Left Ventricular Geometric Patterns Research Articles

Left Ventricular Geometric Pattern Impacts QT Dispersion in Males Athletes and Sedentary Men.

To (1) compare QT dispersion (QTd) and echocardiographic features between athletes with concentric left ventricular (LV) hypertrophy, athletes with eccentric LV hypertrophy, and sedentary controls with a normal LV geometric pattern and (2) quantify associations between QTd and echocardiographic features within these groups. Male athletes competing in different sports and sedentary men were stratified into groups according to their LV geometric pattern. These groups included eccentric LV hypertrophy (LV index > 115g/m2, relative wall thickness [RWT] < 0.42) consisting of 38 athletes, concentric LV hypertrophy (LV index > 115g/m2, RWT > 0.42) consisting of 40 athletes, and normal LV geometric pattern (LV index < 115g/m2, RWT < 0.42) consisting of 40 sedentary controls. Following a cross-sectional design, participants underwent electrocardiographic (ECG) and echocardiographic screening. Data were compared between groups using one-way analyses of variance with Bonferroni post hoc tests. Associations between corrected QTd and echocardiographic variables were quantified using Pearson correlations. Alongside structural disparities between groups, corrected QTd was significantly (p < 0.001) lower in athletes with eccentric LV hypertrophy compared to athletes with concentric LV hypertrophy and sedentary controls. Significant,moderate-to-very-largecorrelations were found between corrected QTd and interventricular septal wall thickness in athletes with concentric (r = 0.416, p = 0.008) or eccentric LV hypertrophy (r = 0.734, p < 0.001), and sedentary controls (r = 0.464, p = 0.003). The provided comparative and relationship data may inform the development of more precise approaches for ECG and echocardiographic screening in athletes, particularly in those with concentric LV hypertrophy who may be at greater risk for developing prolonged QTd.

Assessment of left ventricular wall thickness and dimension: accuracy of a deep learning model with prediction uncertainty.

Left ventricular (LV) geometric patterns aid clinicians in the diagnosis and prognostication of various cardiomyopathies. The aim of this study is to assess the accuracy and reproducibility of LV dimensions and wall thickness using deep learning (DL) models. A total of 30,080 unique studies were included; 24,013 studies were used to train a convolutional neural network model to automatically assess, at end-diastole, LV internal diameter (LVID), interventricular septal wall thickness (IVS), posterior wall thickness (PWT), and LV mass. The model was trained to select end-diastolic frames with the largest LVID and to identify four landmarks, marking the dimensions of LVID, IVS, and PWT using manually labeled landmarks as reference. The model was validated with 3,014 echocardiographic cines and the accuracy of the model was evaluated with a test set of 3,053 echocardiographic cines. The model accurately measured LVID, IVS, PWT, and LV mass compared to study report values with a mean relative error of 5.40%, 11.73%, 12.76%, and 13.93%, respectively. The 𝑅2 of the model for the LVID, IVS, PWT, and the LV mass was 0.88, 0.63, 0.50, and 0.87, respectively. The novel DL model developed in this study was accurate for LV dimension assessment without the need to select end-diastolic frames manually. DL automated measurements of IVS and PWT were less accurate with greater wall thickness. Validation studies in larger and more diverse populations are ongoing.

Left Ventricular Mass, Geometric Patterns, and Diastolic Myocardial Performance in Children with Obstructive Sleep Apnea

Background: Obstructive sleep apnea (OSA), characterized by recurrent partial or complete upper airway obstructions during sleep, is an established risk factor for cardiovascular diseases in children. This study aims to determine the prevalence of left ventricular hypertrophy (LVH), abnormal left ventricular (LV) geometric patterns, and diastolic dysfunction in children with OSA and compare them with healthy controls. Materials and Methods: This was a cross-sectional comparative study conducted on 75 eligible children with OSA aged 2–14 years and 75 age- and sex-matched healthy children. Transthoracic echocardiography was used to assess the LV structures and diastolic function in all the subjects. Results: The mean LV mass index was significantly higher in the patients with OSA (36.53 ± 9.1 g/m2.7) as compared to the control group (32.82 ± 7.9 g/m2.7) (P = 0.008), and it showed a significant correlation with decreasing peripheral oxygen saturation (r = −0.35, P = 0.002). LVH was present in 8.0% of the patients with OSA and none (0%) of the controls. 29.3% of the patients with OSA and 1.3% of the healthy controls had abnormal LV geometry. LV diastolic dysfunction was present in 6.7% of the patients with OSA and 0% of the controls. LV diastolic dysfunction was significantly higher among the patients with OSA who have abnormal LV geometry compared to those with normal LV geometry (P = 0.002). Conclusion: LVH, abnormal LV geometry, and diastolic dysfunction are more common in children with OSA than in healthy controls. Children with OSA and abnormal LV geometry are more likely to have LV diastolic dysfunction.

