Left Ventricular Mass Index Values Research Articles

Myocardial ischemia in patients with mild-to-moderate aortic stenosis: Interaction with cardiac remodeling and adverse events

BackgroundThe association between aortic valve stenosis (AVS) and myocardial perfusion abnormalities has been incompletely characterized. We sought to assess the predictors of myocardial ischemia in patients with mild-to-moderate AVS, and its relationship with long-term prognosis. MethodsEighty-nine patients with mild-to-moderate AVS (peak velocity between 2.6 and 4.0 m/second and aortic valve area > .6 cm2/m2), preserved left ventricular (LV) function, and either normal coronary arteries (28 patients) or non-obstructive coronary artery disease (<50% stenosis; 61 patients) were individuated. Myocardial perfusion imaging was performed using a cadmium–zinc–telluride camera, and the summed difference score (SDS) was computed. The presence of either LV hypertrophy (LVH) (LV mass index [LVMI] > 115 g/m2 [males] or 95 g/m2 [females]) or concentric LV remodeling (relative wall thickness: >.42) was determined at two-dimensional echocardiography. ResultsForty (45%) and 49 (55%) patients had mild and moderate AVS, respectively. Fifty (56%), 17 (19%), and 22 (25%) patients had normal LV geometry, concentric LV remodeling, and LVH, respectively. An interaction between LV remodeling and inducible ischemia was revealed with progressively higher values of SDS in patients with normal LV geometry (3 ± 3), concentric remodeling (4 ± 2), and LVH (7 ± 2) (P < .001).Accordingly, a moderate correlation existed between LVMI and SDS values (R: .67; P < .001). After a median follow-up of 84 ± 47 months, 27 adverse events were recorded, including 19 AV replacements and 8 deaths. On multivariable analysis, the presence of LVH (hazard ratio [HR]: 6.46; 95% confidence interval [CI]: 2.09–20.00; P = .001) and a higher SDS (HR: 1.41; 95% CI: 1.15–1.75; P = .001) were the two independent predictors of AE. ConclusionsIn patients with mild-to-moderate AVS, myocardial ischemia correlates with the severity of adverse LV remodeling. Patients with LVH and ischemia are at increased risk of AE.

#1784 The potential impact of chronic subclinical hypervolemia on left ventricular hypertrophy in children on dialysis: a prospective longitudinal study

