Left Ventricular Mass Index Levels Research Articles

Increasing left ventricular mass and mortality in 303,548 men and women investigated with echocardiography

Abstract Background and Aims Left ventricular hypertrophy (LVH) categories are based on left ventricular mass index (LVMi). This study aimed to generate sex-stratified, statistically-derived thresholds of mortality according to LVMi within a large, real-world patient cohort. Methods and Results Echocardiographic and linked mortality data were extracted from the National Echocardiography Database of Australia. LVH categories were first defined according to American Society of Echocardiography (ASE) criteria in 303,548 adults comprising 155,668 men (aged 61.3±17.3 years) and 147,880 women (61.8±18.3 years). Sex-specific mild to severe thresholds of increasing 5-year mortality based on LVMi increments were generated. Overall, 36,198 men (23.3%) and 38,898 women (26.3%) had LVH. Actual 5-year mortality rose from 16.9%-38.3% and 11.9%-31.2% in men and women with no LVH versus LVH, respectively. The statistical threshold at which LVMi was associated with increased mortality was lower than traditional LVH criteria in both men (Figure A, ≥88g/m2 versus ≥115g/m2) and women (Figure B, ≥82g/m2 versus ≥95g/m2). For men versus lowest-risk LVMi, the fully adjusted risk of 5-year mortality was 14% (95%CI 1.03-1.25) and 68% higher (95%CI 1.49-1.90) when LVMi levels were mildly (88 to <116) to severely (≥140g/m2) increased, respectively. In women, the equivalent LVMi thresholds of 82 to <112 and ≥140g/m2 were associated with a 13% (95%CI 1.03-1.24), and 81% higher (95%CI 1.58-2.08) 5-year mortality risk. Conclusion A high proportion of men and women have LVMi levels associated with elevated mortality risk that are lower than those traditionally used to diagnose or manage LVH. Such individuals may benefit from more proactive recognition and clinical management.

Excess risk of cardiovascular events in patients in the United States vs. Japan with chronic kidney disease is mediated mainly by left ventricular structure and function

While patients receiving dialysis therapy in the United States are more likely to develop cardiovascular disease (CVD) than those in Japan, direct comparisons of patients with predialysis chronic kidney disease (CKD) are rare. To study this, we compared various outcomes in patients with predialysis CKD using data from the Chronic Renal Insufficiency Cohort (CRIC) and CKD Japan Cohort (CKD-JAC) studies and determined mediators of any differences. Candidate mediators included left ventricular (LV) indices assessed by echocardiography. Among 3125 CRIC and 1097 CKD-JAC participants, the mean LV mass index (LVMI) and ejection fraction (EF) were 55.7 and 46.6 g/m2 and 54% and 65%, respectively (both significant). The difference in body mass index (32 and 24 kg/m2, respectively) largely accounted for the differences in LVMI and C-reactive protein levels across cohorts. Low EF and high LVMI were significantly associated with subsequent CVD in both cohorts. During a median follow-up of five years, CRIC participants were at higher risk for CVD (adjusted hazard ratio [95% confidence interval]: 3.66 [2.74-4.89]) and death (4.69 [3.05-7.19]). A three-fold higher C-reactive protein concentration and higher phosphate levels in the United States cohort were moderately strong mediators of the differences in CVD. However, echocardiographic parameters were stronger mediators than these laboratory measures. LVMI, EF and their combination mediated the observed difference in CVD (27%, 50%, and 57%, respectively) and congestive heart failure (33%, 62%, and 70%, respectively). Thus, higher LV mass and lower EF, even in the normal range, were found to be predictive of CVD in CKD.

Differences in Cardiovascular Remodeling in Kidney Transplant Recipients and Peritoneal Dialysis Patients

