Type Of Left Ventricular Hypertrophy Research Articles

Study of unexpectedly detected repolarization in a group of black athletes

IntroductionIl est considéré que la mort subite qui survient lors d'une activité sportive touche un patient ayant une cardiopathie ignorée. L'ECG du sportif de race noire a été peu étudié et des particularités liées à l'ethnie ont été évoquées. Notre travail a pour objectif d'étudier le profil épidémiologique et les particularités de la repolarisation du sportif de race noire.MéthodesUne étude descriptive a été menée durant 8 mois de mars à octobre 2014, incluant des sportifs de race noire sélectionnés parmi tous les sportifs qui étaient suivi dans le centre sectoriel de la Médecine et des Sciences de sports de Sousse. Le recueil de données a été réalisé grâce à un questionnaire medical.RésultatsTrente-cinq (35) athlètes ont été colligés, avec une prédominance masculine (94,28%), ayant un âge moyen de 24,34 ans. Quatre athlètes avaient une hypertrophie ventriculaire gauche à l'échographie cardiaque. Il y'avait 8 athlètes avec un BAV de 1er degré et 8 athlètes avaient un HVG électrique. Les modifications du segment ST étaient plus marquées au niveau des dérivations précordiales. Cinq athlètes (14,2%) avaient des ondes T négatives en V2 et V3, et il s'agissait des mêmes athlètes qui avaient le sus décalage du segment ST dans ces mêmes dérivations. Un aspect de repolarisation précoce a été constaté chez 3 athlètes. Tous ces cas étaient type notch.ConclusionLes sportifs de race noire semblent avoir des modifications électriques assez spécifiques dont il importe de connaitre. Toutefois, notre échantillon n'est pas suffisamment important pour affirmer ces résultats. Une étude comparative avec des sportifs de race blanche serait très intéressante.

Relationship of Remodeling of Carotid Arteries and Left Ventricular Geometry in Patients With Chronic Glomerulonephritis.

to study clinical-functional features of remodeling of carotid arteries and its relation to restructuring of the left ventricle (LV) in patients with chronic glomerulonephritis at pre-dialysis stage. We examined 269 patients (189 men, 80 women) with chronic glomerulonephritis (CGN) aged 17-71 years, at pre-dialysis stages of the disease. We analyzed biochemical parameters of peripheral blood with the determination of daily proteinuria and glomerular filtration rate (GFR). For identification of structural changes of carotid arteries (CA) and LV we used Doppler ultrasound and echocardiography. Atherosclerotic changes of CA were found in 79 patients (29.3%). Four patients (1.4%) had history of acute disturbance of cerebral circulation. Concentric type of left ventricular hypertrophy (LVH) was significantly more prevalent among patients with CA remodeling compared with those without (37.84 vs. 18.75%; p=0.006). Eccentric variant of LVH was significantly more prevalent among patients without atherosclerotic lesions in CA compared with those with CA remodeling (81.25% vs. 62.16%; p=0.001). Increased CA intima media thickness positively correlated with body mass index (r=0.273; p=0.014) and negatively - with GFR (r= -0.222; p=0.048). Statistically significant relationships were also found between the presence of carotid atherosclerosis and structural rearrangements of the heart. We demonstrated a clear relationship between GFR, restructuring of CA and concentric type of change of LV geometry, regardless of the presence of traditional risk factors.

Left Ventricular Hypertrophy and Predictive Factors among Congolese Hypertensive Patients