Abstract Background and Aims Hypervolemia poses a significant challenge in pediatric patients undergoing dialysis, potentially leading to severe complications such as left ventricular hypertrophy (LVH) and cardiac dysfunction. Accurately assessing fluid status in growing children on dialysis could be particularly difficult, and although several non-invasive methods are emerging, each individual measurement has its own strengths and diagnostic limitations in terms of sensitivity and specificity. To date, only a few studies in children have compared the use of different methods simultaneously to detect fluid status, and none of these have evaluated the potential cardiovascular impact of a prolonged subclinical hypervolemia. The latter can be defined as a condition of euvolemia at clinical assessment but hypervolemia at technical evaluation. We evaluated the role of three methods—lung ultrasound (LUS), bioimpedance spectroscopy (BIS), and ultrasound assessment of inferior vena cava collapsibility index (IVC-CI)—in detecting subclinical hypervolemia and examined the cardiac implications. Method In this prospective observational longitudinal study, we included 23 children (&amp;lt;18 years) who were receiving chronic hemodialysis or peritoneal dialysis at the regional pediatric nephrology center of Meyer University Children's Hospital IRCSS, Florence, Italy, between 01/06/2018 and 01/11/2020. We excluded patients with clinical signs of fluid overload. Each patient underwent a multiparametric evaluation of their fluid status (physical examination, LUS, IVC-CI, BIS) every 2 months, and an echocardiography every six months starting from a baseline evaluation. The LVH was defined as a left ventricular mass index (LVMI) of ≥ 95th percentile or a left ventricular wall-thickness z-score &amp;gt; 2 z-score. We divided the patients into two groups and arbitrarily assigned them to the subclinical hypervolemia (SH) group if they had at least two out of three parameters of fluid overload at different methods (≥5 B-lines at LUS, overhydration normalized to extracellular water “OH/ECW” &amp;gt; 7% at BIS, and/or IVC-CI &amp;lt; 40%) in the absence of clinical signs of fluid overload. The others were included in the euvolemic (EU) group. The overload rate by weight (clinical OH), prescribed by the physician clinically, was calculated as the proportional increase from the dry weight (kg of fluid overload / dry weight in kg × 100). Results The two analyzed groups did not differ regarding gender, age and BSA (Table). The clinical OH was significantly higher in the SH population than in the EU group (2.2 ± 1.84 vs 1.30 ± 2.16%, p &amp;lt; 0.01). In the correlation analysis, we found that clinical OH positively correlated with the number of B-lines by LUS (R = 0.2923, p &amp;lt; 0.001) and OH/ECW by BIS (R = 0.4144, p &amp;lt; 0.001), while there was a negative correlation with IVC-CI (R = −0.2597, p = 0.019). However, each method taken individually (LUS, BIS, and IVC-CI) appeared to be inaccurate in predicting fluid status in several individual cases. Although the frequency of hypertension did not differ between the SH and EU groups, uncontrolled hypertension, treatment-resistant hypertension, and hospital admission for hypertensive crises were more frequent in the SH group, with the latter being statistically significant (67% vs 0%, p &amp;lt; 0.01). Furthermore, in the entire cohort, we observed a significant linear correlation between LVMI values and the average values of pre-HD systolic blood pressure recorded in the prior six months (R2 = 0.16, p = 0.002). It is worth noting that the presence of LVH at the last follow-up was significantly more prevalent in the SH group (75% vs 27%, p = 0.04). Conclusion Chronic subclinical hypervolemia, detected with a multi-method evaluation (including LUS, BIS, and IVC-CI), was significantly correlated with clinical OH and associated with a higher risk of LVH. To mitigate the intrinsic limitations of each technique, adopting two or more methods simultaneously can bypass and minimize the risk of evaluative error in assessing fluid status, and help reduce cardiovascular risk.

Vascular calcification in Takayasu arteritis: relationship with metabolic syndrome, left ventricular mass index, and intima-media thickness

ObjectiveThe present study aims to determine the frequency of vascular calcification in Takayasu arteritis (TA) and the risk factors for it and to evaluate its relation with atherosclerotic predictors such as metabolic syndrome (MS), left ventricular mass index (LVMI) and carotid intima-media thickness (CIMT). MethodsA cross-sectional study was conducted in patients with TA; MS was defined according to the US National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III) criteria. The study included 49 TA patients (22 with MS, 27 without MS) and 31 healthy controls (HCs). Non-contrast computed tomography measured calcification in coronary arteries, aorta, and branches. ResultsForty-seven patients (95.9%) were female and mean age was 33.45 ± 8.53 years. Total calcification score (mean ± SD; 5223.9 ± 18041.1 AU vs. 35.87 ± 72.70 AU (p = 0.05)), CIMT, and LVMI were found to be significantly higher in TA patients than HCs (p < 0.05). While there was no significant difference between the total calcification score of MS (+) TA patients and MS (−) TA patients, in both patient groups, the total calcification score was found to be significantly higher than HCs. MS (+) and MS (−) groups were found to have significantly higher CIMT and LVMI values than the control group, in addition, MS (+) patients were found to have significantly higher LVMI and CIMT values than MS (−) group (p < 0.05). ConclusionVascular calcification, CIMT, and LVMI are elevated in all TA patients, with greater impact in the presence of MS.

Left ventricular mass index versus results of diastolic stress echocardiography in patients with heart failure with preserved ejection fraction

Background: Left ventricular mass and left ventricular mass index (LVMI) is an index reflecting the thickness of the cardiac muscle, and the E/e’ ratio is a specific indicator for identifying increased left ventricular filling pressure. Limited data exist regarding the prognostic value of incorporating left ventricular mass index in heart failure with preserved ejection fraction (HFpEF). Aim: This study aimed to assess diagnostic value of LVMI at rest versus diastolic stress echo results in patients with HFpEF. Patients and methods: This study is a cross sectional descriptive study. In our study, we investigated 80 patients with unexplained exertional dyspnea with normal resting LV filling pressure at rest. Some of these patients may show elevated LV filling pressure with exercise. The current guidelines recommend to do diastolic stress echocardiography for those patients. All patients underwent complete resting echocardiography including assessment of diastolic dysfunction using the recommended 2016 guidelines and left ventricular mass index. Then we did diastolic stress echocardiography for all participants and the result of diastolic stress echocardiography was compared with the resting LVMI results.