Aims: Cardiovascular disease (CVD) is the leading cause of death in dialysis patients as well as in kidney transplant recipients (KTx). Left ventricular hypertrophy (LVH) starts early during the course of chronic kidney disease and is a strong predictor of CVD. We hypothesised that kidney transplant is significantly associated with improvement in cardiovascular reserve. We conducted a prospective study to compare changes in CV before and after kidney transplantation in patients with ESRD who received KTx to control individuals who received PD but did not receive a KTx.
 Study Design: A Case-Control Study.
 Place and Duration of Study: Clinic for nephrology Clinical Center University of Sarajevo, Bosnia and Herzegovina.
 Methodology: In this case-control study, we included 50 KTx from the Kidney Transplant Outpatient Clinic for nephrology Clinical Center. For each 50 KTx, PD outpatients matched for gender and age were recruited. All patients underwent transthoracic echocardiography, and LV (left ventricular) mass (LVM), LV mass index (LVMi), and indices of cardiac function were measured. In the small subgroup of 18 KTx, we retrospectively assessed and compared the LVMI measurements, during dialysis and the post-transplant period.
 Results: The prevalence of LVH was 24% in KTx patients and 72% in PD patients (NS). KTx had significantly lower LVM, LVMi levels, E/A ratio, FS, and LA diameter compared with the PD group, while the EF and other echocardiographic parameters did not differ. In the subgroup of 18 KTx, LVMi levels after transplantation were significantly lower than dialysis LVMi levels.
 Conclusion: LVH is the most frequent cardiac abnormality at the time of kidney transplantation. After KTx, the reduction of LVH and diastolic dysfunction was significant. CV remodelling after successful KTx is related to better kidney function, and can explain better outcomes for patients with kidney transplants over patients on long-term dialysis.

The role of triglyceride-glucose index in determining subclinical atherosclerosis in patients with primary hypertension.

With the current study, we aimed at examining the relationship between the triglyceride-glucose (TyG) index and subclinical atherosclerosis in patients with primary hypertension. 185 patients with primary hypertension were included in this study. The following findings were considered to be associated with target organ damage (TOD): urinary protein excretion > 150 mg/dL and microalbumin excretion > 30 mg/dL, carotid intima-media thickness (CIMT) ≥ 0.9 mm or carotid plaque and/or left ventricular mass index (LVMI) > 95 g/m2 in women, > 115 g/m2 in men. TyG index values were positively correlated with levels of CIMT (r=0.434; p<0.001), LVMI (r=0.351; p<0.001), microalbuminuria (r=0.347; p<0.001), and proteinuria (r=0.355; p<0.001). In the multivariable regression model, in which the variables associated with the presence of TOD were included, increased age (OR: 1.04, p=0.025), increased body mass index (OR: 1.10, p=0.042), and increased TyG index value (OR: 1.05, p<0.001) had independent associations with TOD. The threshold value of the TyG index for the presence of TOD was determined as > 8.85 with 79.0% sensitivity and 77.1% specificity (AUC±SE: 0.859±0.03, +PV: 70.6%, -PV: 84.0%, p<0.001). The TyG index had a superior diagnostic discrimination compared to its components in predicting the presence of TOD. Increased TyG index values in patients with primary hypertension are associated with damage to target organs, not merely subclinical atherosclerosis.

Independent and joint association of N-terminal pro-B-type natriuretic peptide and left ventricular mass index with heart failure risk in elderly diabetic patients with right ventricular pacing.

BackgroundElevated levels of N-terminal pro-B natriuretic peptide (NT-proBNP) and left ventricular hypertrophy (LVH) are independent risk factors for heart failure (HF). In addition, right ventricular pacing (RVP) is an effective treatment strategy for bradyarrhythmia, but long-term RVP is associated with HF. However, there is limited evidence on the independent and combined association of NT-proBNP and left ventricular mass index (LVMI) with HF risk in elderly diabetic patients with long-term RVP.MethodsBetween January 2017 and January 2018, a total of 224 elderly diabetic patients with RVP at Fuwai Hospital were consecutively included in the study, with a 5-year follow-up period. The study endpoint was the first HF readmission during follow-up. This study aimed to explore the independent and joint relationship of NT-proBNP and LVMI with HF readmission in elderly diabetic patients with long-term RVP, using a multivariate Cox proportional hazards regression model.ResultsA total of 224 (11.56%) elderly diabetic patients with RVP were included in the study. During the 5-year follow-up period, a total of 46 (20.54%) patients suffered HF readmission events. Multivariate Cox proportional hazards regression analysis showed that higher levels of NT-proBNP and LVMI were independent risk factors for HF readmission [NT-proBNP: hazard risk (HR) = 1.05, 95% confidence interval (CI): 1.01–1.10; LVMI: HR = 1.14, 95% CI: 1.02–1.27]. The optimal cut-off point of NT-proBNP was determined to be 330 pg/ml by receiver operating characteristic (ROC) curve analysis. Patients with NT-proBNP > 330 pg/ml and LVH had a higher risk of HF readmission compared to those with NT-proBNP ≤ 330 pg/ml and non-LVH (39.02% vs. 6.17%; HR = 7.72, 95% CI: 1.34–9.31, P < 0.001).ConclusionIn elderly diabetic patients with long-term RVP, NT-proBNP and LVMI were associated with the risk of HF readmission. Elevated NT-proBNP combined with LVH resulted in a significantly higher risk of HF readmission.