Left Ventricular Geometric Patterns in Newly Diagnosed Hypertension: An Echocardiographic Study

Objective: To investigate patterns of left ventricular (LV) geometric patterns in patients diagnosed with new-onset hypertension using transthoracic echocardiography. The LV diastolic function was also evaluated in these patients. Materials and Methods: The present study was a cross-sectional study that clinically evaluated patients diagnosed with new-onset hypertension at Burapha University Hospital. To classify LV geometric patterns, electrocardiogram, and transthoracic echocardiography to measure LV mass index and relative wall thickness were performed. Other relevant assessments were also conducted, including the diastolic function. Results: Fifty-five patients diagnosed with new-onset hypertension were enrolled, their mean age was 55.3 years, with a standard deviation of 11.8 years. Of all participants, 70.9% (95% CI 57.1 to 82.4) had concentric remodeling, 16.4% (95% CI 7.8 to 28.8) had concentric hypertrophy, 10.9% (95% CI 4.1 to 22.3) had normal geometry and 1.8% (95% CI 0.1 to 9.7) had eccentric hypertrophy. Of all participants, 81.8% were detected to have abnormal LV diastolic dysfunction. Abnormal relaxation pattern was the most common format. Conclusion: In the present study, approximately 10.9% of patients diagnosed with new-onset hypertension had normal LV geometry, whereas 89.1% had abnormal geometry in different patterns. Concentric remodeling was found to be the predominant abnormal geometrical format. Understanding LV geometric patterns helps clinicians stratify risk, predict prognosis, and make informed decisions about treatment strategies for these patients. Keywords: Hypertension; Left ventricular geometric pattern; Diastolic dysfunction

LEFT VENTRICULAR GEOMETRY AMONG CHRONIC KIDNEY DISEASE PATIENTS: THE ROLE OF ANEMIA

BACKGROUND: Anaemia and abnormal left ventricular (LV) geometric pattern are common findings in Chronic Kidney disease (CKD) patients.&#x0D; OBJECTIVES: To assess LV geometric pattern and its relationship with anaemia among CKD patients.&#x0D; METHODS: A cross sectional study of 163 subjects (102 and 61 CKD subjects with and without anaemia respectively). Echocardiography determined the LV geometric pattern while packed cell volume (PCV) levels determined anaemia.&#x0D; RESULTS: The mean age of subjects with and without anaemia was 54.04 ± 14.47 and 54.92 ± 15.67 years respectively (p = 0.717) while the prevalence of LVH among the two groups was 68.8% and 57.9% respectively (p = 0.174). The most frequent LV geometry in both groups was concentric LVH (53.8% and 43.9% respectively). Prevalence of LV systolic dysfunction was 45%, higher among anaemic subjects (58(61.7%) vs 10(17.5%)) p &lt; 0.001. There was a strong negative correlation between PCV and left ventricular mass index (r = -0.345, p = 0.001) among anaemic subjects, but weak positive correlation among patients without anaemia (r = 0.001, p = 0.993).&#x0D; CONCLUSION: Anaemic CKD patients had a high prevalence of abnormal LV geometry with significant contribution from anaemia. Early management of anaemia may thus improve cardiovascular outcomes.

Cardiac Morphology, Function, and Left Ventricular Geometric Pattern in Patients with Hypertensive Crisis: A Cardiovascular Magnetic Resonance-Based Study.