A cross-sectional study of hypertensive patients was carried out in Brazzaville between January 2011 and December 2013. The objectives of the present study are to determine the different types of left ventricular hypertrophy (LVH) and to identify the predictive factors of LVH. It included 556 hypertensive patients with LVH, characterized by left ventricular mass index (LVMI) > 135 g/m2 in men, and > 111 g/m2 in women. Patients’ sociodemographic data and echocardiographic parameters were gathered and analyzed. There were 342 males (61.5%) and 214 females (38.5%), with mean age 53.5 ± 11.5 years. The indications of the test were hypertension initial evaluation in 402 cases (72.3%), investigation of ischemic stroke in 62 cases (11.2%), heart failure in 58 cases (10.4%), dyspnea and chest pain in respectively 22 and 12 cases. Hypertension, old of 5.2 ± 4.5 years, was associated with overweight/obesity in 408 cases (73.4%), physical inactivity in 325 cases (58.5%), hypertension family history in 274 cases (49.3%), diabetes mellitus in 76 cases (13.7%), dyslipidemia in 63 cases (11.3%), tobacco use in 9 cases (1.6%). The prevalence of LVH was 49.4% and consisted into concentric LVH in 470 cases (84.5%), eccentric LVH in 70 cases (12.6%), and in 16 cases (2.9%), it was a concentric left ventricular remodeling. Age, male gender, seniority of hypertension and treatment were predictive factors of LVH. The latter is the most predominant abnormality in the echocardiographic profile of Congolese hypertensive patients. Efficient management on hypertension will lead to reducing its morbidity and mortality.

THE EFFECT OF DEGREE AND TYPE OF LEFT VENTRICULAR HYPERTROPHY ON VENTRICULAR ARRHYTHMIAS IN HYPERTENSION

Finding the arrythmogenic potential in patients with arterial hypertension as well as its correlation with left ventricular hypertrophy (LVH), and its type and degree. The research included 109 hypertensive patients (pts) (54 male and 55 female), 54.2 ± 7.9 years old without symptomatic coronary disease, myocardial infarction and systolic dysfunction. All the pts had a clinical examination, ECG, 24 h Holter monitoring with Lown classification of ventricular arrhythmias, an echocardiogram with left ventricular mass index (LVMI) and a specific type of LVH. QT interval dispersion (QTd) was calculated on 12 leads standard ECG. 75 pts had LVH (LVMI: 172.6 ± 42.95 g/m2) while 35 pts were without LVH (109.3 ± 15.9 g/m2). Non sustained ventricular tachycardia was registered in 13 pts (17.6%) with LVH and 1 female patient without LVH (2.9%). Patients with VT had a considerably higher ILVM (214.9 ± 6.8 vs. 151.9 ± 47.2 g/m2) than the average and higher QTd (73.7 ± 19.1 vs. 55.2 ± 20.2). VT was registered in 3/19 (15.8%) with eccentric nedilated type LVH, 6/38 (15.8%) with concentric LVH, 1/11 (9.1) (disproportional septal LVH) and 3/5 ( 60%) with dilated LVH. Univariate analysis showed a considerable correlation between the degree of arrhythmias and ILVM (p<0.001) and QTd (p=0.012). Ventricular arrhythmias in patients with arterial hypertension are considerably correlated to the degree of LVH expressed in ILVM and QTd.

Genetic Variation in Kruppel like Factor 15 Is Associated with Left Ventricular Hypertrophy in Patients with Type 2 Diabetes: Discovery and Replication Cohorts

Left ventricular (LV) hypertrophy (LVH) is a heritable trait that is common in type 2 diabetes and is associated with the development of heart failure. The transcriptional factor Kruppel like factor 15 (KLF15) is expressed in the heart and acts as a repressor of cardiac hypertrophy in experimental models. This study investigated if KLF15 gene variants were associated with LVH in type 2 diabetes. In stage 1 of a 2-stage approach, patients with type 2 diabetes and no known cardiac disease were prospectively recruited for a transthoracic echocardiographic assessment (Melbourne Diabetes Heart Cohort) (n=318) and genotyping of two KLF15 single nucleotide polymorphisms (SNPs) (rs9838915, rs6796325). In stage 2, the association of KLF15 SNPs with LVH was investigated in the Genetics of Diabetes Audit and Research in Tayside Scotland (Go-DARTS) type 2 diabetes cohort (n=5631). The KLF15 SNP rs9838915 A allele was associated in a dominant manner with LV mass before (P=0.003) and after (P=0.001) adjustment for age, gender, body mass index (BMI) and hypertension, and with adjusted septal (P<0.0001) and posterior (P=0.004) wall thickness. LVH was present in 35% of patients. Over a median follow up of 5.6years, there were 22 (7%) first heart failure hospitalizations. The adjusted risk of heart failure hospitalization was 5.5-fold greater in those with LVH and the rs9838915 A allele compared to those without LVH and the GG genotype (hazard ratio (HR) 5.5 (1.6–18.6), P=0.006). The association of rs9838915 A allele with LVH was replicated in the Go-DARTS cohort. We have identified the KLF15 SNP rs9838915 A allele as a marker of LVH in patients with type 2 diabetes, and replicated these findings in a large independent cohort. Studies are needed to characterize the functional importance of these results, and to determine if the SNP rs9838915 A allele is associated with LVH in other high risk patient cohorts.

