Prevalence Of Left Ventricular Hypertrophy Research Articles

Left ventricular hypertrophy in chronic kidney disease

Background and Aims : CKD patients have a high prevalence of LVH and an increased cardiovascular risk. In this study we have assessed the prevalence of left ventricular hypertrophy (LVH) and left ventricular geometry in a group of 293 patients with high blood pressure and with stage 2–5 chronic kidney disease (CKD), compared with 289 essential hypertensive patients with normal renal function.

Low Klotho/Fibroblast Growth Factor 23 Ratio Is an Independent Risk Factor for Renal Progression in Chronic Kidney Disease: Finding From KNOW-CKD.

BackgroundWe aimed to evaluate soluble Klotho and circulating fibroblast growth factor 23 (FGF23) ratio as a risk factor for renal progression, cardiovascular (CV) events, and mortality in chronic kidney disease (CKD).MethodsWe analyzed 2,099 subjects from a CKD cohort whose soluble Klotho and C-terminal FGF23 levels were measured at enrollment. The Klotho to FGF23 ratio was calculated as Klotho values divided by FGF23 values + 1 (hereinafter called the Klotho/FGF23 ratio). Participants were categorized into quartiles according to Klotho/FGF23 ratio. The primary outcome was renal events, defined as the doubling of serum creatinine, 50% reduction of estimated glomerular filtration rate from the baseline values, or development of end-stage kidney disease. The secondary outcomes consisted of CV events and death. Changes in CV parameters at the time of enrollment and during follow-up according to the Klotho/FGF23 ratio were also examined.ResultsDuring the follow-up period of 64.0 ± 28.2 months, 735 (35.1%) and 273 (13.0%) subjects developed renal events and composite outcomes of CV events and death, respectively. After adjustment, the first (HR: 1.36; 95% CI: 1.08–1.72, P = 0.010) and second (HR: 1.45; 95% CI: 1.15–1.83, P = 0.002) quartiles with regard to the Klotho/FGF23 ratio showed elevated risk of renal events as compared to the fourth quartile group. There was no significant association between Klotho/FGF23 ratio and the composite outcome of CV events and death. The prevalence of left ventricular hypertrophy and vascular calcification was higher in the low Klotho/FGF23 ratio quartiles at baseline and at the fourth-year follow-up.ConclusionsLow Klotho/FGF23 ratio was significantly associated with increased renal events in the cohort of Korean predialysis CKD patients.

Diastolic function parameters in normotensive offspring of hypertensive Nigerians: Comparison with age-matched control

Abstract Background: Systemic hypertension is associated with left ventricular systolic and diastolic dysfunction (LVD). Left ventricular diastolic dysfunction (LVDD) is present in over 25% of adults over 40 years of age and may precede the onset of systemic hypertension. Genetic predisposition may be the reason why some normotensive (NT) individuals develop systemic hypertension despite modest lifestyle modification and others do not. Aim: This study aimed to compare diastolic function parameters in NT offspring of Nigerians with systemic hypertension with those of NT offspring of NT individuals. Materials and Methods: A total of 45 NT offspring of parents with systemic hypertension (ocular hypertension [OHT]) were selected with 45 NT ONT parents, matched for age and sex. All subjects had echocardiography (echo) and electrocardiography (ECG) done. The presence and pattern of LVDD in all subjects were analyzed statistically. Analysis of data was done using the Statistical Package for the Social Sciences (SPSS) version 19. Results: This study observed a statistically significant difference in some LVDD echo parameters between OHT subjects and ONT controls. The left atrial volume (LAV: t = 2.229, P = 0.028), LAV index (LAVI: t = 2.578, P = 0.012), isovolumic relaxation time (IVRT: t = 3.630, P < 0.0001), and difference in atrial reversal and A-wave duration (Ar-A: t = 2.649, P = 0.01) had a statistically significant difference in their mean values between OHT subjects and ONT controls. The prevalence of LVDD in this study was 17.78%. Impaired relaxation (Grade I LVDD) pattern had the highest frequency compared to pseudonormal (Grade II LVDD) pattern (26.67% vs. 4.44%) in OHT subjects. There was no subject in the study population who had restrictive (Grade III or IV LVDD) pattern. It was observed that three sets of LVDD parameters were present in all subjects with LVDD and they were as follows: (1) IVRT + E/A + DT, (2) IVRT + E/A + DT + E/e’, and (3) IVRT + E/A + DT + E/e’ + S/D + Ar-A. The prevalence of abnormal LV geometric pattern was 42.2% (CR: 20%, CH: 13.3%, and EH: 8.9%) in OHT subjects, and this was about two and half times more than the prevalence in ONT controls. Furthermore, the prevalence of LV hypertrophy (CH and EH) in OHT subjects was 22.2%, while it was 14.4% in all subjects in this study. There was a significant correlation between DBP and all echocardiographic LVDD parameters in OHT subjects except A-wave, E/e’ ratio, and systolic fraction (S/D ratio). Conclusions: LVDD and abnormalities are present in NT offspring of systemic hypertensive individuals. These findings suggest that LVDD precedes the development of systemic hypertension.