Inflammation associated with left ventricular hypertrophy in bipolar disorder: A cross-sectional study

ObjectiveInflammation has received increasing attention as a contributor to the pathophysiology of bipolar disorder (BD) and cardiac hypertrophy into heart failure (HF). Accordingly, we chose BD-related inflammatory markers to investigate their relationships with cardiac left ventricular function and structure in BD. MethodsSixty physically healthy and euthymic patients with bipolar I disorder were recruited to compare with 50 healthy normal controls. The echocardiography was performed to estimate left ventricular mass index (LVMI) as a parameter of LV hypertrophy (LVH) and left ventricle ejection fraction (LVEF) as a parameter of systolic function. An LVEF above the normal range (>70%) was defined as a hyperdynamic heart. Participants' levels of inflammatory and atherosclerosis-related parameters were measured. ResultsCompared with normal controls, BD group had significantly higher rates of LVH (63% vs. 42%) and hyperdynamic heart (32% vs. 2%) and higher mean values of LVMI and LVEF. After adjustment for the effects of BMI and age, multiple regression analyses of BD group showed that the peripheral level of interleukin-8 was positively associated with LVMI and the level of soluble tumor necrosis factor receptor 1 (sTNF-R1) was positively associated with LVEF. ConclusionsPatients with BD from young adulthood are likely to have LVH with normal LV function and hyperdynamic heart associated with diastolic dysfunction. Low-grade inflammation may underlie the mechanisms of LV hypertrophy and cardiac dysfunction in BD patients.

PROGRESSION OF HYPERTENSION-MEDIATED ORGAN DAMAGE IN PATIENTS WITH AND WITHOUT NONALCOHOLIC FATTY LIVER DISEASE

Objective: Nonalcoholic fatty liver disease (NAFLD) is the main cause of chronic liver disease and is associated with an increased risk of cardiovascular death. Fatty liver index (FLI) is a validated marker of NAFLD and can be used as a screening measure of hepatic steatosis. The purpose of the study was to compare the progression of hypertension-mediated organ damage (HMOD) in hypertensive patients with and without NAFLD. Design and method: Hypertensive patients (n = 60) without a history of cardiovascular disease participated in the study (mean age, 52 years; males, 55%; baseline clinic BP, 145/92 mmHg) and were followed for one year. In the baseline visit, FLI was calculated, and patients were divided into two groups by FLI below 60 or 60 or above (i.e., high-risk of NAFLD). All patients underwent clinic and 24-hour ambulatory BP measurements, echocardiographic examination, nailfold capillaroscopy, pulse wave velocity, and urinary albumin excretion assessment (albumin to creatinine ratio, [ACR]). Left ventricular mass index (LVMI) was also calculated using the Devereux formula. Results: In baseline visit, patients with FLI &gt; or = 60 (n = 32) compared to the control group had higher values of ACR (26.5±57mg/g vs. 9.6±6.3 mg/g, p = 0.02) and lower values of capillary densities (75±18cap/mm2 vs. 86±12cap/mm2, p = 0.002), whereas there was no relative difference in PWV and LVMI. At the end of follow-up, patients with FLI &gt; or = 60 had higher values of ACR (12.6±11.9 mg/g vs. 6.8±5.3 mg/g p = 0.025), PWV (9.9±2m/sec vs. 8.8±1.3 m/sec, p = 0.02), LVMI (81.4±13.2 g/m2 vs. 72.5±13.2 g/m2, p = 0.02) but lower number of capillaries (65.1±8.8 cap/mm2 vs. 79.6±7.5 cap/mm2, p&lt;0.001). Linear regression analysis revealed that FLI &gt; or = 60 was an independent determinant of follow-up ACR, PWV, LVMI, and the number of capillaries. Conclusions: Increased FLI may adversely modify the progression of HMOD in hypertension.