The effect of conduction velocity slowing in left ventricular midwall on the QRS complex morphology: A simulation study

Midwall fibrosis is a frequent finding in different types of left ventricular hypertrophy. Fibrosis presents a local conduction block that can create a substrate for ventricular arrhythmias and lead to the continuous generation of reentry. Having also impact on the sequence of ventricular activation it can modify the shape of QRS complex. In this study we simulated the effects of slowed conduction velocity in the midwall in the left ventricle and in its anteroseptal region on the QRS morphology using a computer model. Material and methodsThe model defines the geometry of cardiac ventricles analytically as parts of ellipsoids; the left ventricular wall is represented by five layers. The impulse propagation velocity was decreased by 50% in one and two midwall layers, respectively, in the whole left ventricle and in LV anterior region. The effects of slowed conduction velocity on the QRS complex of the 12-lead electrocardiogram are presented as 12-lead electrocardiograms and corresponding values of ECG criteria for left ventricular hypertrophy (ECG-LVH criteria): Gubner criterion, Sokolow–Lyon index (SLI) and Cornell voltage. ResultsAll simulated situations led to increased R wave amplitude in the lead I and of S wave in the lead III, showing a leftward shift of the electrical axis and increased values of ECG-LVH criteria based on limb leads alone or in combination with precordial leads (Gubner criterion, Cornell voltage). The slowed conduction velocity in the whole LV influenced the QRS complex voltage in precordial leads, having an impact on the SLI and Cornell voltage. The changes were pronounced if two layers were involved. ConclusionUsing computer modeling we showed that the midwall slowing in conduction velocity modified the QRS complex morphology. The QRS complex changes were consistent with ECG-LVH criteria, i.e. QRS patterns usually interpreted as the effect of left ventricular hypertrophy (the increased left ventricular mass).

Performance of Sokolow-Lyon index in detection of echocardiographically diagnosed left ventricular hypertrophy in a normal Eastern German population - results of the CARLA study.

BackgroundArterial hypertension is a common disease with high prevalence in the general population. Left ventricular hypertrophy (LVH) is an independent risk factor in arterial hypertension. Electrocardiographic indices like the Sokolow-Lyon index (SLI) are recommended as diagnostic screening methods for LVH.We assessed the diagnostic performance of the SLI in a cohort of a large general population.MethodsWe used electrocardiographic and echocardiographic data from the prospective, population-based cohort study CARdio-vascular Disease, Living and Ageing in Halle (CARLA). Linear and logistic regression models were used to assess the association of SLI with LVH. To assess the impact of the body-mass-index (BMI), we performed interaction analyses.ResultsAUC of SLI to predict LVH was 55.3 %, sensitivity of the SLI was 5 %, specificity 97 %. We found a significant association of SLI after covariate-adjustment with echocardiographically detected LVH (increase of left-ventricular mass index, LVMI 7.0 g/m2 per 1 mV increase of SLI, p < 0.0001). However, this association was mainly caused by an association of SLI with the left-ventricular internal diameter (LVIDd, increase of 0.06 cm/m2 per 1 mV increase of SLI, p < 0.0001). In obese (BMI > 30 kg/m2) we found the strongest association with an increase of 9.2 g/m2 per 1 mV.ConclusionsAlthough statistically significant, relations of SLI and echocardiographic parameters of LVH were weak and mainly driven by the increase in LVIDd, implicating a more eccentric type of LVH in the collective. The relations were strongest when obese subjects were taken into account. Our data do not favour the SLI as a diagnostic screening test to identify patients at risk for LVH, especially in non-obese subjects without eccentric LVH.