Prevalence and clinical characteristics of primary aldosteronism in a tertiary-care center in Korea.

Approximately 29% of Korean adults have hypertension; however, the prevalence of primary aldosteronism among the hypertensive population is largely unknown. The aim of our study was to evaluate the prevalence and clinical characteristics of primary aldosteronism in a tertiary-care center in Korea. We retrospectively analyzed 1173 patients with newly diagnosed or preexisting hypertension who were referred to our tertiary-care hospital between January 2013 and December 2018. Patients were screened for primary aldosteronism with the aldosterone-renin ratio and underwent a saline infusion test for diagnostic confirmation. Adrenal computed tomography and adrenal venous sampling were performed for subtype classification for primary aldosteronism. Among the 1173 patients (mean age, 51.8 years; women, 53.2%), 360 (30.7%) had positive screening-test results, of whom 71 (6.1%) were finally diagnosed with primary aldosteronism. Conclusive subtype differentiation was made in 55 patients, of whom 15 (27%) had an aldosterone-producing adenoma, 4 (7%) had unilateral adrenal hyperplasia, and 36 (66%) had bilateral adrenal hyperplasia. Patients with primary aldosteronism had a higher ambulatory blood pressure, left ventricular mass index, and urinary albumin-to-creatinine ratio than those without. Moreover, the primary aldosteronism group had a higher prevalence of left ventricular hypertrophy and albuminuria than the non-primary aldosteronism group. Primary aldosteronism may be more common (6.1%) among Korean patients with hypertension than generally recognized. Primary aldosteronism was associated with a higher degree and prevalence of target organ damage and a higher blood pressure level. Wide application of screening tests for primary aldosteronism may be beneficial in detecting this potentially curable cause of hypertension.

Prevalence of echocardiographic left ventricular hypertrophy among hypertensives in a tertiary health institution in Nigeria

Objective: Systemic hypertension remains an important risk factors for cardiovascular diseases and a major global public health problem. Left ventricular hypertrophy (LVH) is a recognized complication of hypertension and strongly predicts cardiovascular morbidity and mortality. In Nigeria, few studies evaluated the role of echocardiography in the diagnosis of LVHs among hypertensives. This study sets out to determine the prevalence of LVH among hypertensives as determined by echocardiography. Material and Methods: One hundred and seventy-eight hypertensives and eighty-nine age and sex-matched controls were recruited consecutively into the study. They all had echocardiography done to determine which among had LVH. The partition value for LVH for hypertensives was determined using the 97th percentile of the left ventricular mass for controls as a cutoff point. Results: Echocardiographic determined the prevalence of LVH among hypertensives was 32.4%. Conclusion: The echocardiographic prevalence of LVH was 32.4% in the study population. This is a significant proportion among the study population considering the clinical impact of LVH among patients with hypertension.

HYPERTENSIVE HEART DISEASE, WHAT ARE THE FACTORS PRECIPITATING ITS EARLY ONSET?

Objective: Hypertension is a well-established risk factor for cardiovascular disease. It causes left ventricular pressure overload, and changes in cardiac geometry and LV hypertrophy. This study is intended to assess the clinical and echocardiographic factors associated with and predictive for early impairment of left ventricular function as assessed using global longitudinal strain evaluation in hypertensive patients. Design and method: Cross-sectional descriptive study, with a total number of 130 hypertensive and with the objective of evaluating the study of longitudinal function by 2D strain in patients with systemic hypertension with preserved LVEF and the determination of predictors the decrease GLS in this population. This work is to make a complete study echo cardiographic, including LVEF biplane Simpson method, calculation of left ventricular mass indexed and relative parietal thickness, analysis diastolic function and the study of longitudinal strain of the LV by the speckle tracking technique (calculation of GLS) Results: The prevalence of left ventricular hypertrophy (LVH) was found in (66%). half of the patients (49%) presented a concentric hypertrophy, It was clearly noted that 73%of the patients had a relative wall thickness (RWT)> 0.42. Alterations in diastolic function were detected in 89% of the group, 18% had severe diastolic dysfunction with elevation in filling pressure. Analysis of the longitudinal systolic function of the left ventricle took the average GLS as a reference value. The mean GLS was found to be -16.9 ± 3.2%, within a range between -25% and-11.6%. Low GLS values (>-17%) were found in 45.5%. In particular, 34.4% of the patients had no left ventricular hypertrophy (LVH) and 50.7% of them presented LVH. The average systolic and diastolic blood pressures, taken at the time of echocardiographic analysis, were found higher in the subgroup of hypertensive patients with low GLS. Statistical analysis revealed significant correlation between the decrease in GLS and diabetes the values of blood pressure and elevated filling pressures. Conclusions: The evaluation of longitudinal systolic function by 2D strain provides new insight of myocardial function in hypertension that could improve the pathophysiological understanding and identify high-risk heart failure patients eligible for preventive strategies.