(1) Background: Altered cardiac morphology and function are associated with increased risks of adverse cardiac events in hypertension. Our study aimed to assess left ventricular (LV) morphology, geometry, and function using cardiovascular magnetic resonance (CMR) imaging in patients with hypertensive crisis. (2) Methods: Patients with hypertensive crisis underwent CMR imaging at 1.5 Tesla to assess cardiac volume, mass, function, and contrasted study. Left ventricular (LV) function and geometry were defined according to the guideline recommendations. Late gadolinium enhancement (LGE) was qualitatively assessed and classified into ischemic and nonischemic patterns. Predictors of LGE was determined using regression analysis. (3) Results: Eighty-two patients with hypertensive crisis (aged 48.5 ± 13.4 years, and 57% males) underwent CMR imaging. Of these patients, seventy-eight percent were hypertensive emergency and twenty-two percent were urgency. Diastolic blood pressure was higher under hypertensive emergency (p = 0.032). Seventy-nine percent (92% of emergency vs. 59% of urgency, respectively; p = 0.003) had left ventricular hypertrophy (LVH). The most prevalent LV geometry was concentric hypertrophy (52%). Asymmetric LVH occurred in 13 (22%) of the participants after excluding ischemic LGE. Impaired systolic function occurred in 46% of patients, and predominantly involved hypertensive emergency. Nonischemic LGE occurred in 75% of contrasted studies (67.2% in emergency versus 44.4% in urgency, respectively; p < 0.001). Creatinine and LV mass were independently associated with nonischemic LGE. (5) Conclusion: LVH, altered geometry, asymmetric LVH, impaired LV systolic function, and LGE are common under hypertensive crisis. LVH and LGE more commonly occurred under hypertensive emergency. Longitudinal studies are required to determine the prognostic implications of asymmetric LVH and LGE in hypertensive crisis.

Central blood pressure obtained by cuff-based oscillometry as a determinant of left ventricular hypertrophy in hypertensive patients.

Limited and conflicting data have been reported on the prognostic relevance of central blood pressure (CBP) compared with brachial blood pressure (BP) in the anticipation of hypertension-mediated organ damage and the majority of data derived using applanation tonometry with its known complexities. The objective of the present study was to investigate the diagnostic factors of left ventricular hypertrophy (LVH) with a special highlight on the utility of non-invasive oscillometric CBP measurement and derived hemodynamic indices compared to brachial BP as indicators of LVH. This cross-sectional study included 300 hypertensive patients (mean age 55.3 years, 61.3% female, 51.7% obese) with a mean duration of hypertension was 5.8 years. They underwent measurement of brachial BP, using a mercury sphygmomanometer, and CBP, using a Mobil-O-Graph, alongside the determination of left ventricular (LV) mass by two-dimensional transthoracic echocardiography. LVH and LV geometric patterns were defined by LV mass index/height 2.7 and relative wall thickness. Bivariate then multivariate analysis showed that age, BMI, central systolic BP (SBP), and pulse wave velocity (PWV) were significant determinants of LVH and optimally controlled brachial BP was a significant negative determinant for LVH. Central SBP had an acceptable diagnostic performance to determine LVH in patients with hypertension (AUC = 0.722, 95% confidence interval: 0.618-0.824, SE = 0.21, P -value <0.001). Using one-way ANOVA, a comparison of means among age groups showed that the steady increase in central SBP and PWV with aging was greater among LVH patients than non-LVH patients. Estimated central SBP using Mobil-O-Graph showed a significantly higher correlation to LVH than brachial SBP values. The consistent increase in central SBP and PWV with aging was greater among LVH patients than non-LVH patients.

Pulmonary Hypertension and Left Ventricular Geometric Types in Sickle Cell Anemia

Pulmonary hypertension (PHT) is multifactorial in origin and a major cause of morbidity and mortality in the sickle cell populace. Its correlation with abnormal left ventricular geometric patterns has not been established. Subjects were sickle cell anemic patients of the hematology clinic of a tertiary hospital who gave informed consent. A modified Medical Research Council questionnaire was used to obtain the demographic, anthropometric, and clinical variables of the subjects. Blood samples were taken for hematologic and biochemical analysis. Spirometry, electrocardiography, and echocardiography were done for all subjects. SPSS version 25 was used for analysis. A p ≤0.05 was used for significance. In total 111 subjects with sickle cell anemia were recruited. Male:female ratio was 1:1.4. The prevalence of PHT was 8.1%. Those with PHT were older and had higher blood pressure, lower respiratory rate, higher body mass index, lower estimated glomerular filtration rate, and a higher prevalence of avascular necrosis of the head of femur, stroke, and chest pain. About 2/3 (66.7%) of those with PHT had concentric left ventricular hypertrophy (LVH) whereas none of those with eccentric LVH had PHT. Age, body mass index, systolic blood pressure, aortic root diameter, concentric LVH, serum creatinine, history of stroke, chest pain, and avascular necrosis of the head of femur correlated directly whereas eccentric LVH correlated inversely with PHT. Concentric LVH, relative systemic hypertension, history of chest pain, and respiratory rate were the independent correlates of PHT in subjects with sickle cell anemia. PHT is known to be of poor prognostic significance. Its association with relative systemic hypertension and concentric LVH suggests the need to initiate early treatment to reduce morbidity and mortality in this group.

