiographic examination with intracardiac fluid-dynamic analysis by Color Vector Flow Mapping (Hyperdoppler, Esaote, Genova, Italy). The following parameters were obtained: vortex area (VA); vortex length (VL); vortex depth (VD). Bland Altman Plot has been used to assess intra and inter-observer variability. Results Mean Vortex Depth was significantly higher in CR (p=0.011), CH (p=0.001) and EH (p=0.025) compared to CTRL (p=0.013, p=0.001 and p=0.022, respectively). In addition, CH had significantly higher Vortex Length (p= 0.008) and larger VA (p=0.012) compared to CTRL. No significative differences in vortices parameters have been observed between CH and EH. Conclusion(s) Quantitative fluid-dynamic assessment was feasible and reliable in the whole population and is a promising tool to complement standard echocardiography for the early characterization of different types of LV remodeling.