HYPERTENSIVE HEART DISEASE IN ADOLESCENCE. PRELIMINARY RESULTS OF THE PESESCAD-HTA STUDY

Objective: Identify the presence of hypertensive heart disease and its relationship with prehypertension and hypertension Design and method: A descriptive, cross-sectional study was carried out in 385 prehypertensive adolescents and 128 adolescents with essential hypertension, aged 12–15 years, from among a total of 1,545 adolescents screened in the School Screening for High Blood Pressure in Adolescents Project (PESESCAD-HTA). An echocardiogram was performed in 513 adolescents (prehypertensive plus hypertensive). For the multivariate analysis of risk factors related to LVH, a decision tree was obtained using the chi square automatic interaction detector (CHAID) technique. Results: Among prehypertensive and hypertensive adolescents, the prevalence of left ventricular hypertrophy was 6.49% (CI = 4.43–9.41) and 21.09% (CI = 14.92–58.95), respectively. In the sample of 513 individuals with prehypertension and hypertension, a decision tree was designed, using the chi square automatic interaction detector (CHAID) technique, with the presence of left ventricular hypertrophy as the dependent variable. Conclusions: The best predictors of left ventricular hypertrophy were a family history of obesity, and its interaction with the age and the sex of the adolescent.

CENTRAL SYSTOLIC BLOOD PRESSURE DETERMINES LEFT VENTRICULAR MASS INDEX IN CHILDREN ON DIALYSIS

Objective: Cardiovascular disease is highly prevalent in the chronic kidney disease population. The aim of the present study was to assess data from 24 h ambulatory blood pressure (BP) monitoring and 24 h pulse wave analysis (PWA) in dialyzed children and investigate their association with left ventricular mass as a marker of increased cardiovascular risk. Design and method: Children and adolescents aged 6 to 18 years, on dialysis for more than 12 months, [16 on peritoneal dialysis (PD) and 12 on hemodialysis (HD)], underwent 24 h ambulatory BP monitoring, 24 h PWA, and echocardiography. The population represents the whole pediatric dialysis cohort in Greece for the years 2019-2020. Results: Left ventricular mass index (LVMI) levels and prevalence of left ventricular hypertrophy (LVH) were similar between PD and HD patients. Peripheral and central BPs, and pulse wave velocity (PWV) values were also similar between PD and HD patients. However, HD patients presented significantly higher augmentation index (AIx75) (30.54 ± 6.14 vs 22.10 ± 9.96 %, p < 0.05), cardiac index (CI) (4.35 ± 0.90 vs 3.35 ± 0.54 l/m2, p < 0.005) and heart rate (94.20 ± 9.39 vs 84.92 ± 12.61 beats/min, p < 0.05) compared to the PD patients. Mean arterial pressure (MAP) z score (R2 = 0.34, P < 0.005), SBP/DBP dip (R2 = 0.21 and R20.22, respectively, P < 0.05), central systolic BP (cSBP) z score (R2 = 0.39, P < 0.001), PWV (R2 = 0.26, P = 0.005), CI, (R2 = 0.14, P < 0.05), AIx (R2 = 0.26, P = 0.005) associated with LVMI. Among laboratory parameters only Hb levels associated with LVMI. In stepwise linear regression with dependent variable LVMI and covariates Hb, MAP, SBP/DBP dip, cSBP, PWV, CI, AIx, the parameter that independently associated with LVMI levels was cSBP (B = 2.68, 95%CI 1.45–3.91, p < 0.001). All children with LVH in the PD group and 50% with left ventricular hypertrophy in the HD group had high cSBP (>95th pc). Conclusions: cSBP is the major determinant of LVMI levels in children on dialysis. Performing PWA seems to have an important role on the assessment of CV risk in children on dialysis.