THE INFLUENCES OF ACHIEVED BLOOD PRESSURE ON CARDIOVASCULAR OUTCOMES IN HYPERTENSIVE PATIENTS WITH DIFFERENT LEFT VENTRICULAR GEOMETRIC PATTERN: A PROSPECTIVE COHORT STUDY IN CHINA

Objective: Intensive antihypertensive therapy might bring additional benefits for hypertensive patients with high risks of cardiovascular diseases. The left ventricular(LV) geometric patterns could reasonably stratify cardiovascular risks in hypertensive patients, which might facilitate the selection of individuals who were more suitable for intensive antihypertensive therapy. Design and method: This investigation is a community-based, multi-center, prospective cohort study to investigate the geographical profile of cardiovascular disease risk across China. In total, 7680 hypertensive patients were recruited. Firstly, we divided all individuals into four subgroups, including normal geometry(NG), concentric remolding(CR), eccentric hypertrophy(EH) and concentric hypertrophy(CH) based on the diagnostic thresholds recommended by the EACVI/ASE and EMINCA study respectively, respectively. Secondly, we defined the primary endpoint as composite endpoints including the stroke, hospitalization for heart failure and coronary artery disease. We exhibited the hazard ratios of patients with different achieved systolic blood pressure (achieved SBP&gt;140mmHg, 130&lt;SBP&lt; = 140mmHg, and SBP&lt; = 130mmHg) after receiving anti-hypertensive therapy from general practitioners in the NG, CR, EH and CH subgroups based on the diagnostic thresholds of echocardiographic measurements from EMINCA study and EACVI/ASE guideline respectively. Results: We firstly validated that the diagnostic thresholds based on EMINCA study could preferably stratify cardiovascular risks for Chinese hypertensive patients considering the racial differences (Figure 1). And we demonstrated the additional benefits from intensive antihypertensive therapy featured by a SBP target lower than 130mmHg only occurred in the patients with CH regardless of according to the diagnostic thresholds from EMINCA study and EACVI/ASE guidelines (Figure 2). Intriguingly, we found the unexpected negative correlation between achieved SBP and occurrence of the primary endpoint in the patients with CR, exhibited by higher cardiovascular risks of patients with a achieved SBP below 130mmHg (Figure 2), which might be due to that CR patients were positively associated with extracardiac organ damage and might be more susceptible to the hypotension and organ hypoperfusion. Conclusions: The patients with CH might profit additionally from intensive anti-hypertensive therapy, but it needs to be more cautious in the patients with CR.

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.

Human Immunodeficiency Virus, Cardiac abnormalities on Echocardiogram and the use of Highly Active Antiretroviral Therapy in Nigerian Patients

