Left Ventricular Hypertrophy Index Research Articles

Association between atherogenic index of plasma and left ventricular hypertrophy in patients with chronic heart failure with mid-range ejection fraction

Aim: The aim of the present study was to investigate whether an association between lipid indices- atherogenic index of plasma (AIP), Castelli Risk Index I (CRI-I), Castelli Risk Index II (CRI-II) and triglyceride index (TGL-index) and the development of left ventricular hypertrophy exists in patients with heart failure with mid-range ejection fraction (HFmrEF). Material and methods: The study involved 56 patients with HFmrEF and normal lipid profile, median age 64 (47-84) and 22 healthy subjects, median age 58 (51-69). The patients were divided in two subgroups: subjects with left ventricular hypertrophy (n=32); (HFmrEF+LVH) and subjects without left ventricular hypertrophy (n=24); (HFmrEF-LVH). The lipid profile was measured by laboratory, while lipid indices were calculated, using the established formulas. Results: There was not statistically significant difference between the lipid indices in patients with heart failure with mid-range ejection fraction compared to healthy controls (p>0.05). HFmrEF+LVH patients showed statistically significantly higher values of atherogenic index of plasma than HFrEF-LVH patients: 0.16 (0.05/0.37) vs. 0.04 (0.01/0.11); (KW=5.80; p=0.02). TC/HDL, LDL/HDL and TG/HDL values were not significantly higher in HFmrHEF+LVH than HFmrEF-LVH patients: 4.8 (3.98/5.75) vs. 4.49 (3.58/5.63); 2.91 (2.1/4.0) vs. 2.9 (2.5/4.25) and 1.36 (1.11/2.08) vs. 1.13 (0.9/1.53), respectively (p>0.05). No significant gender differences between lipid indices were found. Atherogenic index of plasma showed correlation with LVH (r=0.45; p=0.01) and interventricular septum thickness (r=0.55; p=0.002). Conclusion: Our findings show an association between atherogenic index of plasma and LVH in patients with HFmrEF with normal lipid profile. Further studies are warranted to confirm whether determination of AIP may be used for monitoring development and progression of left ventricular hypertrophy in heart failure with mid-range ejection fraction.

Electrocardiographic features of patients with hypertrophic cardiomyopathy

Introduction. Hypertrophic cardiomyopathy is a disorder of the myocardium characterized by asymmetric or symmetric left ventricular hypertrophy. It is often an inherited disorder with an autosomal dominant pattern. The aim of this study was to evaluate the electrocardiographic characteristics of patients with hypertrophic cardiomyopathy, as well as to assess the accuracy of current electrocardiographic criteria for left ventricular hypertrophy used as indicators of hypertrophic cardiomyopathy. Material and Methods. This retrospective study was conducted using hospital medical records of 42 patients with the diagnosis of hypertrophic cardiomyopathy. Detailed electrocardiography analysis, apart from all the usual parameters, included the calculation of indices used to diagnose left ventricular hypertrophy including Sokolow augmented vector left, Cornell voltage, Cornell product, and Sokolow-Lyon index. Results. Sinus rhythm was present in 95.2% of patients, while atrial fibrillation was found in 4.8%. The majority of patients presented with left axis deviation. A slight positive correlation was found between the Sokolow augmented vector left index and posterolateral wall thickness (r = 0.475; p < 0.05), and also between the Cornell voltage index and posterolateral wall thickness (r = 0.368; p < 0.05). A borderline positive correlation was found between the Cornell product index and posterolateral wall thickness (r = 0.290; p = 0.063). Interventricular septum thickness showed no significant correlation with any of the electrocardiographic indices of left ventricular hypertrophy. Conclusion. In patients with hypertrophic cardiomyopathy, the Sokolow augmented vector left and Cornell voltage indices were the best indicators of posterolateral wall hypertrophy, whereas none of the examined indices correlated well with the interventricular septum thickness.

Interaction of high-intensity endurance exercise and nandrolone on cardiac remodeling: role of adipo-cardiac axis.

Given the cardiac pathological remodeling following to anabolic androgenic steroids (AASs) consumption, we examined the effect of chronic administration of nandrolone decanoate with high-intensity endurance exercise on the left ventricular hypertrophy index, levels of hydroxyproline, tumor necrosis factor-alpha (TNF-α), adiponectin (APN) and its receptors (AdipoR1 and AdipoR2) expression in rats' hearts. The male Wistar rats randomly divided to six groups included the control (CTL), exercise (Ex), nandrolone (Nan), vehicle (Arach), trained vehicle (Ex+Arach), and trained nandrolone (Ex+Nan) groups that were treated for eight weeks. Nandrolone consumption significantly enhanced the hypertrophy index (p<0.05) and exercise intensified this effect. It also increased the level of cardiac hydroxyproline (p<0.001), however exercise completely masked this effect. The values of TNF-α protein and AdipoR1 protein significantly increased in trained nandrolone-treated (Ex+Nan) group in comparison with CTL group (p<0.05), however, did not show significant alteration in Nan or Ex groups. High-intensity endurance exercise significantly enhanced the AdipoR2 protein (p<0.05), but, co-administration of nandrolone with exercise prevented this effect. The mRNA expression of AdipoR1 significantly reduced in the animals that received nandrolone for eight weeks and exercise recovered this effect (p<0.001). Despite an additive effect of high-intensity endurance exercise plus nandrolone on TNF-α level, their effects on hydroxyproline and APN receptors expression is incompatible in heart of rat. It is suggests a part of beneficial regulatory role of endurance exercise against nandrolone induced heart remodeling may apply through modulation of APN system.