CHANGES IN CLINICAL PROFILE OF REFRACTORY HYPERTENSIVES AFTER THE INTRODUCTION OF SPIRONOLACTONE

Objective: To characterize prevalence and clinical profile of patients with RfHTN among a historical cohort of patients with RHTN in 2 moments: before and after the introduction of spironolactone. Design and method: A cross-sectional analysis was performed during the pre-spironolactone period (before 2005) with 1,048 participants with RHTN (72.3% women, average age: 61.2 ± 11.3 years). All of them were submitted to a standard protocol including clinical and laboratory tests, 24-hour ABPM, echocardiogram, and pulse wave velocity. In a second analysis, refractory patients were evaluated after the introduction of spironolactone (post-spironolactone period – after 2005). The statistical analysis included bivariate comparisons between patients with RHTN and those with RfHTN, as well as logistic regressions to assess independent correlations of RfHTN pre- and post-spironolactone. Results: In the initial cross-sectional analysis (pre-spironolactone), RfHTN prevalence was 14%. Age < 60 years, smoking, obesity and left ventricular hypertrophy (LVH) were independently correlated with RfHTN. After the introduction of spironolactone, prevalence increased to 17.6%. It was observed that refractory patients using spironolactone presented less aortic stiffness, lower prevalence of LVH, cerebrovascular disease and peripheral arterial disease (PAD), what might indicate a reduced cardiovascular risk despite the lack of blood pressure control. Refractory patients have also presented higher magnitude of white-coat effect, reflecting an exacerbated sympathetic activity. Age < 60 years and lower prevalence of PAD were correlated with RfHTN in the post-spironolactone period. Conclusions: The use of spironolactone seems to reduce cardiovascular risk despite the lack of blood pressure control.

Seamens' Sign: a novel electrocardiogram prediction tool for left ventricular hypertrophy.

IntroductionPatients with left ventricular hypertrophy (LVH) diagnosed by electrocardiogram (ECG) have increased mortality and higher risk for life-threatening cardiovascular disease. ECGs offer an opportunity to identify patients with increased risk for potential risk-modifying therapy. We developed a novel, quick, easy to use ECG screening criterion (Seamens’ Sign) for LVH. This new criterion was defined as the presence of QRS complexes touching or overlapping in two contiguous precordial leads.MethodsThis study was a retrospective chart review of 2,184 patient records of patients who had an ECG performed in the emergency department and a transthoracic echocardiogram performed within 90 days. The primary outcome was whether Seamens’ Sign was noninferior in confirming LVH compared to other common diagnostic criteria. Test characteristics were calculated for each of the LVH criteria. Inter-rater agreement was assessed on a random sample using Cohen’s Kappa.ResultsMedian age was 63, 52% of patients were male and there was a 35% prevalence of LVH by transthoracic echocardiogram (TTE). Nine percent were positive for LVH on ECG based on Seamens’ Sign. Seamens’ Sign had a specificity of 0.92. Tests assessing noninferiority indicated Seamens’ Sign was non-inferior to all criteria (p < 0.001) except for Cornell criterion for women (p = 0.98). Seamens’ Sign had 90% (0.81–1.00) inter-rater agreement, the highest of all criteria in this study.ConclusionWhen compared to both the Sokolow-Lyon criteria and the Cornell criterion for men, Seamens’ Sign is noninferior in ruling in LVH on ECG. Additionally, Seamens’ Sign has higher inter-rater agreement compared to both Sokolow-Lyon criteria as well as the Cornell criteria for men and women, perhaps related to its ease of use.

Cardiovascular Hypertension-Mediated Organ Damage in Hypertensive Urgencies and Hypertensive Outpatients.

BackgroundThe prevalence of hypertension mediated organ damage (HMOD) in patients attending the Emergency Department (ED) with symptomatic blood pressure (BP) rise is unknown, and whether HMOD varies between asymptomatic and symptomatic patients with grade 3 hypertension is unclear.AimThis study aimed to investigate cardiac and vascular HMOD in hypertensive urgencies (HU) and asymptomatic outpatients with grade 1–3 hypertension.MethodsPatients attending the ED with a symptomatic BP rise ≥180/110 mmHg were prospectively enrolled (HU group), after the exclusion of acute organ damage. HMOD and BP were assessed after 72 h from ED discharge in an office setting. These patients were matched by age and sex to outpatients with grade 3 hypertension (Grade 3 group), and by age, sex, and 72 h office BP values to outpatients with any grade hypertension (Control group).ResultsA total of 304 patients were enrolled (76 patients in the HU group, 76 in the Grade 3 group, and 152 in the Control group). Grade 3 patients had increased left ventricular mass (LVMi) compared to patients with HU (106.9 ± 31.5 vs. 96.1 ± 30.7 g/m2, p = 0.035). Severe left ventricular hypertrophy (LVH) was more frequent in grade 3 (21.1 vs. 5.3%, p = 0.004), and pulse wave velocity (PWV) was similar in the two groups. There was no difference in LVMi between ED and Control patients (96.1 ± 30.7 vs. 95.2 ± 26.6 g/m2, p = 0.807). LVH prevalence was similar (43.4 vs. 35.5%, p = 0.209, respectively), but patients with HU had thicker interventricular septum (11.9 ± 2.2 vs. 11.1 ± 2.2 mm, p = 0.007). PWV was similar between these two groups. Patients with HU needed more antihypertensive drugs than Control patients (2 vs. 1, p < 0.001).ConclusionsPatients with HU had a better cardiac HMOD profile than outpatients with grade 3 hypertension. Their cardiac and vascular HMOD is more comparable to an outpatient with similar in-office BP, although they need more antihypertensive medications.