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 &lt; 0.05), cardiac index (CI) (4.35 ± 0.90 vs 3.35 ± 0.54 l/m2, p &lt; 0.005) and heart rate (94.20 ± 9.39 vs 84.92 ± 12.61 beats/min, p &lt; 0.05) compared to the PD patients. Mean arterial pressure (MAP) z score (R2 = 0.34, P &lt; 0.005), SBP/DBP dip (R2 = 0.21 and R20.22, respectively, P &lt; 0.05), central systolic BP (cSBP) z score (R2 = 0.39, P &lt; 0.001), PWV (R2 = 0.26, P = 0.005), CI, (R2 = 0.14, P &lt; 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 &lt; 0.001). All children with LVH in the PD group and 50% with left ventricular hypertrophy in the HD group had high cSBP (&gt;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.

Effect of amlodipine versus bisoprolol in hypertensive patients on maintenance hemodialysis: A randomized controlled trial.

Background:Left ventricular hypertrophy and asymmetric dimethylarginine (ADMA) are surrogate markers of cardiovascular disease (CVD) in the dialysis population. This study aimed to evaluate the effect of a calcium channel blocker-based antihypertensive regimen compared to a beta-blocker-based antihypertensive regimen on left ventricular mass index (LVMI) and ADMA levels in hypertensive patients on hemodialysis (HD).Methods:This was a parallel-design, open-label, single-center randomized controlled trial on 46 hypertensive patients on maintenance HD, with no history of CVD. Patients were randomly assigned to receive amlodipine 10 mg/d (n = 23) or bisoprolol 10 mg/d (n = 23). Office-based blood pressure (BP) was targeted to ≤ 140/ 90 mm Hg. The outcome was the change in LVMI and ADMA from baseline to 6 months.Results:Baseline demographic and clinical characteristics did not vary between groups. After 6 months of treatment, amlodipine-based therapy induced a greater reduction in LVMI from baseline than bisoprolol-based treatment (35 ± 34.2 vs 9.8 ± 35.9 gm/m2; P = .017). A similar reduction in the mean BP occurred with treatment in both groups. ADMA concentration decreased significantly from baseline in the amlodipine group (0.75 ± 0.73 to 0.65 ± 0.67 nmol/mL; P = .001), but increased nonsignificantly in the bisoprolol group (0.64 ± 0.61 to 0.78 ± 0.64 nmol/mL; P = .052).Conclusion:This study showed that compared to a bisoprolol-based regimen, an amlodipine-based antihypertensive regimen resulted in a significantly greater reduction in LVMI and ADMA levels from baseline in hypertensive patients on HD despite similar BP reduction in both groups. These findings support the re-evaluation of amlodipine as a potential first-line antihypertensive treatment in patients on HD without previous CVD.Trial Registration:Clinicaltrials.gov Identifier: NCT04085562, registered September 2019.

Endothelial Dysfunction and Endocan Levels in Patients with Gilbert Syndrome and Moderate Hyperbilirubinemia.

In this study, we aim to evaluate the presence of endothelial dysfunction in Gilbert syndrome patients with left ventricular mass index (LVMI) and endocan levels. The study included 60 patients who diagnosed with Gilbert syndrome and 60 healthy controls who did not have any known diseases. Human endocan levels were measured using a sandwich ELISA method. The endocan and LVMI levels were lower in the Gilbert syndrome group than in the healthy controls. In the Gilbert syndrome group, total bilirubin level was negatively correlated with LVMI (r = -0246; P = .007) and endocan levels (r = -.270; P = .046). In the Gilbert syndrome group, increasing age (β ± SE = 20.78 ± 7.47; P = .006), was a positive independent predictor of LVMI, and increasing high-density lipoprotein cholesterol (HDL-C) (β ± SE = -.27 ± .09; P = .007), and total bilirubin levels (β ± SE = -6.09 ± 3.02; P = .046) were found to be a negative independent predictor. These results support that endothelial dysfunction is decreased in Gilbert Syndrome patients with mild hyperbilirubinemia compared with the healthy control group.

Subclinical Left Atrial and Ventricular Dysfunction in Acromegaly Patients: A Speckle Tracking Echocardiography Study.