Abstract 10695: Early Overnutrition in Rats Induces Premature Cardiac Alterations Independently of Blood Pressure: Leptin-TRH Pathway Involvement

Animal models are an interesting tool to evaluate future consequences of early nutritional insults. We described in adult mice that: leptin induces cardiac cTRH, leading to cardiac damage regardless of blood pressure in hyperleptinemic Agouti. Conversely, cTRH in the ob/ob lacking leptin is similar to control and even do not have Left Ventricular Hypertrophy (LVH). Moreover, leptin restitution induces cTRH and later LVH. Also, in C57BL/6 a 3-week subanorexigenic leptin dose induced cTRH and sequent LVH. All this suggests that heart damage in obesity depends on the novel leptin-cTRH pathway. Plus, Leptin directly induces TRH in cell culture (Aisicovich 2019, AHA) To further investigate the impact of early dietary interventions in childhood, we studied rat litter size reduction, a model with a reported increase in body weight, fat, leptin, insulin and cholesterol levels (Stefanidis A, 2012) We hypothesize that leptin rise increases cTRH leading to cardiac damage, independently of hypertension. On postnatal day 4, Wistar rat litters of 11 pups at birth were adjusted to 4 male pups (overnourished ON) or 11 (control C). At weaning, we individualized rats with free access to water and standard diet up to 7 weeks old. The rise in body weight, food consumption, and fat in ON vs C (p&lt;0.02 n=10 ANOVA) confirmed the model. There weren’t any blood pressure differences between groups, still LVH index increased (heart weight/tibia length) (p&lt; 0.01 n=6) in ON vs C. As expected, in ON the higher leptin increased cTRH mRNA (p&lt; 0.01 n=6) as protein [WB (p=0.05 n=3) IHQ (p&lt;0.04 n=6)] vs C. According to cTRH actions, hypertrophic and fibrotic markers TGF-B and Collagens 1 and 3 mRNA increased (p&lt;0.01, n=6) confirmed by IHQ and Sirius red staining (p&lt; 0.01 n=6) Also, echocardiogram showed increases in LV end-diastolic (0.26±0.08 vs 0.61±0.07 ml p &lt;0.01) and end-systolic (0.02±0.02 vs 0.11±0.01 ml p &lt;0.01) volumes, and decreases in LV ejection fraction (94.5±2.2 vs 83.3±1.9 % p &lt;0.01) and SF (54.4±2.6 vs 45.0±2.3 % p &lt;0.02) This could be restored by cTRH inhibition as demonstrated in the cardiac infarct model (Schuman ML, 2021) Our results point out that early overnutrition induces evident cardiac damage already at 7 weeks, independently of blood pressure and mostly driven by the leptin-TRH pathway.

Inter-relationships of different electrocardiographic indicators of left ventricular hypertrophy in 25,000 Chinese adults

Abstract Background Several electrocardiographic (ECG) indices have previously been proposed to diagnose left ventricular hypertrophy (LVH). Such indices utilize different criteria, including increased QRS voltage, prolonged QRS duration, left axis deviation, and LAFB and LBBB-like patterns in varying combinations. However, the inter-relationships of these different electrocardiographic indices of LVH with each otherare not fully understood. The purpose of this study is to estimate the relationships between the different LVH indices. Methods Electronic tracings of 12-lead ECGs recorded in 24,786 adult participants in the China Kadoorie Biobank recorded in 2014 were accessed to detect presence of LVH. ECG parameters of LVH, including individual and combinations of such parameters (voltage-only criteria such as Sokolov-Lyon, Cornell, Gubner as well as scores such as Romhilt-Estes point score) were estimated using customized computer software (Cardiolyse Oy, Finland) and compared proprietary LVH point score algorithms (Mortara, USA). Relationships between the different indices were assessed using a correlation matrix to explore associations between individual parameters and combined indices of such parameters. The matrices were used to construct heat maps and identify clustering of individual parameters. Results Overall, approximately 10% of the population had LVH assessed by Mortara algorithms. This graph shows that along with the free standing peaks, the rest are divided into two clusters of interconnected individual parameters. In the center of the largest cluster is the parameter, reflecting R-peak magnitude in aVL lead. In the center of another cluster was the left ventricular strain pattern, as described in Romhilt-Estes point score system. Overall, the Sokolov-Lyon index and LVH point score in Veritas algorithm had the strongest relationships with each other, but the Gubner and Cornell indices had relatively weak correlations with the other indices (Table 1). The mean correlation coefficient between five combined LVH indices was as follows: Veritas (Mortara) – 0.58, Sokolov-Lyon – 0.56, Romhilt-Estes – 0.45, Gubner – 0,32, Cornell – 0,3. Conclusions Parameters such as R-peak magnitude in aVL and left ventricular strain pattern were the most strongly related with each other. Aggregate indices, such as the Sokolov-Lyon index and LVH point score in Veritas algorithm were the most strongly related with all other indices, but the Gubner and Cornell indices were only weakly correlated. The results reinforce the utility of Sokolov-Lyon index and Mortara algorithms as the optimum measures of LVH. Funding Acknowledgement Type of funding sources: None.