Correlation between Types of Left Ventricular Hypertrophy and Chronic Kidney Disease in Hypertensive Heart Disease

Background: Heart and kidneys are both target organ damage in hypertension. Left ventricular hypertrophy (LVH) is a sign of heart remodelling in people with hypertension. There are only few studies about correlation between type of LVH remodelling and chronic kidney disease (CKD). This study aims to know which type of LVH has the strongest correlation with CKD in hypertensive heart disease (HHD). Method: In this retrospective study, we collected 84 records of echocardiography and renal function parameters of HHD patients from January 2014 to April 2015 in our institution. LVH was measured by Inter-ventricular Septal diastolic (IVSd) and Left Ventricle Internal Diameter diastolic (LVIDd) in echocardiography and further classified into concentric and eccentric. Renal function was analyzed by plasma ureum & creatinine levels and estimated glomerular filtration rate (eGFR) using MDRD formula. Result: 23 out of 84 people (27.4%) are eccentric LVH (IVSd mean 13.73 ± 1.82, LVIDd mean 56.78 ± 4.11), 17 out of 84 people (20.2%) are CKD (eGFR mean 34.46 ± 17.01), and 7 out of 84 people (8.3%) are both eccentric LVH and CKD. Bivariate analysis using Spearman's Test showed significant correlation between LVIDd and serum creatinine level (r = 0.284, p < 0.05). Fisher's Exact Test showed no significant association between eccentric & concentric LVH and CKD (p > 0.05). Conclusion: There is correlation between left ventricular dimension and serum creatinine level in HHD patients, but there is no association between type of LVH and CKD.

Left ventricular hypertrophy as a marker of adverse cardiovascular risk in persons of different age groups

The paper considers modern conceptions about the prognostic value of left ventricular hypertrophy (LVH) different types. The role of interaction of demographic, hemodynamic, regulatory, intracardiac factors in the formation of prognostic peculiarities in patients with different types of LVH is marked. The data of own investigations indicating that the left ventricular myocardial mass has not less important value in long-term general prognostication than belonging to a concentric or eccentric LVH type in elderly patients with hypertension are presented. Some data concerning left atrial dilatation as an inalienable component of the cardiovascular continuum in essential hypertension are submitted. Pathogenic and prognostic contribution of metabolic disorders associated with hypertension and abdominal obesity in the development of the heart's left parts structural and functional disorders is shown. Issues of long-term outcome in elderly hypertensive patients with metabolic syndrome taking into account the peculiarities of left ventricular geometry are highlighted.

Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: A systematic review and meta-analysis

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Correlation between Global Longitudinal Strain and QRS Voltage on Electrocardiogram in Patients with Left Ventricular Hypertrophy

Left ventricular hypertrophy (LVH) is as an independent risk factor. Discrepancies were reported between LV mass (LVM) estimated by echocardiography and electrocardiography (ECG) findings. We hypothesized that QRS voltage criteria may reflect not only anatomical changes (LVM) but also changes in LV function and we tested the relationship between QRS voltage and echocardiographic parameters of LV function in patients (pts) with different types of LVH. We prospectively enrolled pts with LVH and preserved ejection fraction (LVEF >50%): 20 pts with isolated arterial hypertension, HTN, 20 pts with severe aortic stenosis, AS (indexed aortic valve area <0.6 cm(2)/m(2)), and 20 pts with symmetric hypertrophic cardiomyopathy, HCM. Standard 12-lead ECG (including Sokolow and Cornell voltage indices) and a comprehensive two-dimensional (2D) echocardiography were performed in all. Left ventricular mass was calculated according to Devereux formula. Global longitudinal strain (GLS) was assessed by speckle tracking echocardiography. A significant correlation was found between both ECG indices and LVM assessed by echocardiography. Moreover, significant correlations were found between Sokolow-Lyon voltage and LVEF (r = 0.26; P = 0.03), GLS (r = 0.59; P < 0.001) and E/e' average (r = 0.43; P < 0.001). Cornell voltage index correlated significantly only with GLS. In multivariable analysis GLS emerged as the only independent correlate of both Sokolow-Lyon (ß = 0.6, P < 0.001) and Cornell voltage indices (ß = 0.45, P < 0.001). These findings suggest that in pts with LVH, ECG should no longer be used only as a surrogate method for LVM estimation (structural changes only), but rather as an investigation complementary to imaging, incorporating information on overall LV remodeling (changes in structure and function).