Value of estimated pulse wave velocity to identify left ventricular hypertrophy prevalence: insights from a general population

BackgroundAortic stiffness shares a similar profile of risk factors with left ventricular hypertrophy (LVH) and can also lead to LVH by itself. Published data have demonstrated the correlation between aortic stiffness and LVH. Recent data have revealed estimated pulse wave velocity (ePWV) to be a simple and cost-effective marker of the severity of aortic stiffness. Our analysis aimed to explore the association between ePWV and LVH prevalence, and to investigate the incremental value of ePWV for the identification of LVH prevalence.MethodsThe present analysis based on a cross-sectional survey which included 11,597 participants from rural areas of southeastern China between Sep 2020 and Feb 2021. ePWV was formulated based on mean blood pressure and age according to a published algorithm.ResultsThe prevalence of LVH was 14.56%. With the adjustment of age, sex, education, income and physical activity level, current drinking and smoking status, BMI, waist circumference, serum creatinine, total cholesterol, high density cholesterol, mean blood pressure, fasting plasma glucose, anti-hypertensive therapy, anti-diabetic therapy, lipid-lowering therapy, and cardiovascular disease history, every standard deviation increment of ePWV associated with a 2.993 times risk of LVH prevalence. When dividing ePWV into quartiles, the top quartile had a 4.520 times risk of LVH prevalence when compared with the bottom quartile. Furthermore, smooth spline analysis displayed that the association was linear in the whole range of ePWV (p for non-linearity = 0.073). Additionally, subgroup analysis revealed the association was robust to sex, obesity and diabetes, and younger people and hypertensive population were more vulnerable to the increase of ePWV than their corresponding counterparts. Finally, ROC analysis showed a significant advancement when introducing ePWV into established risk factors (0.787 vs. 0.810, p for comparison < 0.001), and reclassification analysis also confirmed significant improvement from ePWV to identify LVH prevalence (category-free net reclassification analysis = 0.421, p < 0.001; integrated discrimination index = 0.023, p < 0.001).ConclusionOur analysis demonstrated a linear association between ePWV and LVH prevalence. Furthermore, our results suggest younger people and hypertensive population are more likely to have LVH prevalence with the increase of ePWV. More importantly, our findings implicate the incremental value of ePWV to optimize the identification of LVH prevalence in a general Chinese population.

The Prevalence of Cardiovascular Diseases and associated factors among patients in Low- and Middle-Income settings

Background &nbsp;Cardiovascular Diseases (CVDs) are the public health problems worldwide, causing over 18.9 million deaths per year. The major risk factors which are also preventable are tobacco use, diabetes, high blood pressure, overweight/ obesity and alcohol consumption. The aim of this study was to determine the Prevalence of CVDs and associated factors. Methodology We conducted a cross-sectional hospital-based study that consecutively enrolled 785 consenting adults who came to attend Jakaya Kikwete Cardiac Institute (JKCI) mobile clinic in South Western urban Tanzania, a typical LMIC, in 2018. A structured questionnaire was used to obtain demographic data and gather several co-morbid information. A 12 lead Electrocardiogram (ECG) and 2D, M mode Transthoracic Echocardiogram were done to determine the structural and none structural heart diseases from the participants. Results &nbsp;Of 785 participants, 528 (67.3 %) were females, 479 (61%) were middle aged (40-60 years) and 196 (25%) were 65 years old and above, their mean age (±SD) was 56 (±14) years. Most of participants were married 558 (71%), 625 (80%) sponsored by the National Health Insurance Fund (NHIF) and less than half were employed. Of all the participants, tobacco users were 29(3.6%), diabetics 60 (7.5%), alcoholic users 99 (12.5%) and more than half were overweight/obese. The prevalence of Systolic Hypertension was 65% and Diastolic Hypertension was 50% Few participants 85 (11%) had chest pain, 56 (7%) had tachycardia and difficulty in breathing 45 (6%). By ECHO diagnosis; the prevalence of dilated cardiomyopathy was 3.8%, hypertensive heart diseases 2.3% and valvular heart diseases was 2%. Majority 780 (99%) and 694 (88%) had normal Left Ventricular Systolic and Diastolic functions respectively. Furthermore, by ECG diagnosis, the prevalence of Left Ventricular Hypertrophy was 8% and ischemic heart disease was diagnosed in 4% of the participants. In a multivariate analysis, CVD were found to be statistically significant associated with the age 65+ years, 3.41 [95% CI 1.49 -7.78, p- value 0.004], diastolic blood pressure above or equal to 90 mmHg, 1.61 [95% CI 1.05 -2.48, p -value 0.03] and overweight/ obese 1.94 [95% CI 1.28 -2.92, p-value 0.002]. Conclusion The prevalence of cardiovascular diseases was found to be high and the main associated risk factors were advanced age, overweight/obese and diastolic hypertension. Some of the participants had already developed asymptomatic structural heart disease and features which were suggesting of coronary artery diseases.&nbsp; Recommendations Efforts for an early detection of CVD should be undertaken in order to offer an early and appropriate interventions