ResumoFundamento Embora se saiba que a fração de ejeção (FE) do ventrículo esquerdo (VE) medida por eletrocardiograma seja preservada em pacientes com acromegalia, não há informação suficiente sobre deformação longitudinal global e deformação do átrio esquerdo (SLG-VE e SAE).Objetivo O objetivo deste estudo foi avaliar as funções do ventrículo esquerdo (VE) e do átrio esquerdo (AE) por ecocardiograma strain (ES) em pacientes com acromegalia.Métodos Este estudo incluiu 50 pacientes com acromegalia na forma ativa da doença e 50 controles saudáveis com idade, sexo e área de superfície corporal similares. Além dos ecocardiogramas de rotina, medições de SLG-VE e SAE foram realizadas com o ES.Resultados Os valores dos SAE e SLG-VE foram significativamente mais baixos em pacientes com acromegalia (p<0,05 para todos). Na análise bivariada, a pressão arterial sistólica, o pró-hormônio N-terminal do peptídeo natriurético cerebral, o fator de crescimento semelhante à insulina tipo 1, e detectou-se que os níveis de IMVE tinham correlação positiva com SAE e SLG-VE (p<0,05). O nível de IGF-1 tinha forte correlação com SAE e SLG-VE (p<0,001 e β=0,5 vs. p<0,001 e β=0,626, respectivamente); 48% dos pacientes com acromegalia têm SLG-VE reduzido (<20%). O índice de massa do ventrículo esquerdo (IMVE) determina independentemente a presença de SLG-VE reduzido, e cada 1g/m2 de aumento no nível de IMVE aumenta a probabilidade de redução de SLG-VE em 6%.Conclusão Embora a fração de ejeção de VE seja normal em pacientes com acromegalia, os valores de SAE e SLG-VE são significativamente mais baixos. Além do aumento em IMVE, outro achado do envolvimento cardíaco pode ser a redução de SAE e SLG-VE. Portanto, além do ecocardiograma de rotina, SAE e SLG-VE podem ser úteis para avaliar os sinais iniciais de envolvimento cardíaco antes da ocorrência de alterações cardíacas irreversíveis.

Abstract 11505: Left Ventricular Mass Index and Risk of Cognitive Decline in a General Elderly Population (Tanushimaru Cohort Study)

Introduction: Elevated cardiovascular disease risk factor burden is a recognized contributor to poorer cognitive function. Recent cohort study suggested that higher N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels predicted incident dementia. However, there is little study of the longitudinal association between left ventricular (LV) structure and future cognitive decline. Hypothesis: LV structure is associated with cognitive decline. Methods: We recruited 1943 participants (mean age: 65.8±11.3 years, male 39.9%) as a population-based sample of Tanushimaru, Japan in 2009 and followed 837 adults in 2018 after excluding those with heart disease history. The subjects received 2-dimensional echocardiography to quantify LV mass index (LVMI) in 2009. The 30-point Mini-Mental State Examination (MMSE) was used to assess cognitive function in 2009 and in 2018. We classified MMSE scores ≦23, 24-27, ≥28 as dementia, mild cognitive impairment (MCI) and normal cognition (NC). Multivariable logistic regression analyses were performed to examine the association between LVMI and cognitive decline. Results: Mean MMSE scores in 2009 and in 2018 among 837 participants were 28.1±2.0 and 28.4±2.3, respectively. Cognitive status progressed from NC to MCI/dementia in 19.3% (96/498) or from NC/MCI to dementia in 2.9% (24/826). Mean LVMI levels were 81.9±19.7g/m2 in men and 76.5±18.4g/m2 in women. Conversion from NC to MCI/dementia was not associated with LVMI, while larger LVMI was significantly associated with the progression from NC/MCI to dementia (p=0.002). Age, sex-adjusted odds ratio for progression to dementia was 1.50 (95% confidence interval, 1.16-1.97) as LVMI increased by 10 g/m2. The association was independent of body mass index, systolic blood pressure, and microalbuminuria. LVMI &amp;gt; 90.6 g/m 2 in men and &amp;gt; 99.9 g/m 2 in women accurately predicted progression to dementia (p &amp;lt; 0.0001). These cutoff points were smaller in men and larger in women than the current criteria for LV hypertrophy. Conclusions: Larger LVMI was not associated with early stage of cognitive decline, but can be a risk factor for progression to dementia. We recommend to carefully evaluate cognitive function among at-risk individuals with larger LVMI.

The Association of Morning Hypertension With Target Organ Damage in Patients With Chronic Kidney Disease and Hypertension.