Concentric hypertrophy geometry is a significant determinant of impaired global longitudinal strain in patients with normal cardiac structure and function

BackgroundIn recent years, the assessment of global longitudinal strain (GLS) derived by speckle-tracking analysis has become a clinically feasible alternative to left ventricular (LV) ejection fraction (LVEF) for the assessment of myocardial function. However, the determinant factors of impaired GLS in structurally and functionally normal patients are unclarified. The objective of this study was to elucidate the determinant factors of impaired GLS in structurally and functionally normal patients. MethodsWe evaluated structurally and functionally normal patients scheduled to undergo noncardiac surgery. The evaluated patient characteristics were age, sex, presence of hypertension, presence of diabetes mellitus, presence of hyperlipidemia, systolic blood pressure, and body mass index. The concentrations of B-type natriuretic peptide and high-sensitivity troponin I were measured. Echocardiography was performed to determine the LVEF, GLS, transmitral early diastolic velocity/transmitral atrial velocity ratio, LV mass index (LVMI), and relative wall thickness (RWT). Patients with preserved LVEF (≥50%) were divided into the normal GLS group (GLS ≤ -20%) and the impaired GLS group (GLS > -20%). On the basis of the RWT and LVMI values, the patients were categorized as having four types of LV geometry. Logistic regression analysis was performed to ascertain the determinant factors of impaired GLS. ResultsThe study cohort comprised 75 structurally and functionally normal patients (age 67.7 ± 12.6 years, 45 men). The GLS was normal in 43 patients and impaired in 32 patients. There was a significant difference in RWT between the impaired and normal GLS groups. The evaluation based on the LV geometry showed that six of seven patients with concentric hypertrophy geometry had impaired GLS, and the GLS was significantly more impaired in patients with concentric hypertrophy geometry than in patients with normal geometry or eccentric hypertrophy geometry. Logistic regression analysis revealed that LV concentric hypertrophy geometry was a significant determinant factor of impaired GLS (odds ratio 22.4, P = 0.042). ConclusionsGlobal longitudinal strain is more impaired in structurally and functionally normal patients with concentric hypertrophy geometry compared with those with eccentric hypertrophy geometry or normal geometry. In addition, concentric hypertrophy geometry is a significant determinant for impaired GLS in patients with normal cardiac structure and function.

Blood pressure parameters affecting ventricular repolarization in obese children.

Ventricular repolarization (VR) increases the risk of sudden cardiac death due to ventricular arrhythmia. We aimed to evaluate the blood pressure (BP) parameters affecting VR in obese children. Obese (BMI ≥ 95p) and healthy children ≥ 120cm between January 2017 and June 2019 were included. Demographic and laboratory data, peripheral and central BPs evaluated by a device capable of ambulatory blood pressure monitoring (ABPM), and pulse wave analysis were assessed. Electrocardiographic ventricular repolarization indices, left ventricular mass index (LVMI), and relative wall thickness (RWT) were calculated. A total of 52 obese and 41 control patients were included. Uric acid, triglyceride, total cholesterol, LDL, and ALT values, systolic and diastolic office BPs, 24-h, daytime and nighttime systolic and mean arterial BPs, daytime diastolic BP SDS levels, daytime and nighttime systolic loads, daytime diastolic load, 24-h, daytime and nighttime central systolic and diastolic BPs, and pulse wave velocity values were significantly higher, whereas 24-h, daytime and nighttime AIx@75 were similar between the groups. fT4 levels of obese cases were significantly lower. QTcd and Tp-ed were higher in obese patients. Although RWT was higher in obese cases, LVMI values and cardiac geometry classifications were similar. The independent factors affecting VR in obese cases were younger age and higher diastolic load at night (B = - 2.83, p = 0.010; B = 0.257, p = 0.007, respectively). Obese patients have higher peripheral and central BP, arterial stiffness, and higher VR indices that develop before an increase in LVMI. It would be useful to prevent obesity from an early age and follow up nighttime diastolic load to control VR associated sudden cardiac death in obese children. A higher resolution version of the Graphical abstract is available as Supplementary information.