Middle age serum sodium levels in the upper part of normal range and risk of heart failure.

With increasing prevalence of heart failure (HF) owing to the ageing population, identification of modifiable risk factors is important. In a mouse model, chronic hypohydration induced by lifelong water restriction promotes cardiac fibrosis. Hypohydration elevates serum sodium. Here, we evaluate the association of serum sodium at middle age as a measure of hydration habits with risk to develop HF. We analysed data from Atherosclerosis Risk in Communities study with middle age enrolment (45-66 years) and 25 years of follow-up. Participants without water balance dysregulation were selected: serum sodium within normal range (135-146 mmol/L), not diabetic, not obese and free of HF at baseline (N = 11 814). In time-to-event analysis, HF risk was increased by 39% if middle age serum sodium exceeded 143 mmol/L corresponding to 1% body weight water deficit [hazard ratio 1.39, 95% confidence interval (CI) 1.14-1.70]. In a retrospective case-control analysis performed on 70- to 90-year-old attendees of Visit 5 (N = 4961), serum sodium of 142.5-143 mmol/L was associated with 62% increase in odds of left ventricular hypertrophy (LVH) diagnosis [odds ratio (OR) 1.62, 95% CI 1.03-2.55]. Serum sodium above 143 mmol/L was associated with 107% increase in odds of LVH (OR 2.07, 95% CI 1.30-3.28) and 54% increase in odds of HF (OR 1.54, 95% CI 1.06-2.23). As a result, prevalence of HF and LVH was increased among 70- to 90-year-old participants with higher middle age serum sodium. Middle age serum sodium above 142 mmol is a risk factor for LVH and HF. Maintaining good hydration throughout life may slow down decline in cardiac function and decrease prevalence of HF.

Hyperphosphatemia is associated with cardiac valve calcification in chronic hypoparathyroidism.

To evaluate the association between metabolic abnormalities and cardiovascular risk factors in patients with chronic hypoparathyroidism (HPP). Patients 18years and older, glomerular filtration > 30mL/min/1.73 m2and no documented coronary artery disease were selected. Serum calcium, phosphorus, glucose, lipids, PTH, 25(OH)D and FGF23 were measured. Cardiovascular risk was estimated by the European Society of Cardiology (ESC) calculator. Transthoracic echocardiogram and carotid ultrasound were performed to detect carotid plaques (CP), carotid intima-media thickness (IMT), cardiac valve calcification (CVC), and left ventricular hypertrophy (LVH). Thirty-seven patients (94.6% female), aged 56.0 ± 13.5years and HPP duration 7.0 (4.0; 11.3) years, were included. Fifteen were classified as low cardiovascular risk, 9 as intermediate risk, 9 as high risk and none as very high risk. The prevalence of CP, CVC and LVH was 24.3%, 24.3% and 13.5%, respectively. IMT values were within normal ranges in all cohort.FGF23 were not associatedwithCP, IMT, CVC or LVH.After logistic regression, phosphorus was the only significant metabolic variable impacting CVC in univariate analysis (OR 2.795; 95% CI 1.132-6.905; p = 0.026), as well as in the multivariate analysis (OR 3.572; 95% CI 1.094-11.665; p = 0.035).Analysis by ROC curve showed serum phosphorus > 5.05mg/dL(AUC 0.748; CI 0.584-0.877; p = 0.05) as the best cutoff point associatedwith valve heart calcification (sensitivity 78%;negative predictive value91.3%). Hyperphosphatemia was associatedwith CVC in HPP patients.Further studies are needed to investigate whether the control of hyperphosphatemia may reduce cardiovascular risk in this population.