Background: An increasing relationship between HIV/AIDS, highly active anti – retroviral therapy (HAART) and cardiovascular diseases (CVD) have been noted over time. The occurrence of acquired immunodeficiency syndrome (AIDS) – associated heart disease found in post – mortem studies is notably higher than those diagnosed clinically implying that many HIV/AIDS patients may have cardiac abnormalities that are not diagnosed during their lifetime. This misdiagnosis persists even in the presence of dire consequences such as overt heart failure or even death. Aim: This study set to determine what cardiac abnormalities are present in Nigerian HIV positive patients and what differences exist in the manifestations of these cardiac abnormalities between HIV positive patients who have been on HAART and those who are non-treated with HAART. Methods: This was a cross-sectional analytical study with a comparison group in which two groups consisting of 76 HIV positive treatment naïve and 76 HIV positive HAART treated patients who met the inclusion criteria were sampled. The study protocol was reviewed and approved by the Research and Ethics Committee of the University of Benin Teaching Hospital, Benin City. All patients had an echocardiography done and data obtained was entered into and analyzed using the IBM-SPSS version 22.0. A p-value ≤ 0.05 was considered significant for all statistical comparisons done. Results: Total prevalence of ECHO abnormalities was 91.4% in HIV Positive patients. Echocardiographic cardiac abnormalities were more prevalent in HAART treated patients [94.7%] than treatment naïve patients [ECHO = 88.2%]. The cardiac abnormalities found include increased LVMI, left ventricular diastolic dysfunction, increased left ventricular mass, pericardial effusion and abnormalities in left ventricular geometry. Pericardial effusion was more prevalent in treatment naïve patients with treatment naïve patients also noted to have the worst form of left ventricular geometry with over half having abnormal left ventricular geometric patterns compared to about 1/3rd in HAART treated patients. Conclusion: Overall, HAART treated patients had cardiac abnormalities on echocardiogram than treatment naïve patients.

The impact of different left ventricular geometric patterns on right ventricular deformation and function in the elderly with hypertension: A two-dimensional speckle tracking and three-dimensional echocardiographic study.

This study aimed to evaluate the impact of different left ventricular geometric patterns on right ventricular deformation and function in the elderly with essential hypertension via two-dimensional speckle tracking and three-dimensional echocardiography. A total of 248 elderly people with essential hypertension were divided into four groups based on the left ventricular mass index (LVMI) and relative wall thickness (RWT): the normal geometric, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy groups. Moreover, 71 participants were recruited as the control group. These participants were examined by two-dimensional speckle tracking and three-dimensional echocardiography to obtain the right ventricular strain parameters, three-dimensional volume, and function parameters. The right ventricular strain parameters decreased gradually from the normal geometric group to the concentric hypertrophy group (P < 0.05), and the strain parameters in the concentric remodeling, eccentric hypertrophy, and concentric hypertrophy groups were lower than those in the control and normal geometric groups (P < 0.05). The right ventricular three-dimensional echocardiographic parameters only changed in the eccentric hypertrophy group (P < 0.05) and the concentric hypertrophy group (P < 0.05) in the form of an increase in volume and a decrease in function. Multivariate linear regression analysis showed that the right ventricular free wall longitudinal strain was independently associated with the systolic blood pressure (SBP), LVMI, and RWT (P < 0.05) and was primarily affected by the LVMI (normalized β = 0.637, P < 0.05). The systolic function of the right ventricular myocardium declined in the elderly with essential hypertension due to impaired myocardial mechanics. The right ventricular strain parameters could indicate mechanical damage in the concentric remodeling group earlier than the right ventricular three-dimensional volume and function parameters. The right ventricular free wall longitudinal strain was primarily subject to the LVMI.

DEEP LEARNING MODELS FOR AUTOMATING ASSESSMENT OF LEFT VENTRICULAR WALL THICKNESS AND DIMENSIONS

Left ventricular (LV) geometric patterns aid clinicians in the diagnosis and prognostication of various cardiomyopathies. Two-dimensional transthoracic echocardiogram is the clinical standard for the assessment of LV dimensions. Assessment of LV dimensions and wall thickness is known to be associated with significant interobserver and intraobserver variability. Automation of echocardiographic interpretation using machine learning may allow non-experts to assess LV dimensions while improving reliability.

Left ventricular geometry and electrocardiographic criteria in assessing left ventricular hypertrophy in sickle cell anemia patients