Circulating miR-19b-3p as a Novel Prognostic Biomarker for Acute Heart Failure.

BackgroundCirculating microRNAs are emerging biomarkers for heart failure (HF). Our study aimed to assess the prognostic value of microRNA signature that is differentially expressed in patients with acute HF.Methods and ResultsOur study comprised a screening cohort of 15 patients with AHF and 5 controls, a PCR‐discovery cohort of 50 patients with AHF and 26 controls and a validation cohort of 564 patients with AHF from registered study DRAGON‐HF (Diagnostic, Risk Stratification and Prognostic Value of Novel Biomarkers in Patients With Heart Failure). Through screening by RNA‐sequencing and verification by reverse‐transcription quantitative polymerase chain reaction, 9 differentially expressed microRNAs were verified (miR‐939‐5p, miR‐1908‐5p, miR‐7706, miR‐101‐3p, miR‐144‐3p, miR‐4732‐3p, miR‐3615, miR‐484 and miR‐19b‐3p). Among them, miR‐19b‐3p was identified as the microRNA signature with the highest fold‐change of 8.4 and the strongest prognostic potential (area under curve with 95% CI, 0.791, 0.654–0.927). To further validate its prognostic value, in the validation cohort, the baseline level of miR‐19b‐3p was measured. During a follow‐up period of 19.1 (17.7, 20.7) months, primary end point comprising of all‐cause mortality or readmission due to HF occurred in 48.9% patients, while patients in the highest quartile of miR‐19b‐3p level presented the worst survival (Log‐rank P<0.001). Multivariate Cox model showed that the level of miR‐19b‐3p could independently predict the occurrence of primary end point (adjusted hazard ratio,1.39; 95% CI, 1.18–1.64). In addition, miR‐19b‐3p positively correlated with soluble suppression of tumorigenicity 2 and echocardiographic indexes of left ventricular hypertrophy.ConclusionsCirculating miR‐19b‐3p could be a valuable prognostic biomarker for AHF. In addition, a high level of circulating miR‐19b‐3p might indicate ventricular hypertrophy in AHF subjects.RegistrationURL: https://www.clinicaltrials.gov. Unique Identifier: NCT03727828.

Effect of amlodipine on ventricular hypertrophy in hypertension patients: a systematic review and meta-analysis.

Left ventricular (LV) hypertrophy predicts worse cardiac outcomes. Blood pressure lowering is associated with the reduction of LV hypertrophy. This study evaluated the effect of a calcium channel blocker, amlodipine, on LV hypertrophy in patients with hypertension. Studies were identified by conducting a literature survey in electronic databases, and study selection was carried out according to precise eligibility criteria. Meta-analyses of mean change between the follow-up and baseline values of systolic/diastolic blood pressure (SBP/DBP) and LV hypertrophy indices were performed. Meta-regression analyses were performed to examine the factors affecting changes in these indices. Twenty-three studies [involving 737 patients; age 56.4 years, 95% confidence interval (CI): 53.5-59.2; females 34%, 95% CI: 25-44%; body mass index 26.4 kg/m2, 95% CI: 24.6-28.1] were included. Amlodipine treatment led to a significant reduction in SBP (-24.9 mmHg; 95% CI: -28.3 to -21.6; P<0.0001) and DBP (-14.8; 95% CI: -16.4 to -13.3; P<0.0001), without affecting the heart rate. Amlodipine treatment also significantly reduced the LV mass index. The mean difference (MD) between the follow-up and baseline LV mass index was -12.9; 95% CI: -15.4 to -10.4 (P<0.001). This decrease in LV mass index was positively associated with the follow-up duration [meta-regression coefficient (MC): 0.392; 95% CI: 0.050-0.733; P=0.026] and baseline LV mass index (MC: 0.139; 95% CI: 0.007-0.271; P=0.040). Amlodipine treatment significantly reduced the LV posterior wall thickness, which was also positively associated with the follow-up duration. There was no significant decrease in the LV end-diastolic diameter following amlodipine treatment. Amlodipine treatment in patients with hypertension significantly reduced the LV mass index and LV posterior wall thickness, without notably affecting the LV end-diastolic diameter. Since many of the included studies were non-randomized, open-label, or lacking appropriate comparability, we therefore performed pooled analyses of the changes from baseline, and a comparative account could not be carried out.