Abstract P117: Association Of Ambulatory Blood Pressure Monitoring Parameters With Left Ventricular Hypertrophy: Analysis Of Pooled Population- And Community-based Studies

Objectives: Ambulatory blood pressure (BP) monitoring (ABPM) parameters beyond mean BP may be useful for identifying individuals at high risk for cardiovascular end-organ damage. We examined the association between ABPM parameters, including 24-hour BP load, peak BP, peak increase in BP, and mean BP with left ventricular hypertrophy (LVH). Methods: Data were pooled from five US-based studies in which participants underwent ABPM for 24 hours (n=2,892). We defined systolic BP (SBP) load as the weighted average of the percent awake SBP readings ≥ 130 mm Hg and asleep SBP readings ≥ 110 mm Hg; peak SBP as the weighted average of awake and asleep 90 th percentile of SBP; peak increase as the difference between the peak SBP and mean SBP. These parameters were then categorized into quartiles. LVH was assessed by 2D-echocardiography. Analyses were stratified by mean 24-hour BP &lt; 130/80 and ≥ 130/80 mm Hg. Results: Among participants with mean 24-hour BP &lt; 130/80 mm Hg, the prevalence of LVH increased from the lowest to the highest quartile for SBP load, peak SBP, peak increase in SBP, and mean SBP ( Table ). The adjusted prevalence ratio (PR) for the association of the highest versus the lowest quartile with LVH was 1.82 (95%CI: 1.08-3.05) for SBP load, 2.00 (95%CI: 1.18-3.38) for peak SBP, 1.38 (95%CI: 0.85-2.23) for peak increase in SBP, and 1.51 (95%CI: 0.98-2.32) for mean SBP. Among participants with mean 24-hour BP ≥ 130/80 mm Hg, the prevalence of LVH increased for all ABPM parameters from the lowest to the highest quartile. The multivariable-adjusted PR for the association of the highest versus the lowest quartile with LVH was 1.39 (95%CI: 0.98-1.97) for SBP load, 1.66 (95%CI: 1.09-2.53) for peak SBP, 1.08 (95%CI: 0.76-1.53) for peak increase in SBP, and 1.88 (95%CI: 1.24-2.83) for mean SBP. Conclusion: The 24-hour SBP load and peak SBP were associated with a higher prevalence of LVH when mean 24-hour BP was &lt; 130/80 mm Hg. The 24-hour peak SBP and mean SBP were associated with a higher prevalence of LVH when mean 24-hour BP was ≥ 130/80 mm Hg.

Abstract P233: Child Opportunity Index And Prevalence Of Obesity And Hypertension In Adolescents With Congenital Heart Disease

Introduction: The Child Opportunity Index (COI) is a measure of neighborhood conditions encompassing educational, health, environmental, social, and economic components that affect child development. Worse COI has been associated with increased cardiometabolic risk in children. Hypertension (HTN) and obesity leads to left ventricular hypertrophy (LVH) and are risk factors for cardiac events in adulthood. However, the impact of COI on patients with congenital heart disease (CHD) has not been well described. Hypothesis: We hypothesized that CHD youths with lower COI would have higher rates of obesity and hypertension compared to higher COI patients. Methods: We retrospectively reviewed adolescent CHD patients with an echocardiogram between 2012-2019. Patients aged 13-17 years with blood pressure (BP), height, weight, and echo measurement for LVMi-HT 2.7 were included. Home location was geocoded and linked to public COI data. Patients were classified by COI into Very Low (VL), Low (L), Moderate (M), High (H), and Very High (VH) opportunity levels. Obesity was defined as body mass index (BMI) ≥ 95 th percentile. Blood pressure was defined as normotensive (NT, SBP &lt; 120 mm Hg), elevated BP (E-BP, 120 ≤ SBP &lt; 130 mm Hg), Stage 1 HTN (HTN-1, 130 ≤ SBP &lt; 140 mm Hg), and Stage 2 HTN (HTN-2, SBP ≥ 140 mm Hg). Left ventricular hypertrophy (LVH) was defined as LVMi-HT 2.7 ≥ 38.6 g/ht 2.7 . Results: A total of 801 patients (mean age 15.5 ± 1.5 years, 57.43% male [460/801]) were included in this analysis. COI groups were VL 157/801 (19.6%), L 165/801 (20.6%), M 226/801 (28.2%), H 142/801 (17.7%), and VH 111/801 (13.9%). Overall, 117/801 (14.6%) patients were obese, 141/801 (17.6%) patients were hypertensive, and 209/801 (26.1%) patients had LVH. Obesity within COI groups was VL 34/157 (21.7%), L 26/165 (15.8%), M 30/226 (13.3%), H 20/142 (14.1%), and VH 7/111 (6.3%). HTN-1 or HTN-2 was seen in VL 25/157 (15.9%), L 36/165 (21.8%), M 41/226 (18.1%), H 23/142 (16.2%), VH 16/111 (14.4%). LVH was present in VL 50/157 (31.9%), L 47/165 (28.5%), M 63/226 (27.9%), H 26/142 (18.3%), and VH 23/111 (20.7%). Conclusions: Youths with CHD living in lower opportunity areas have a high proportion of obesity and hypertension. Furthermore, end-organ changes are seen with a high prevalence of LVH in lower opportunity CHD youths. In conclusion, these findings support the importance of considering social determinants of health like neighborhood opportunity in assessing cardiovascular risk in CHD youths.