BackgroundLeft ventricular hypertrophy (LVH) is recognized as a cardiovascular risk factor and is a known consequence of sickle cell anemia (SCA). Abnormal left ventricular geometric patterns have been described but the determinants have not been well elucidated. MethodElectrocardiography (ECG) and Echocardiography (ECHO) was done on subjects with SCA and hemoglobin A(HBA). Those with systemic hypertension were excluded. Voltages, durations, and intervals were measured as appropriate and recorded in a standard proforma. Analysis was made using a standard statistical software. ResultsEighty four people with SCA and 91 with HBA were recruited as cases and controls respectively. Subjects with SCA have more abnormal LV geometric patterns than those with HBA(p=0.000). Eccentric LVH(p=0.000) was more in SCA subjects while concentric LVH(p=0.054) and concentric remodeling(p=0.319) were not. Forty-one and fifty-two subjects with SCA and HBA respectively did ECGs. . Subjects with eccentric LVH had lower hip circumference, higher left atrial diameter, right atrial area, higher sokolow-lyon voltage sum, stroke volume and cardiac output. The Sokolow-Lyon voltage criteria at the traditional cut off point was not different between those with and without eccentric LVH. However, Sokolow-Lyon voltage criteria at a cut-off of ≥4.7mV detected eccentric LVH with a sensitivity of 60% and specificity of 83.3%.While Sokolow-Lyon voltage sum, stroke volume, right atrial area, and left atrial diameter correlated positively, pulse rate and hip circumference correlated inversely with eccentric LVH. Sokolow Lyon voltage sum was the independent determinant of eccentric LVH in this study. ConclusionSickle cell anemia predisposes to abnormal LV geometric patterns, especially eccentric LVH. There may be a need to review the electrocardiographic cut off points for defining eccentric LVH in the SCA populace.

RELATIONSHIPS BETWEEN NAFLD BIOCHEMICAL SCORES AND LEFT VENTRICULAR GEOMETRIC PATTERN IN NAÏVE ESSENTIAL HYPERTENSIVE PATIENTS

Objective: The not alcoholic fatty liver disease (NAFLD) is associated with an increased cardiovascular mortality and morbidity. An hypothesis for this association could be the left ventricular (LV) geometric alteration sometime found in hypertension that is a known prognostic factor for cardiovascular events in hypertension. We searched for a relationship between biochemical scores of NAFLD and left ventricular (LV) hypertrophy (LVH) or LV geometric patterns changes in a large group of never treated essential hypertensive (EH) patients. Design and method: In 434 naïve (49 ± 14 years, 234 males) we evaluated BMI, waist circumference, liver steatosis at abdominal echography, the biochemical scores of liver steatosis: Liver Fat Score (LFS), Fatty Liver Index (FLI), Hepatic Steatosis Index (NAÏVE), and the fibrosis scores: NAFLD Fibrosis Score (NFS), APRI, FIB-4, parameters of glucose and insulin homeostasis, liver blood tests, lipids, platelets count, glomerular filtration rate (GFR), reactive C protein. LV mass and relative wall thickness was calculated with echocardiography. Patients were classified in 4 groups of LV geometry: 1 = LV normal geometry, 2 = LV concentric remodeling, 3 = concentric LVH, 4 = eccentric LVH. Results: A LVH was present in 17.3% of patients, and these patients had higher LFS (P &lt; 0.001), FLI (P = 0.008), NAÏVE (P = 0.004) and NFS (P = 0.011) scores than patients without LVH. LVH was independently associated with the FLI score but not with fibrosis scores. The steatosis scores (LFS, NAÏVE, FLI) linearly increased across the four LV geometric patterns (P = 0.007, P = 0.001, P = 0.003, respectively). The fibrosis score NFS was significantly higher in subjects with concentric LVH (P = 0.041). The LFS was independently associated with BMI, GAUC, G120, and triglycerides levels. The NFS was independently associated with waist circumference, GFR and weakly with fasting glucose level. Ultrasound steatosis was not different among the four LV geometric patterns. Conclusions: In naïve EH patients the biochemical steatosis scores show a relationship with LVH and LV geometric changes, while fibrosis is associated with concentric LVH. An accurate investigation to reveal a NAFLD should be done in EH patients with altered LV geometry and to better understanding of mechanisms linking the two conditions.

Change of Left Ventricular Geometric Pattern in Patients with Preserved Ejection Fraction Undergoing Coronary Artery Bypass Grafting.

Left ventricular (LV) remodeling and geometric patterns are associated with variations in prognosis. Two hundred twenty-eight patients who underwent selective isolated coronary artery bypass grafting (CABG) were included, divided into normal geometry, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy at baseline. More than half participants with normal geometry at baseline remained in that category, and similar ratio of concentric remodeling reverted to normal geometry on follow-up. The concentric hypertrophy at baseline tended to progress to eccentric geometry rather than normal geometry, while changes from eccentric to concentric hypertrophy was uncommon. iLVEDD had a significant association with an increased risk of developing an abnormal geometric pattern from a normal or concentric remodeling pattern, and iLVESD and LAScd involved in the regression from an abnormal geometric pattern. Thus, dynamic changes in LV geometric pattern are common on 1-year follow-up after CABG and LA strain has an incremental role for early detection in this process.