Association of Urinary Sodium Excretion and Left Ventricular Hypertrophy in People With Type 2 Diabetes Mellitus: A Cross-Sectional Study

BackgroundIt has been well documented that left ventricular hypertrophy (LVH) is highly associated with the incidence of cardiovascular disease (CVD). Evidence indicated that high sodium intake was closely related with LVH in general population. However, information is not available regarding the association between urinary sodium excretion and LVH in patients with type 2 diabetes mellitus (T2DM). This study aimed to explore the association between urinary sodium excretion and LVH in patients with T2DM.MethodsThis cross-sectional analysis included baseline data from 1,556 individuals with T2DM enrolled in the NanFang Prospective Diabetes Study (NFPDS). Urinary sodium excretion levels were measured from 24-hour urine samples of inpatients and morning fasting urine samples of outpatients. Left ventricular dimensions were assessed by echocardiography. The associations between urinary sodium excretion and the risks of cardiovascular events, LVH and left ventricular mass index (LVMI) were examined using linear regression analysis, logistic regression and restricted cubic splines (RCS).ResultsUrinary sodium excretion levels were positively associated with cardiometabolic risk factors, including systolic blood pressure, body mass index, waist circumference and LVMI (All P<0.001). Odds ratios of the highest quartile of urinary sodium excretion compared with the lowest quartile were 1.80 (95% CI, 1.28-2.54; P=0.001) for LVH and 1.77 (95% CI, 1.06-2.94; P=0.028) for CVD, after adjusted for demographics, lifestyle risk factors and cardiovascular risk factors. Multivariable-adjusted RCS analysis of the association between urinary sodium excretion and LVMI showed a significant association (P=0.001) and lacked evidence of a nonlinear association (P=0.406).ConclusionThis study indicated that high urinary sodium excretion was independently associated with increased risk of LVH and CVD in patients with T2DM, suggesting that control of sodium intake may be valuable for the prevention of diabetic cardiovascular complications.

Effect of Bone Marrow Mesenchymal Stem Cells (BMSCs) on Cardiac Function and Ventricular Remodeling in Diabetic Rat Models Through Inhibiting MicroRNA (miR)-34a

Diabetes mellitus (DM) is harmful to heart tissue. We transplanted bone marrow mesenchymal stem cells (BMSCs) in this study to improve the function of diabetic heart. 45 rats were divided into healthy group, DM group (treated with high-fat diet), and BMSCs group (BMSCs transplantation into the ventricular wall) followed by analysis of miR-34a and aldehyde dehydrogenase 2 (ALDH2) levels, heart function, and ventricular remodeling in the three groups of rats. BMSCs were successfully cultured with high purity, and the myocardium in the BMSCs group was successfully labeled by DAPI. The left ventricular hypertrophy index and myocardial tissue CVF of rats with DM increased significantly, suggesting that ventricular remodeling in DM rats was stimulated. However, when BMSCs were transplanted to the ventricular wall, although the ventricular remodeling was not completely avoided, apoptosis of BMSCs group was significantly reduced. MiR-34a relative level in BMSCs group was obviously elevated, whereas ALDH2 level showed opposite trend with a negative relationship. MiR-34a can effectively bind to the 3′-UTR of ALDH2 mRNA, indicating that it can directly regulate gene expression. BMSCs can promote the synthesis of ALDH2 by inhibiting the expression of miR-34a, and improve the cardiac function and ventricular remodeling of diabetic rats.

Main Factors Related with the White Coat Effect Level in Patients with Arterial Hypertension and Bronchial Asthma

Aim. To study the main relationships of the white coat effect (WCE) levels in patients with arterial hypertension (AH) with bronchial asthma (BA) who treated with AH and BA drugs in routine clinical practice.Material and Methods. We analyzed the prospective cohort study data of AH patients, some of them had BA without exacerbation. We have formed two groups of patients:1 - control group, patients with AH without BA, the second - with AH + BA. The study consisted of three visits (first visit, 6 months and 12 months visits) and data collection period (30.1±7.6 months of follow-up). The following procedures were performed at the first and 12 month visits: clinical blood pressure (BP) measurements (sitting and standing), 24-hour monitoring ambulatory (ABPM), spirometry, clinical and biochemical blood tests, BA control questionnaires (ACQ) and quality of life (QL) questionnaire (GWBQ), at the second visit clinical BP measurement was performed and, if necessary, the drug dose was corrected.Results. The study included 125 patients, 28 men, 97 women. The first group of AH patients without BA included 85 people, the second (AH + BA) - 40. In AH patients without BA with ischemic heart disease, arterial revascularization, regular alcohol intake and smoking we identified the association with the lower WCE levels. In AH+BA patients with diabetes mellitus, gastrointestinal diseases, higher education was identified WCE decrease. In AH patients without asthma we found inverse relationships WCE levels with respiratory function parameters, the nighttime BP decrease, heart rate and the difference between standing and sitting BP levels, and correlations with the EchoCG variables (the left ventricular hypertrophy (LVH) indices), with age, AH duration and body mass index (BMI). In patients with AH + BA we found inverse correlations between WCE levels and some EchoCG variables, the difference between standing and sitting BP levels, and correlations with body weight, BMI.Conclusion. Thereby, in AH patients without BA with ischemic heart disease, revascularization, regular alcohol intake, smoking we identified the association with the lower WCE levels. This patients WCE indices had inverse correlations with height, respiratory function parameters, the BP nighttime decrease, the difference between standing and sitting BP levels and direct relationships with EchoCG variables of LVH, age, AH duration and BMI. In AH + BA patients with diabetes, gastrointestinal diseases, higher education we found relationships with lesser WCE manifestation. WCE levels in this group had inverse correlations with some EchoCG indicators, the standing and sitting BP difference and direct relations with weight and BMI.