Echocardiographic left ventricular hypertrophy and geometry in Chinese chronic hemodialysis patients: the prevalence and determinants

BackgroundTo investigate the prevalence of left ventricular hypertrophy (LVH) and explore left ventricular geometry in maintenance hemodialysis (MHD) patients, and to explore the risk factors of LVH which is an important predictor of cardiovascular events.MethodsThe subjects were patients who are on MHD for more than 3 months in Peking University People's Hospital from March 2015 to February 2017. Demographic and clinical data were retrospectively collected. Left ventricular mass was measured by echocardiography. LVH is defined by Left ventricular mass index (LVMI) > 115 g/m2 for men and > 95 g/m2 in women. LVMI and relative wall thickness were used to determine left ventricular geometry. Logistic regression was used to analyze the risk factors of LVH.ResultsAltogether, 131 patients including 77 males were enrolled. The median age was 60 (47, 69) years, with a median dialysis vintage of 48 (18, 104) months. There were 80 patients with LVH, the prevalence rate was 61.1%, and 66.3% of them were moderate to severe LVH. We found that (1) most of the patients were concentric hypertrophy; (2) one-third of the patients were concentric remodeling; (3) only 4 cases with normal geometry. The pre-dialysis serum sodium level and time average pre-dialysis systolic blood pressure (SBP) were independent risk factors of LVH.ConclusionLVH is prevalent in MHD patients. Concentric hypertrophy and concentric remodeling are the most common geometric patterns. Attention should be paid to long-term pre-dialysis SBP management and pre-dialysis sodium control as they might be potentially modifiable risk factors for LVH.

Prevalence of Left Ventricular Hypertrophy in Chronic Hemodialysis Patients of Military Hospital Mohamed V in Rabat

Prevalence of Left Ventricular Hypertrophy in Chronic Hemodialysis Patients of Military Hospital Mohamed V in Rabat

Implication of Different ECG Left Ventricular Hypertrophy in Patients Undergoing Transcatheter Aortic Valve Replacement.

BackgroundVarious ECG criteria for left ventricular hypertrophy (LVH) have been proposed, but their association with clinical outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement is unknown. We investigated the prevalence of ECG LVH according to different criteria and its prognostic impact on clinical outcomes after transcatheter aortic valve replacement.Methods and ResultsIn this prospective observational cohort, we evaluated 700 patients who underwent transcatheter aortic valve replacement between March 2010 and December 2019. Baseline preprocedural LVH was defined by 3 ECG criteria—Sokolow‐Lyon, Romhilt‐Estes, and Cornell voltage criteria. The primary outcome was major adverse cardiac or cerebrovascular event (MACCE; composite of death, myocardial infarction, stroke, or rehospitalization from cardiovascular cause); the key secondary outcome was all‐cause and cardiovascular mortality. Among 596 eligible patients, the prevalence of LVH was determined as 56.3% by Sokolow‐Lyon, 31.1% by Romhilt‐Estes, and 48.1% by Cornell criteria. Regardless of the criteria, patients with ECG LVH had more severe aortic stenosis hemodynamics and higher left ventricular mass index. After multivariate adjustment, the presence of LVH by the Cornell criteria was significantly associated with lower risks of MACCE (adjusted hazard ratio [HR], 0.68; 95% CI, 0.51–0.91; P=0.009), all‐cause mortality (adjusted HR, 0.55; 95% CI, 0.34–0.90 [P=0.017]), and cardiovascular mortality (adjusted HR, 0.40; 95% CI, 0.20–0.79 [P=0.008]). However, this association was absent with the Sokolow‐Lyon and Romhilt‐Estes criteria.ConclusionsECG LVH by Cornell criteria only was significantly associated with lower risks of MACCE and all‐cause or cardiovascular mortality.RegistrationURL: https://www.clinicaltrials.gov; Unique identifier: NCT03298178.