Objectives: To determine the association between morning hypertension and target organ damage (TOD) in patients with chronic kidney disease (CKD) and hypertension.Methods: In this cross-sectional study, 447 patients with CKD and hypertension from two centers were enrolled. Ambulatory blood pressure monitoring was conducted in all patients. Linear regression and logistic regression analysis were used to determine the association between morning hypertension and TOD in patients with CKD and hypertension, including assessments of estimated glomerular filtration rate (eGFR), left ventricular mass index (LVMI), urine protein/creatinine ratio (UPCR), and left ventricular hypertrophy (LVH).Results: Overall, 194 (43.4%) participants had morning hypertension. Morning hypertension was strongly correlated with LVH [odds ratio (OR), 2.14; 95% confidence interval (CI), 1.3–3.51; p < 0.01], lower level of eGFR (β = −0.51; 95%CI, −0.95–−0.08; p < 0.05), higher LVMI (β = 0.06; 95%CI, 0.04–0.08, p < 0.001), and UPCR (β = 0.22; 95%CI, 0.06–0.38, p < 0.01), independent of nocturnal hypertension and elevated morning blood pressure surge. As a continuous variable, both morning systolic blood pressure (SBP) and diastolic blood pressure (DBP) were found to be associated with LVH and higher level of UPCR and LVMI (p < 0.05), whereas only morning SBP was negatively correlated with eGFR (p < 0.01).Conclusion: Morning hypertension was strongly correlated with cardiac damage and impaired kidney function in CKD patients with hypertension, independent of nocturnal hypertension and morning surge in blood pressure. Morning hypertension in CKD patients warrants further attention.

Two-Year Change in Blood Pressure Status and Left Ventricular Mass Index in Chinese Children.

Background: Elevated blood pressure (BP) is associated with target organ damage, such as left ventricular hypertrophy (LVH), in childhood. However, it is unclear if children who resolve elevated BP have reduced levels of left ventricular mass index (LVMI). This study aimed to examine the association between change in BP status over 2 years and LVMI among Chinese children.Methods: Data were from 1,183 children aged 6–11 years at baseline in 2017 who were followed up in 2019 in the Huantai Childhood Cardiovascular Health Cohort Study. Change in BP status over 2 years from baseline to follow-up was categorized as: persistent normal BP, resolved elevated BP (elevated BP at baseline, normal BP at follow-up), incident elevated BP (normal BP at baseline, elevated BP at follow-up), and persistent elevated BP. Elevated BP status was defined according to national reference standards as systolic or diastolic BP levels ≥ sex-, age-, and height-specific 95th percentiles.Results: LVMI levels were lowest in children with persistent normal BP (30.13 g/m2.7), higher in those with incident elevated BP (31.27 g/m2.7), and highest in those with persistent elevated BP (33.26 g/m2.7). However, LVMI levels in those who had resolved elevated BP (30.67 g/m2.7) were similar to those with persistent normal BP. In the fully adjusted model, compared with children with persistent normal BP, those with persistent elevated BP and incident elevated BP had higher LVMI at follow-up (ß = 3.131, p < 0.001; ß = 1.143, p = 0.041, respectively). In contrast, those who had resolved elevated BP did not have a significantly higher LVMI (ß = 0.545, p = 0.194) than those with persistent normal BP.Conclusion: Developing or maintaining elevated BP over a 2-year period in childhood associated with higher levels of LVMI, but those able to resolve their elevated BP status over the same period had LVMI levels that were similar with those who had normal BP at both time points. Thus, it is important to identify children with elevated BP at early time and to take effective measures to lower their BP levels, thereby reducing high LVMI levels and related cardiovascular diseases in the future.

Beneficial effects of sodium glucose cotransporter 2 inhibitors on left ventricular mass in patients with diabetes mellitus.