ASSESSMENT OF TOTAL CARDIOVASCULAR RISK IN PATIENTS WITH ARTERIAL HYPERTENSION AND COMORBID CHRONIC OBSTRUCTIVE PULMONARY DISEASE

The aim – to determine the total cardiovascular risk (CVR) in patients with AH and comorbid COPD. Material and Methods. The study included 120 patients with hypertension stage II, grade 2, 3 and 3 in combination with COPD grade II-III and clinical groups A, B, C, D. The study methods included general clinical examination (collection of complaints, medical history, clinical examination, anthropometric parameters), laboratory (blood lipids, blood glucose, blood creatinine, calculated glomerular filtration rate according to CKD-EPI) and instrumental methods (electrocardiography, Doppler echocardiography, ambulatory blood pressure monitoring, spirometry). Results. The SCORE scale revealed that in one case there were no individuals with low CVR among patients with AH and comorbid COPD. In the patient group, 57.5 % were found to have a moderate CVR, 36.7 % had a high CVR, and a very high risk was established in 5.8 % of cases. Pulse pressure, aortic stiffness index, ECG and EchoCG signs of left ventricular hypertrophy, and glomerular filtration rate were analyzed to detect asymptomatic hypertensive target organ damage. The patients were stratified by determining the total CVR. It was found that there were no patients with a moderate degree of CVR in group 1, the number of patients with a high degree of CVR increased to 85.0 %, and a very high degree of CVR increased to 15.0 %. Conclusion. The cardiovascular risk in patients with AH and comorbid COPD depends not only on the degree of AH, the profile of cardiac risk factors and target organ damage, but also on the degree and clinical group of COPD. An increase in overall cardiovascular risk has been revealed, which requires the inclusion of COPD to the prognostic extracardiac risk factors in patients with AH.

COMPARING THE DISCRIMINATIVE ABILITY OF DIFFERENT ELECTROGRAPHIC CRITERIA FOR LEFT VENTRICULAR HYPERTROPHY IN PREDICTING CARDIOVASCULAR EVENTS IN HYPERTENSIVE PATIENTS

Abstract Objective: Several ECG criteria are used clinically to define Left Ventricular Hypertrophy (LVH), but there is no consensus on which of these criteria is better at predicting cardiovascular (CV) events in hypertensive patients. In this post-hoc analysis, our objective was to compare the discriminative ability and strength of association of different LVH criteria to predict the risk of CV-morbidity and mortality. Design and method: We used the database of the Anglo-Scandinavian Cardiovascular Outcome Trial Our primary outcome was composite of fatal and non-fatal CV event including: coronary heart disease, stroke and coronary re-vascularisation. We developed several cox regression models, separately for each LVH criterion (Modified Sokolov, Cornell, Framingham, Strain Pattern, Cornell-Strain, Cornell-Product), after adjusting for a-priori confounders (age, sex, smoking status, diabetes, pulse pressure, chronic kidney disease stage 3) and other confounders found using stepwise selection (number of anti-hypertensives, previous vascular disease, metabolic syndrome, atrial fibrillation). We compared discriminative ability using c-statistic, goodness of fit of the model using Bayesian information criterion (BIC), hazard ratios (HR) and z-statistics for strength of association of each one of these LVH criteria in respective models. Results: 9.7% to 17.2% of 17959 hypertensive patients had LVH at baseline as defined by one or more LVH criterion (see Fig. 1). During a median follow up of 5.6 Years (IQR 5.2–6.1) there were 2736 CV events. Figure 1 shows that, whilst c-statistics and accuracy of most criteria are similar, strain pattern and the Cornell strain are better in improving the prediction models and with a higher strength of association with the CV-outcomes (HR 1.52 95% CI: 1.35 - 1.71, Z-statistic 6.88 and HR 1.37 95% CI: 1.226 - 1.519, Z-statistic 5.70, respectively). Both criteria had excellent BIC too. Conclusions: In hypertensive patients, compared to other ECG criteria of LVH, strain pattern and Cornell-strain index are stronger and better predictor of the risk of CV morbidity and mortality.

Relationship Between Gene Polymorphism of Methylenetetrahydrofolate Reductase C677T and Left Ventricular Hypertrophy in Chinese Patients with Chronic Kidney Disease.

This study aimed to investigate the relationship between the gene polymorphism of methylenetetrahydrofolate reductase (MTHFR) C677T and left ventricular hypertrophy (LVH) in patients with chronic kidney disease (CKD). A total of 763 Chinese patients with CKD undergoing genetic testing were included in the study. The association between the gene polymorphism of MTHFR C677T and echocardiographic parameters was analyzed through univariate and multivariate analyses. We found a remarkably positive association between MTHFR C677T gene polymorphism and LVH indexes, including interventricular septal thickness (F = 3.8; P = .022), left ventricular posterior wall thickness (F = 3.0; P = .052), left ventricular mass (F = 3.9; P = .022), and left ventricular mass index (F = 2.6; P = .075). After adjusting for the potential confounders linking the polymorphism,we found that the positive association between the polymorphism and LVH indexes still existed in patients with CKD in some multiple linear regression models (P <.05). MTHFR C677T gene polymorphism may be a genetic susceptibility marker for the development of LVH in patients with CKD.