Polycystic ovarian syndrome increases prevalence of concentric hypertrophy in normotensive obese women.

BackgroundIt remains unclear as to whether polycystic ovary syndrome (PCOS) is an additional risk factor in the development of left ventricular (LV) hypertrophy in obese women. In the current study, we provide clarity on this issue by rigorously analysing patient LV geometry beyond the basic clinical measures currently used. Importantly, the cohort contained only normotensive patients that would normally be deemed low risk with no further intervention required.MethodsThe study comprised 24 obese women with PCOS and 29 obese Control women. Transthoracic echocardiography was used to evaluate LV structure/function. Basic clinical and metabolic data were collected for each participant consisting of age, BMI, blood pressure, fasting glucose, LDL-C, HLD-C, cholesterol and triglyceride levels. Exclusion criteria; BMI < 30 g/m2, type 2 diabetes, hypertension.ResultsBoth groups exhibited concentric remodelling of the LV posterior wall at a prevalence of ~20%, this associated with grade 1 diastolic dysfunction. Estimated LV mass/height2.7 was increased patients with PCOS (45 ± 2.2 vs 37 ± 1.6) with 33% exhibiting LV mass/height2.7 above ASE guidelines, compared to 7% in Controls. Furthermore, 25% of patients with PCOS were characterised with concentric hypertrophy, an alteration in LV geometry that was not observed in the Control group.ConclusionsTo our knowledge, this is the first study to assess LV geometric patterns in obese women with PCOS. The results suggest that obese women with PCOS are at greater risk of concentric hypertrophy than obese only women and provide justification for additional cardiovascular risk assessment in normotensive obese/PCOS women.

Left ventricular remodelling in bicuspid aortic valve disease.

Characterization of left ventricular (LV) geometric pattern and LV mass could provide an important insight into the pathophysiological adaptations of the LV to pressure and/or volume overload in patients with bicuspid aortic valve (BAV) and significant (≥moderate) aortic valve (AV) disease. This study aimed to characterize LV remodelling and its prognostic impact in patients with BAV according to the predominant type of valvular dysfunction. In this international, multicentre BAV registry, 1345 patients [51.0 (37.0-63.0) years, 71% male] with significant AV disease were identified. Patients were classified as having isolated aortic stenosis (AS) (n = 669), isolated aortic regurgitation (AR) (n = 499) or mixed aortic valve disease (MAVD) (n = 177). LV hypertrophy was defined as a LV mass index >115 g/m2 in males and >95 g/m2 in females. LV geometric pattern was classified as (i) normal geometry: no LV hypertrophy, relative wall thickness (RWT) ≤0.42, (ii) concentric remodelling: no LV hypertrophy, RWT >0.42, (iii) concentric hypertrophy: LV hypertrophy, RWT >0.42, and (iv) eccentric hypertrophy: LV hypertrophy, RWT ≤0.42. Patients were followed-up for the endpoints of event-free survival (defined as a composite of AV repair/replacement and all-cause mortality) and all-cause mortality. Type of AV dysfunction was related to significant variations in LV remodelling. Higher LV mass index, i.e. LV hypertrophy, was independently associated with the composite endpoint for patients with isolated AS [hazard ratio (HR) 1.08 per 25 g/m2, 95% confidence interval (CI) 1.00-1.17, P = 0.046] and AR (HR 1.19 per 25 g/m2, 95% CI 1.11-1.29, P < 0.001), but not for those with MAVD. The presence of concentric remodelling, concentric hypertrophy and eccentric hypertrophy were independently related to the composite endpoint in patients with isolated AS (HR 1.54, 95% CI 1.06-2.23, P = 0.024; HR 1.68, 95% CI 1.17-2.42, P = 0.005; HR 1.59, 95% CI 1.03-2.45, P = 0.038, respectively), while concentric hypertrophy and eccentric hypertrophy were independently associated with the combined endpoint for those with isolated AR (HR 2.49, 95% CI 1.35-4.60, P = 0.004 and HR 3.05, 95% CI 1.71-5.45, P < 0.001, respectively). There was no independent association observed between LV remodelling and the combined endpoint for patients with MAVD. LV hypertrophy or remodelling were independently associated with the composite endpoint of AV repair/replacement and all-cause mortality for patients with isolated AS and isolated AR, although not for patients with MAVD.