Sodium glucose cotransporter 2 inhibitor (SGLT2i) has recently been suggested to reduce the risk of cardiovascular events. Left ventricular hypertrophy (LVH) is associated with cardiovascular events. Diabetic macroangiopathy is a crucial complication in patients with diabetes mellitus (DM). This study examined the effect of SGLT2i on LVH in patients with type 2 DM (T2DM). The retrospective cohort study was conducted in consecutive outpatients with T2DM from 2010 to 2020. Left ventricular mass index (LVMI) was used as an indicator of LVH based on echocardiography. The minimum follow-up period was 1year. After propensity score-matching for clinical profiles, patients who underwent annual echocardiography twice for a routine checkup and took SGLT2i were defined to the SGLT2i group, whereas patients without SGLT2 inhibitors were defined to the non-SGLT2 group. SGLT2i was administered after baseline echocardiography followed by a second examination. LVMI levels in the SGLT2i group (n=169) significantly decreased from baseline compared with those in the non-SGLT2i group (n=169), % changes in LVMI2.7(g/m2.7 ) in median (interquartile ranges [IQR]) were - 7.7 (-18.7, 2.5) vs -3.6 (-14.3, 5.8), respectively, P =0.017). In a subgroup analysis, LVMI levels in the patients who had LVH in the SGLT2i group more significantly decreased than those without LVH, % changes in LVMI2.7(g/m2.7 ) in median (IQR) were -13.5 (-22.1, -2.4) vs -2.8 (-12.6, 9.8), respectively, P <0.001). SGLT2i treatment was shown to improve LVH in patients with T2DM and may play a pivotal role in the future treatment of diabetic cardiovascular complications.

A predictive marker for target organ damage in primary hypertension: serum uric acid levels

Background: This study aims to investigate the relationship between serum uric acid levels, the left ventricular mass index (LVMI), and carotid intima-media thickness (CIMT) in primary hypertension patients. Material and Method: A total of 139 primary hypertension patients, including 45 (32.4%) men and 94 (67.6%) women were involved in the study. The laboratory and clinical demographic findings, as well as the LVMI and CIMT levels of the patients, were collected from patient files. Results: 37% of the study population were found to have hyperuricemia. LVMI (99.75}13.4 vs 86.17±17.6; p=0.010) and CIMT (0.88±0.26 vs 0.75±0.17; p=0.023) levels were found to be higher in the hyperuricemia versus the non-hyperuricemia group. According to the correlation analysis, there was a positive correlation between uric acid and LVMI (r=0.282, p=0.032) and CIMT (r=0.285, p=0.002) levels. Robust regression analysis showed that uric acid was an independent risk factor for both the LVMI (β±SE: 1.615±1.03, p&lt;0.05) and CIMT (β±SE: 0.251±0.09, p&lt;0.05). Conclusion: We found serum uric acid levels to be closely related to the target organ damage associated with primary hypertension, and even related with target organ damage independent from blood pressure.

Change in waist circumference over 2 years and the odds of left ventricular hypertrophy among Chinese children

Background and aimsHigh waist circumference (WC) is associated with left ventricular mass index (LVMI) in childhood. However, no studies have assessed the association between WC change and left ventricular hypertrophy (LVH) in childhood. This study aimed to investigate the association between change in WC status over 2 years on LVH among Chinese children. Methods and resultsData were from a population-based prospective cohort study in China. Children without LVH at baseline (n = 1067) were assigned to four WC status change groups (persistent normal WC, WC loss, WC gain, and persistent abdominal obesity). Over a 2-year follow-up, 103 (out of 1067) children had LVH. LVMI levels were the highest among the persistent abdominal obesity group (31.5 ± 3.8 g/m 2.7), lower in the WC gain group (31.0 ± 3.6 g/m 2.7) and the WC loss group (29.8 ± 3.7 g/m 2.7), and lowest in the persistent normal WC group (29.1 ± 3.7 g/m 2.7). Compared with children in the persistent normal WC group, the odds of LVH was highest in the persistent abdominal obesity group [odds ratio (OR) = 3.57, 95% confidence interval (CI): 2.18–5.83], followed by the WC gain group (OR = 2.85, 95% CI: 1.50–5.41). In contrast, the odds of LVH was not increased in the WC loss group (OR = 0.93, 95% CI: 0.21–4.07). ConclusionAlthough these findings highlight the importance of maintaining normal WC in childhood to reduce the odds of developing LVH, our data suggest the increased odds associated with abdominal obesity can be reversed by WC loss.