Left atrial volume indexed for height2 is a new sensitive marker for subclinical cardiac organ damage in female hypertensive patients.

Left atrial enlargement (LAe) is a subclinical marker of hypertensive-mediated organ damage, which is important to identify in cardiovascular risk stratification. Recently, LA indexing for height was suggested as a more accurate marker of defining LAe. Our aim was to test the difference in LAe prevalence using body surface area (BSA) and height2 definitions in an essential hypertensive population. A total of 441 essential hypertensive patients underwent complete clinical and echocardiographic evaluation. Left atrial volume (LAV), left ventricular morphology, and systolic-diastolic function were evaluated. LAe was twice as prevalent when defined using height2 (LAeh2) indexation rather than BSA (LAeBSA) (51% vs. 23%, p < 0.001). LAeh2, but not LAeBSA, was more prevalent in females (p < 0.001). Males and females also differed in left ventricular hypertrophy (p = 0.046) and left ventricular diastolic dysfunction (LVDD) indexes (septal Em/Etdi: p = 0.009; lateral Em/Etdi: p = 0.003; mean Em/Etdi: p < 0.002). All patients presenting LAeBSA also met the criteria for LAeh2. According to the presence/absence of LAe, we created three groups (Norm = BSA-/h2-; DilH = BSA-/h2+; DilHB = BSA+/h2+). The female sex prevalence in the DilH group was higher than that in the other two groups (Norm: p < 0.001; DilHB: p = 0.036). LVH and mean and septal Em/Etdi increased from the Norm to the DilH group and from the DilH to the DilHB group (p < 0.05 for all comparisons). These results show that LAeh2 identified twice as many patients as comparing LAe to LAeBSA, but that both LAeh2 and LAeBSA definitions were associated with LVH and LVDD. In female patients, the LAeh2 definition and its sex-specific threshold seem to be more sensitive than LAeBSA in identifying chamber enlargement.

Abstract 15613: Evaluating the Heart Failure With Preserved Ejection Fraction (HFpEF) Phenotype Amongst Persons Living With HIV; a Miami Health System Analysis

Introduction: Current evidence suggests a 1 to 2-fold increased risk of heart failure among persons living with HIV (PWH), with possible underlying mechanisms including increased vascular stiffness, chronic inflammation and myocardial toxicity. This study evaluated the prevalence of HFpEF and differences in cardiovascular complications in PWH with and without HFpEF. Methods: Participants included 257 of 965 PWH at our Special Immunology Clinic at the Jackson Memorial and University of Miami Hospitals from 2017-19. Demographic, clinical, and laboratory information, were obtained from retrospective review of the electronic health records. HFpEF was confirmed by clinical and echocardiography findings, from which H2FpEF score was derived. Patients with an EF &lt;50% were excluded. Results: The prevalence of HFpEF was 0.7%, while the mean H2FpEF score was 3.3±1.4. Thus, on average the cohort had an intermediate probability of HFpEF. When comparing persons with compared with those without HFpEF, mean age (56.4 vs. 52.0 years) and proportion of women (57.1 vs.45.0%) did not significantly differ. Similarly, groups did not differ on mean CD4 count (665 vs. 568 cells/uL, p=0.40), % with undetectable Viral Load (85.7% vs. 71.6%, p=0.41), or antiretroviral therapy use (100.0% vs. 92.8%, p=0.46). Of note, the prevalence of coronary artery disease (CAD) (14.3% vs. 1.6%, p=0.009), myocardial infarction (28.6 vs. 1.8%, p&lt;0.001), abnormal stress testing (14.3% vs. 0.8%, p=0.001), PCI (14.3% vs. 0.9%, p=0.001), type II diabetes (57.1% vs. 16.0%, p=0.003), HbA1C (8.0±2.9% vs. 5.9±1.4%, p=0.004) and chronic kidney disease (57.1% vs. 10.2%, p&lt;0.001) were higher in PWH with HFpEF. Of note, the groups had comparable mean EF (55.0 vs. 56.0%, p=0.66), diastolic dysfunction (33.3% vs. 41.9%, p=0.68), left ventricular (LV) hypertrophy (28.6% vs. 20.9%, p=0.62) and LV mass index (86.4±30.8 vs. 79.1±23.2 g/m2, p=0.34). Conclusions: The overall prevalence was similar to that reported in persons 45 years of age or more in the general population. Risk markers for atherosclerotic disease were significantly higher in PWH with HFpEF. HIV disease severity did not appear to be associated with HFpEF prevalence. Further studies evaluating the pathophysiology of HFpEF in PWH are needed.