Assessment and management of left ventricular hypertrophy in Type 2 diabetes patients with high blood pressure

Diabetes is associated with left ventricular hypertrophy (LVH). This article reviews the assessment and management of LVH in Type 2 diabetic patients and the available evidence on blood-pressure management in these patients in order to reduce LVH. The best treatment of LVH starts with early identification and rapid implementation of adequate treatment, especially in populations at higher risk. Angiotensin II receptor antagonists and angiotensin-converting enzyme inhibitors should be the first-line therapy, because they are proven to be the most effective in reducing LVH in Type 2 diabetic patients. In patients where angiotensin II receptor antagonists and angiotensin-converting enzyme inhibitors are contraindicated or not tolerated, calcium-channel blockers should be the second option.

Echocardiographic indices of left ventricular hypertrophy and diastolic function in hypertensive patients with preserved LVEF classified as dippers and non-dippers

IntroductionLong-lasting arterial hypertension causes left ventricular hypertrophy (LVH) and impairs left ventricular diastolic function. Our aim was to compare echocardiographic parameters between hypertensive patients defined as dippers and non-dippers during ambulatory blood pressure (BP) monitoring.Material and methodsWe analysed 61 consecutive subjects with treated hypertension undergoing 24-h BP monitoring and transthoracic echocardiographic examination and included in the study patients with preserved left ventricular ejection fraction (EF ≥ 50%). Echocardiographic and arterial pressure parameters were compared between the group classified as dippers (n = 26, 57 ±13 years, 16 males) and non-dippers (n = 35, 60 ±12 years, 24 males) according to present or absent decrease of BP during the night > 10%. Echocardiographic data were compared between both groups and control subjects without hypertension.ResultsDippers had lower average systolic, diastolic and mean arterial pressure during the night hours but did not differ according to the mean pressure calculated from a 24-hour period. All echocardiographic parameters were similar in dippers and non-dippers. All patients with arterial hypertension presented with larger dimension of both ventricles and left atrium, thicker left ventricular walls, higher LV mass and mass index and preserved EF and E/A ratio as compared with normotensive controls. Normal geometry, concentric remodelling and eccentric hypertrophy were similarly distributed in both groups. Concentric hypertrophy was more prevalent in non-dippers as compared to the dippers (71.4% vs. 38.5%, p < 0.043).ConclusionsThe concentric type of LVH is the prevalent pattern in non-dippers. Non-dipping blood pressure pattern may be responsible for the development of left ventricular concentric hypertrophy secondary to hypertension.

The Coronary Circulation and Blood Flow in Left Ventricular Hypertrophy and in the Transition to Heart Failure

Two distinct types of left ventricular hypertrophy (LVH) have been described: the so called “physiologic” hypertrophy, which is normally found in professional athletes, and “pathologic” LVH which is found in patients with inherited heart muscle disease such as hypertrophic cardiomyopathy (HCM) or patients with cardiac and systemic diseases characterized by pressure or volume overload.