EXAGGERATED BLOOD PRESSURE RESPONSE IN EXERCISE IS ASSOCIATED WITH LACK OF LEFT VENTRICULAR HYPERTROPHY REGRESSION IN HYPERTENSIVE PATIENTS AFTER 6 YEARS FOLLOW-UP

Objective: Regression of left ventricular hypertrophy (LVH) is independently associated with improved cardiovascular outcome. In this study we aimed to investigate the role of exaggerated blood pressure response (EBPR) during exercise in LVH regression in hypertensive subjects over time. Design and method: 1413 hypertensive subjects, (mean age 57 ± 11 years), 51% males, with baseline office blood pressure (BP) 144/89mmHg were followed for a mean period of 6.4 ± 3.0 years. At baseline and last follow-up visit all patients underwent office BP, laboratory tests and echocardiographical determination of left ventricular mass index (LVMI). At baseline, all subjects underwent treadmill exercise testing (Bruce protocol) in order to identify the presence of EBPR based on the systolic BP elevation at peak exercise (&gt; or = 210 mmHg for men and &gt; or = 190 mmHg for women). Main outcome variable was LVH Regression/prevention (LVH Regr/prev), defined as: LVH at baseline visit with normal LVMI values at last visit or absence of LVH at baseline and last visit. BP control was considered optimal when the mean of office BP measurements during follow-up was &lt; 140/90 mmHg. Results: 46% of study population presented LVH Regr/prev during follow-up period. Cox-regression analysis, after adjustment for clinical and biochemical variables, revealed that low levels of baseline LVMI (HR = 0.98, 95% CI 0.97–0.99, p &lt; 0.0001), absence of EBPR (HR = 0.81, 95% CI 0.67–0.98, p = 0.02) and optimal BP control during follow-up (HR = 1.19, 95% CI 1.01–1.56, p = 0.03) were independent predictors of LVH Regr/prev during follow-up. Conclusions: In conclusion, beyond optimal BP control, EBPR is a significant predictor of structural cardiac alterations overtime. These finding strengthens the clinical importance of EBPR during the baseline evaluation of hypertensive subjects.

Blood pressure response in exercise is associated with future cardiac structural alterations in hypertensive patients

Abstract Background/Introduction Exaggerated blood pressure response (EBPR) during the exercise treadmill test (ETT) is often observed in individuals without known cardiovascular disease. Although it is generally considered as an abnormal response and a risk factor for hypertension development, its clinical significance remains controversial. On the other hand, regression of left ventricular hypertrophy (LVH) is independently associated with improved cardiovascular outcome. Purpose In this study we aimed to investigate the role of EBPR during exercise in LVH regression in hypertensive subjects over time. Methods 1413 hypertensive subjects, (mean age 57±11 years), 51% males, with baseline office blood pressure (BP) 144/89mmHg were followed for a mean period of 6.4±3.0 years. At baseline and last follow-up visit all patients underwent office BP, laboratory tests and echocardiographical determination of left ventricular mass index (LVMI). At baseline, all subjects underwent treadmill exercise testing (Bruce protocol) in order to identify the presence of EBPR based on the systolic BP elevation at peak exercise (&amp;gt; or =210 mmHg for men and &amp;gt; or =190 mmHg for women). Main outcome variable was LVH Regression/prevention (LVH Regr/prev), defined as: LVH at baseline visit with normal LVMI values at last visit or absence of LVH at baseline and last visit. BP control was considered optimal when the mean of office BP measurements during follow-up was &amp;lt;140/90mmHg. Results 46% of study population presented LVH Regr/prev during follow-up period. Cox-regression analysis, after adjustment for clinical and biochemical variables, revealed that low levels of baseline LVMI (HR=0.98, 95% CI 0.97–0.99, p&amp;lt;0.0001), absence of EBPR (HR=0.81, 95% CI 0.67–0.98, p=0.02) and optimal BP control during follow-up (HR=1.19, 95% CI 1.01–1.56, p=0.03) were independent predictors of LVH Regr/prev during follow-up. Conclusions Beyond optimal BP control, EBPR is a significant predictor of left ventricular mass changes overtime. Hence, ETT can provide clinical relevant information, including EBPR, which may help in the improvement of risk stratification of hypertensive subjects. Funding Acknowledgement Type of funding source: None

Impact of obstructive sleep apnea on left ventricular mass index in men with coronary artery disease.