Left ventricular and atrial remodelling in hypertensive patients using thresholds from international guidelines and EMINCA data.

To investigate differences in the prevalence of left ventricular (LV) and left atrial (LA) remodelling in hypertensive patients using various thresholds defined by international guidelines and data from the Echocardiographic Measurements in Normal Chinese Adults (EMINCA) study and different indexation methods. LV mass (LVM), relative ventricular wall thickness, and LA volume (LAV) were measured using 2D echocardiography in 612 healthy volunteers selected from the EMINCA study population and 306 adult Chinese patients with hypertension who were age- and gender-matched using propensity score-matched analysis. LVM and LAV values were indexed to body surface area (BSA), height2.7, height1.7, and height2 recommended by guidelines or investigators. Using a previously reported method, LV geometry was divided into normal geometry, concentric remodelling, eccentric hypertrophy, and concentric hypertrophy. The prevalence of LV hypertrophy (LVH) and LV geometric patterns in hypertensive patients were compared using different thresholds and indexation methods. Echocardiographic thresholds from guidelines and healthy volunteers exhibited notable differences, particularly for LAV indexed to height2 and for LVM indexed to height1.7, which resulted in a significantly lower prevalence of LA dilatation and LVH in healthy volunteers. The total proportion of abnormal LV geometric patterns was significantly lower with thresholds from healthy volunteers than from guidelines when LVM was indexed to BSA, height1.7, and height2,7. Using current echocardiographic thresholds and indexing methods recommended by guidelines may lead to significant misdiagnosis of LA dilatation, and abnormal LV geometry in Chinese patients with hypertension, and thresholds based on ethnic-specific normal echocardiographic reference values and an accurate indexing algorithm are warranted.

Phenotyping the right heart according to left ventricular geometry patterns in severe HFrEF

Abstract Background Right ventricular (RV) failure significantly impact on heart failure with reduced ejection fraction (HFrEF) prognosis. How and whether specific functional and geometrical phenotypes of the RV function adapt and combined with left ventricular (LV) geometry is unknown. Purpose To test the RV function across LV geometrical patterns looking at respective prognostic roles. Methods We retrospectively examined a population of patients homogenously diagnosed with chronic HFrEF (defined as LV ejection fraction (EF) less than 35%) and treated with optimal therapy (OT) and all implanted with ICD for primary prevention of sudden cardiac death. Patients were categorized by echocardiography according to remodeling pattern based on left ventricular mass index and relative wall thickness into four groups: normal geometry (NG), concentric remodeling (CR), concentric hypertrophy (CH) and eccentric hypertrophy (EH). RV parameters were: tricuspid annulus plane systolic excursion (TAPSE), TAPSE/pulmonary artery pressures (PAPs), RV basal diameter and fractional area change (FAC). Outcome variable was all-cause mortality, assessed with multivariable Cox proportional hazard (PH) models. Results Among 193 patients (age 66±11 years, 81% men, 74% with ischemic etiology of HF and EF 28±5%) 21% had NG, 3% had CR, 8% had CH, and 68% had EH. Distribution of RV echo parameters across LV remodeling groups is shown in table 1. Over a median follow-up time of 4 (1.9 – 6.1) years, 65 deaths occurred. In multivariable Cox PH models adjusted for age, LVEF, ischemic etiology and LV geometry, TAPSE, TAPSE/PAPs, RV basal diameter and FAC strongly and independently predicted the outcome variable [HR 0.92 (95% C.I. 0.86–0.98), HR 0.08 (95% C.I. 0.01–0.57), HR 1.87 (95% C.I. 1.29–2.71), HR 0.97 (95% C.I. 0.95–1.00), respectively all p-value &amp;lt;0.05]. Conclusion In a homogeneously defined population of severe HFrEF outpatients receiving OT, the majority showed EH remodeling pattern, which did not predict the primary outcome. LV geometry did not further stratify patients in this high risk group. Conversely, RV dysfunction proved to be a strong predictor of mortality, independently of age, LV function and etiology of HF, regardless LV morphology. Funding Acknowledgement Type of funding sources: None.