Non-alcoholic fatty liver disease is independently associated with left ventricular hypertrophy in hypertensive Type 2 diabetic individuals

Non-alcoholic fatty liver disease (NAFLD) and left ventricular hypertrophy (LVH) are highly prevalent in Type 2 diabetes and both conditions are associated with an increased risk of incident cardiovascular disease. The aim of this study is to evaluate whether there is an association between NAFLD and echocardiographically detected LVH in Type 2 diabetes. We studied 116 consecutive patients with hypertension and Type 2 diabetes after excluding those with pre-existing history of cardiovascular disease, advanced kidney disease, excessive alcohol consumption and other known causes of chronic liver disease (e.g., virus, medications, autoimmunity, iron overload). NAFLD was diagnosed by means of ultrasonography, whereas LVH was diagnosed by means of conventional trans-thoracic echocardiography in all patients. The prevalence of LVH was markedly higher among diabetic patients with NAFLD than among those without this disease (82% vs 18%; p=0.01). Multivariate logistic regression analysis revealed that NAFLD was associated with LVH independently of age, sex, body mass index, systolic blood pressure, glycated hemoglobin, duration of diabetes, and parameters of kidney function. Our findings suggest that hypertensive Type 2 diabetic patients with NAFLD have a remarkably higher frequency of LVH than do hypertensive diabetic patients without steatosis, and that NAFLD is associated with LVH independently of classical cardiovascular risk factors and other potential confounders.

The coronary circulation and blood flow in left ventricular hypertrophy

Two distinct types of left ventricular hypertrophy (LVH) have been described: the so called "physiologic" hypertrophy, which is normally found in professional athletes, and "pathologic" LVH which is found in patients with inherited heart muscle disease such as hypertrophic cardiomyopathy (HCM) or patients with cardiac and systemic diseases characterized by pressure or volume overload. Patients with pathologic LVH have often symptoms and signs suggestive of myocardial ischemia despite normal coronary angiograms. Under these circumstances ischemia is due to coronary microvascular dysfunction (CMD). The abnormalities of the coronary microcirculation may be unrelated to the degree of LVH and cause a reduction in maximum myocardial blood flow which, in the absence of epicardial stenoses, is suggestive of CMD. There is no technique that enables direct visualization of coronary microcirculation in vivo in humans. Therefore, its assessment relies on the measurement of parameters which reflect its functional status, such as myocardial blood flow and coronary flow reserve which is an integrated measure of flow through both the large epicardial coronary arteries and the microcirculation. In this review article we discuss the pathophysiological mechanisms responsible for CMD in patients with primary and secondary LVH and how the recognition of this phenomenon is providing new important information on patient stratification and prognosis. Finally, we discuss how assessment of CMD may be used as a valuable surrogate marker to test the efficacy of old and new drugs. This article is part of a Special Issue entitled "Coronary Blood Flow".

Patterns of isolated septal hypertrophy and their clinical correlations in essential hypertension

The morphological patterns and their clinical correlations in 96 essential hypertensive patients (pts) with isolated septal hypertrophy (IVSH) were studied by 2-dimensional echocardiography. Three patterns of IVSH: basal (B), diffuse (D), and midportion (M) types, were identified by parasternal long-axis image, and four patterns of hypertrophy in the left ventricular (LV) wall: diffuse except posterior wall (type I), anterolateral wall and anterior septum (type II), whole septum (type III), and anterior septum (type IV), were recognized by parasternal short-axis image. A total of 12 different types of LV hypertrophy could be classified. B + I, B + IV, and D + I types were each present in more than 10 pts. The B + IV type had the oldest mean age of 72 years (vs B + I: 63,p<0.05 and D + I: 64,p=0.1), D + 1 vs B + I,p=0.5. The D + I type had the highest mean diastolic blood pressure, 108 mmHg (vs B + I: 103,p<0.05, and B + IV: 96,p<0.001), B + I vs B + IV,p<0.01. The B + I type had the longest duration of hypertension, 24 years (vs B + IV: 15,p<0.001 and D + I: 21,p=0.1), B + IV vs D + I,p<0.05. Seven pts (70%) of M + I type had a family history of cardiomyopathy and/or apical hypertrophy. We conclude that arterial hypertension is associated with a spectrum of isolated septal hypertrophy correlating with clinical characteristics.