Effects of Baseline Left Ventricular Hypertrophy and Decreased Renal Function on Cardiovascular and Renal Outcomes in Patients with Fabry Disease Treated with Agalsidase Alfa: A Fabry Outcome Survey Study

PurposeThe initiation of enzyme-replacement therapy prior to the occurrence of substantial and irreversible organ damage in patients with Fabry disease is of critical importance. The Fabry Outcome Survey is an international disease registry of patients with a confirmed diagnosis of Fabry disease. In this study, data from the Fabry Outcome Survey were used for the assessment of the risks for cardiovascular and renal events in patients who received agalsidase alfa treatment. MethodsEligible patients were males and females aged ≥18 years with Fabry disease treated with agalsidase alfa. Cardiovascular events included myocardial infarction, left ventricular hypertrophy (LVH), heart failure, arrhythmia, conduction abnormality, and cardiac surgery. Renal events included dialysis, transplantation, and renal failure. Kaplan–Meier curves and log-rank tests were used for comparing event-free probabilities and time to first cardiovascular or renal event, from agalsidase alfa initiation to a maximum of 120 months, in patients with LVH versus normal left ventricular mass index (LVMI; ≤50 g/m2.7 in males and ≤48 g/m2.7 in females) at treatment initiation (baseline), and in patients with a low estimated glomerular filtration rate (eGFR; <90 mL/min/1.73 m2) versus normal eGFR at baseline. Multivariate Cox regression analysis was used for examining the association between key study variables and the risks for cardiovascular and renal events. FindingsAmong the 560 patients (269 males; 291 females) with available LVMI data, 306 (55%) had LVH and 254 (45%) had normal LVMI at baseline. The risk for a cardiovascular event was higher in the subgroup with LVH versus normal LVMI at baseline (hazard ratio [HR] = 1.57; 95% CI, 1.21–2.05; P < 0.001), but the risk for a renal event was similar between the 2 subgroups (HR = 1.90; 95% CI, 0.94–3.85; P = 0.074). Among the 1093 patients (551 males; 542 females) with available eGFR data, 433 (40%) had a low eGFR and 660 (60%) had a normal eGFR at baseline. The subgroup with a low eGFR at baseline had a significantly higher risk for a cardiovascular event (HR = 1.33; 95% CI, 1.04–1.70; P = 0.021) or a renal event (HR = 5.88; 95% CI, 2.73–12.68; P < 0.001) compared with patients with a normal eGFR at baseline. ImplicationsIn the present study, the presence of LVH and/or reduced renal function at agalsidase alfa initiation was associated with a significantly higher risk for a cardiovascular or renal event, indicating that cardiovascular and renal pathologies in Fabry disease may be inter-related. Early initiation of agalsidase alfa treatment prior to the onset of severe organ damage may improve outcomes. ClinicalTrials.gov identifier: NCT03289065.

P.004 Pharmacological activation of trace amine-associated receptor 1 decreases nicotine self-administration in rodents without development of tolerance

Apelin, an adipocyte-derived factor, exhibited a number of cardioprotective properties; however, its effect in diabetes which is a major risk factor for cardiovascular disease (CVD) needs to be further studied. So this work was designed to evaluate the effect of apelin on diabetes and its associated cardiac hypertrophy with its possible underlying protective mechanisms.Thirty male adult Wistar rats were categorized into three groups, 10 rats each, normal control group: received standard food and water regime. Diabetic control group: received streptozotocin (STZ) at a dose of (55 mg/kg, i.p., once) dissolved in citrate buffer (pH 4.5). Apelin-13 treated diabetic group: STZ diabetic rats received an intra peritoneal injection of apelin-13 at a dose of (100 nmol/kg/day), and given daily for 8 weeks. at the end of the experiment, oral glucose tolerance test (OGTT) was assayed, then rats were sacrificed and serum glucose, insulin, triglyceride (TG), total cholesterol, high density lipoprotein (HDL) cholesterol, serum lactate dehydrogenase (LDH) and serum creatine kinase – MB (CK-MB) were measured, together with cardiac hypertrophy index (CHI), left ventricular hypertrophy index (LVHI) and left ventricular protein and collagen content levels. Myocardial superoxide dismutase (SOD), catalase, reduced glutathione (GSH) and malondialdehyde (MDA) were determined in the myocardial tissue of experimental rats.Treatment with apelin-13 improved hyperglycemia and hyperlipidemia, and significantly protected against STZ-induced structural alterations in cardiac tissue, it also produced a significant reduction in MDA while it elevated the level of antioxidant enzymes in hearts of diabetic rats.This study suggested that apelin can ameliorate diabetes and its associated myocardial hypertrophy through mainly its anti diabetic, anti hyperlipidemic and anti oxidative stress properities.

Defining the electrocardiographic and echocardiographic abnormalities in a population of older adults with cardiovascular disease in rural south africa