Left ventricular hypertrophy (LVH) is associated with augmented risk for mortality in patients with coronary artery disease (CAD). These patients often have obstructive sleep apnea (OSA). We aimed to evaluate the relationship between OSA and the left ventricular mass index (LVMI) in men with CAD. Consecutive patients with CAD were recruited and underwent overnight portable monitoring for the assessment of OSA. LVMI was ascertained using high-resolution echocardiography. Univariate and multivariate regression analyses were conducted to explore the associations between the OSA parameters and the LVMI levels. Of the 1,053 examined male patients with CAD, 425 (40.4%) had moderate-to-severe OSA (respiratory event index ≥ 15 events/h). The prevalence of LVH (LVMI > 125 g/m²) was 36.0% (n = 379). The mean LVMI values increased with increasing OSA severity (P < .001). Patients with respiratory event index ≥ 30 events/h had 2.30 (95% confidence interval 1.50-3.54, P < .001) times increased risk of LVH than those without OSA (respiratory event index < 5 events/h) independent of confounders. The minimum oxygen saturation levels were the strongest factor correlated with LVMI (β = -0.299, P = .004) of several OSA indices. Patients with minimum oxygen saturation < 70% had an adjusted odds ratio of 3.62 (95% confidence interval 1.81-7.25, P < .001) for LVH development compared with those with minimum oxygen saturation ≥ 90%. OSA severity was associated with a higher likelihood of LVH in men with CAD, which is partially related to severe nocturnal intermittent hypoxemia. Aggressive effort at managing OSA among patients with CAD may further reduce the cardiovascular risk.

The adipokine fatty-acid binding protein 4 and cardiac remodeling

BackgroundPrevious publications about the association between fatty-acid binding protein 4 (FABP4) and cardiac remodeling have reported different, both beneficial and harmful, associations. Aim of the present investigation was to evaluate the association of FABP4 with parameters of myocardial remodeling defined by cardiac magnetic resonance imaging (CMR).MethodsWe investigated plasma FABP4 levels in 331 patients (71% men, mean age 63±13 years) with preserved left ventricular ejection fraction (LVEF ≥ 55%) who underwent a CMR examination. We used linear cox regression to investigate associations between FABP4 and left ventricular end-diastolic diameter (LVEDD), right ventricular end-diastolic diameter (RVEDD), relative wall thickness (RWT), left ventricular mass index (LVMI), and LVEF (unadjusted and adjusted for age, sex, body mass index, cardiac biomarkers, and comorbidities).ResultsFABP4 levels were associated with lower LVMI and higher NT-proBNP levels in an adjusted model. The inverse association between FABP4 and LVMI was more pronounced in lower FABP4 levels, whereas the positive association between FABP4 and NT-proBNP was more pronounced in relatively high NT-proBNP levels.ConclusionsPossible beneficial and harmful associations between FABP4 and left ventricular size have been reported. Our results suggest a beneficial association with LVMI (more pronounced in lower FABP4 levels) but a harmful association with NT-proBNP (more pronounced in higher FABP4 levels). Therefore, our results might indicate a potential dose-dependent association of FABP4, but this observation needs further investigation in larger study samples.

Huoxue Qianyang decoction ameliorates cardiac remodeling in obese spontaneously hypertensive rats in association with ATF6-CHOP endoplasmic reticulum stress signaling pathway regulation

ObjectiveEndoplasmic reticulum (ER) stress is involved in hypertension related cardiac remodeling. We aimed to evaluate the effects of Huoxue Qianyang (HXQY) decoction on cardiac remodeling in obese spontaneously hypertensive rats (SHRs), and explore its impacts on the activating transcription factor 6 (ATF6)-C/EBP homologous protein (CHOP) ER stress signaling pathway. MethodsTwenty-seven obese SHRs were randomly divided into Obese SHR, Obese SHR + HXQY and Obese SHR + Valsartan groups, and treated with the indicated drugs for 8 weeks. Nine age-matched male SHRs were used as controls. Systolic blood pressure (SBP), body weight (BW), and the left ventricular mass index (LVMI) were measured weekly or at end point. Then, angiotensin II (Ang II), fasting glucose (FPG) and fasting insulin (FIN), total cholesterol (TC), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C) and triglyceride (TG) levels were evaluated with commercial kits. Apoptotic cardiomyocytes were detected by the terminal deoxynucleotidyl transferase mediated dUTP nick end labeling (TUNEL) method. The expression levels of GRP78, ATF6, PERK/pPERK and CHOP were assessed by quantitative PCR and Western blot. ResultsTreatment with HXQY decoction resulted in significantly reduced SBP, BW, LVMI, Ang II, TC and LDL-C levels, as well as the homeostasis model assessment of insulin resistance (HOMA-IR) score in obese SHRs. Apoptosis in heart tissues of obese SHRs was significantly attenuated after HXQY decoction administration, paralleling reduced expression of GRP78, ATF6, PERK/pPERK and CHOP at both mRNA and protein levels. ConclusionCardiac remodeling in obese SHRs is ameliorated by intervention with HXQY decoction in association with inhibited ATF6−CHOP ER stress signaling pathway.