Impact of amlodipine or ramipril treatment on left ventricular mass and carotid intima-media thickness in nondiabetic hemodialysis patients

Objective: Left ventricular hypertrophy (LVH) and atherosclerosis are frequently observed in uremic patients and they have appeared as an independent predictor of cardiovascular morbidity and mortality. The aim of this study was to compare the effects of ramipril and amlodipine on left ventricular mass index (LVMI) and carotid intima-media thickness (CIMT) in nondiabetic hypertensive hemodialysis patients. Methods: A total of 112 hemodialysis (HD) patients were included in this study. Patients were randomly allocated to receive ramipril or amlodipine for 1 year. Blood pressure (BP) measurements, LVMI, and CIMT were assessed at baseline and 6-month intervals. Biochemical parameters and inflammatory markers were also determined at the initiation and during the study period. Results: Similar BP decrease was observed in treatment groups. During follow-up, LVMI and CIMT progressed likewise in both treatment groups despite BP control. However, subgrouping analyses due to the pattern of left ventricular geometry showed that LVMI in patients with eccentric LVH increased, whereas LVMI decreased in subjects with concentric LVH under antihypertensive treatment. Discussion: BP control with ramipril or amlodipine could not provide adequate protection for development or progression of atherosclerosis and eccentric type of LVH in nondiabetic HD patients.

Copper chelation as a potential treatment for left-ventricular hypertrophy in type 2 diabetes

To the Editor: We read with great interest the report by Cooper et al. [1] on unblinded treatment for left-ventricular hypertrophy in type 2 diabetes patients using triethylenetetramine for chelation of copper vs placebo. The results are very promising and certainly merit independent confirmation in larger double-blind, placebo-controlled trials. The authors should be commended for their detailed description of measurement of the primary endpoint of their study, left-ventricular mass by magnetic resonance imaging. However, the authors did not provide information on the way they measured serum copper or urinary copper excretion. Such information would be of interest for future trials and comparison of obtained results. It would also be of interest if the authors could discuss the seeming discrepancy between their conclusion that copper excretion fell to placebo levels after 12 months of treatment, while mean values shown in Fig. 2b of their article seem to plateau at approximately 6 times those of placebo after 10 and 12 months of treatment, with the difference at 10 months of treatment still highly significant. It seems that the non-significance of the p value at 12 months of treatment could be the consequence of loss of statistical power for comparison rather than of a decline in copper excretion between 10 and 12 months of treatment. In their report, the authors state that during the last 6 months of the study, five patients discontinued triethylenetetramine and one patient discontinued placebo. To effectively judge statistical power at 10 vs 12 months of treatment, it would be important to know how many patients discontinued during the last 2 months of the study. This is important because the authors suggested that triethylenetetramine only leads to excretion of ‘excess’ copper, without threat of deficiency [1], while ongoing copper loss could lead to copper deficiency with risk of anaemia, pancytopenia and neurodegeneration [2, 3]. Another relevant point concerning the statistical analyses is that the copper values appeared to be highly skewed, in which case it would be more appropriate to report transformed values and use non-parametric statistics.

Myocardial Energetics in Left Ventricular Hypertrophy

The heart carries out its pumping function by converting the chemical energy stored in fatty acids and glucose into the mechanical energy of actin-myosin interaction of myofibrils. Development of congestive heart failure is usually preceded by a period of compensated left ventricular hypertrophy (LVH) and alterations in myocardial bioenergetics have been considered to play an important role in this transition. Myocardial energetic state that is reflected by the ratio of Phosphocreatine to Adenosine Triphosphate (PCr/ATP) is significantly decreased in hearts with LVH. The severity of this abnormality is linearly related to the severity of cardiac hypertrophy as well as left ventricular (LV) dysfunction, and is independent of a persistent myocardial ischemia. The decrease in PCr/ATP is accompanied by a decrease in creatine kinase flux and alterations in substrate utilization in LVH hearts. Moreover, there is a profound heterogeneity in alterations in myocardial energy metabolism in hearts with post-infarction hypertrophy with the most severe abnormality present in the inner layers of the periscar border zone (BZ). This review will discuss various aspects of myocardial energetics in animal models of three different types of LVH (pressure-overload, volume overload and post-infarction) with a brief description of myocardial energetics in humans with LVH.