Abstract Background The African continent is undergoing an epidemiologic transition from infectious to cardiovascular (CV) diseases. National health systems face a critical shortage of population-level data to target the growing burden of hypertension (HTN). Very little is known on the impact of HTN on the rural population in many African countries, where over 85% of the rural population will migrate to cities and shape the modern CV disease spectrum of Africa in the next decade. Purpose To characterize the prevalence of HTN and HTN-related EKG and TTE abnormalities in a rural cohort in South Africa (n=5,059). Methods Between 2014 and 2015, 804 EKGs and 158 TTEs were performed on participants aged 40 or older randomly sampled from a longitudinal cohort residing in the Agincourt sub-district of rural South Africa. EKGs and TTEs were interpreted by two blinded physicians, and clinically meaningful variables defined using the Minnesota code (EKG) and European Association of Cardiovascular Imaging guidelines (TTE). Chi-square tests were conducted to define the association of EKG/TTE abnormalities with HTN, and stratify by gender. Results Over 55% of the sample (n=810) met blood pressure criteria for HTN, with a high prevalence of obesity (29%). On EKG, 36.5% participants had left ventricular hypertrophy (LVH), 13.6% T wave abnormalities, 7.5% Q wave abnormalities and 18.8% prolonged QT interval. Males (n=291) had more LVH (45% vs 30.8%, p&amp;lt;0.01) and Q wave abnormalities (10% vs 5.9%, p=0.04) than females. Instead, females (n=438) had more prolonged QT intervals (28.8% vs 21%, p=0.02). Compared to those without HTN, participants with HTN had more LVH (45.4% vs 22.1%, p&amp;lt;0.01), ST segment abnormalities (17.4% vs 10.7%, p&amp;lt;0.01) and prolonged QT interval (23.4% vs 11.4%, p&amp;lt;0.01). On TTE, there was a high prevalence of moderate (31%) / severe (25.8%) diastolic dysfunction, and concentric LVH (31.6%). Females had more concentric LVH (40.8% vs 13.5%, p&amp;lt;0.01), and high relative wall thickness (70% vs 18.1%, p&amp;lt;0.01) than males. Participants with HTN had more concentric LVH (42.5% vs 8.2%, p&amp;lt;0.01), LV mass (58.5% vs 20.4%, p&amp;lt;0.01) and LV mass index (52.8% vs 30.6%, p&amp;lt;0.01), than those without HTN. Conclusions The rural population in South Africa is already affected by a high burden of HTN and high obesity levels. Within this cohort, patients with HTN have significantly more EKG and TTE abnormalities that predict adverse CV outcomes. EKG and TTE evaluation can be used to identify high-risk groups that national health systems should prioritize with frequent monitoring and more aggressive medical treatment. Funding Acknowledgement Type of funding source: Private hospital(s). Main funding source(s): Brigham and Women's Hospital

A novel DSN-based fluorescence assay for MicroRNA-133a detection and its application for LVH diagnosis in maintenance hemodialysis patients.

Left ventricular hypertrophy (LVH) is the most powerful predictor of cardiovascular mortality in maintenance hemodialysis (MHD) patients. Circulating microRNA‐133a (miR‐133a) was reported to be a potential biomarker for LVH in MHD patients. The aim of this experiment is to establish a novel DSN (duplex‐specific‐nuclease)‐based fluorescence assay for the ultrasensitive detection of miR‐133a and investigate its application for LVH diagnosis in MHD patients. The results indicate DSN enzyme combined with ultrathin metallic MoS2 nanosheets presents high sensitivity, specificity, and low fluorescence background for miR‐133a detection. Then, circulating miR‐133a levels in plasma from 40 MHD patients and 20 healthy controls are analyzed by such assay. The levels of miR‐133a are down‐regulated in MHD patients with LVH compared to MHD patients without LVH and healthy controls, and the ROC (receiver operating characteristic) curve shows strong separation between MHD with LVH patients and MHD without LVH patients. Furthermore, the liner regression analysis shows negative correlation of miR‐133a level and interventricular septum thickness (IVS) as well as left ventricular mass index (LVMI), the indicators of LVH. Therefore, our findings reveal DSN‐based fluorescence assay for miR‐133a is suitable for LVH diagnosis in MHD patients.

Impact of pericoronary adipose tissue inflammation on left ventricular hypertrophy and regional physiological indices in stable coronary artery disease patients with preserved systolic function.

Systemic low-grade inflammation has been shown to be associated with left ventricular hypertrophy (LVH). However, the relationship between pericoronary adipose tissue attenuation (PCATA) and both LVH and regional physiological indices remains unknown. This study aimed to evaluate the association of PCATA with LVH and regional physiological indices in stable coronary artery disease (CAD) patients with preserved systolic function. A total of 114 CAD patients who underwent coronary CT angiography (CTA) and invasive physiological tests showing ischemia due to a single de novo lesion were included in the study. On proximal 40-mm segments of all three major coronary vessels on CTA, PCATA was assessed by the crude analysis of the mean CT attenuation value [-190 to - 30 Hounsfield units [HU)] and the culprit vessel PCATA was used for the analysis. Regional physiological indices were invasively obtained by pressure-temperature sensor-tipped wire. The patients were divided into three groups by culpritvessel PCATA tertiles, and clinical, CTA-derived, and physiological indices were compared. Univariable and multivariable analyses were further performed to determine the predictors of LVH. Angiographic stenosis severity, culpritlesion locations, culprit vessel fractional flow reserve, coronary flow reserve, index of microcirculatory resistance, total and target vessel coronary calcium score, and biomarkers including high-sensitivity C-reactive protein were not different among the groups. The left ventricular (LV) mass, LV mass index (LVMI), and LV mass at risk were all significantly different in the three groups with the greatest values in the highest tertile group (all, P < 0.05). On multivariable analysis, male gender, NT-proBNP, and PCATA were independent predictors of LVMI. Culprit vessel PCATA was significantly associated with LVMI, but not with regional physiology in CAD patients with functionally significant lesions and preserved systolic function. Our results may offer insight into the pathophysiological mechanisms linking pericoronary inflammation and LVH to worse prognosis.