Impact of anemia treatment for left ventricular hypertrophy using long-acting erythropoietin-stimulating agents from the pre-dialysis to maintenance dialysis period in patients with chronic kidney disease, retrospective longitudinal cohort study

BackgroundAnemia in patients with chronic kidney disease (p-CKDs) may initiate or exacerbate left ventricular hypertrophy (LVH). This study aimed to determine whether treatment using long-acting erythropoietin-stimulating agents (L-ESAs) is independently associated with LVH during the pre-dialysis to maintenance dialysis period in p-CKDs.MethodsPhysical and laboratory examinations were performed 120 days before initiating dialysis in p-CKDs (baseline). To evaluate the left ventricular mass index (LVMI) after starting dialysis, the mean hemoglobin (Hb) was defined as the average at the start of dialysis and 6 months after starting dialysis. Changes in the LVMI were observed in three groups according to mean Hb levels (Hb < 10.1, 10.1 < Hb < 11.0, and Hb > 11.0 g/dL for Groups 1, 2, and 3, respectively). LVMI was evaluated using echocardiography at the pre-dialysis, initiation, and maintenance dialysis periods.ResultsA lower LVMI at dialysis initiation and an improvement in LVMI were detected in the highest tertile group of mean Hb (11.0 g/dl). Consequently, in the high Hb group (Hb level > 11.0 g/dl), LVMI remained low from dialysis initiation until after 6 months.The relationship between Hb and LVMI was not significant; however, a constant correlation with β ≥ 0.4 in the absolute value was maintained.ConclusionL-ESAs may correlate with Hb and LVMI after administration, independent of the baseline LVMI and Hb values. These findings have therapeutic implications in the treatment strategies for p-CKDs during the pre-dialysis to maintenance dialysis period.

VERTICAL JUMPING CAPACITY AND CARDIAC ADAPTATIONS: IS THERE A LINK IN SOCCER PLAYERS?

https://youtu.be/OpSY8X_Nlf0 BACKGROUND Athletes' cardiac screening is challenging. The distinction between abnormal and normal is further hindered by the fact that cardiac adaptations differ between endurance and power athletes. Soccer performance depends on both cardiovascular and musculoskeletal systems. Most of the studies are focused on cardiac and aerobic adaptations related to left ventricular hypertrophy (LVH), but there is lack of studies examining musculoskeletal and anaerobic adaptations that elicit cardiac remodeling. The aim of this study was to examine whether the anaerobic jumping performance, as evaluated by vertical jump parameters achieved at a repetitive jump test (RVJ), was related to the left ventricular mass index (LVMI) in Greek soccer players. METHODS/DESIGN Elite male professional players (N = 19, age = 25.7 ± 4.6 yrs) participated in this study as part of their annual physical and physiological performance screening. The participants performed a RVJ test consisted of 15 continuous maximal effort countermovement jumps. Echocardiography measurements of left ventricular mass (LVM) and body surface area (BSA) were used to calculate the LVMI as LVM/BSA in g/m2. LVMI value of 115 g/m2 is considered to be a cut-off value for LVH and two groups were additionally formed: group A with LVMI ≥ 115 g/m2 (n = 11) and group B with LVMI &amp;lt; 115 g/m2 (n = 8). Independent samples T-test was used to examine the maximum jump height (JHmax) difference between the groups. Pearson's correlation analysis was run to check the relationship between LVMI raw values and JHmax. Statistical analysis was performed using the R-based Jamovi software (version: 2.3.3.0), with the level of significance set at a = 0.05. RESULTS LVMI raw values were 143.14 ± 18.06 g/m2 and 108.22 ± 9.66 g/m2 in groups A and B, respectively. Group A had significantly lower JHmax compared to Group B (0.29 ± 0.04 m vs 0.35 ± 0.04 m, respectively; t17 =−3.39, p = 0.003, Hedges' g = 1.43: large effect size). In the total sample, LVMI raw values correlated significantly with JHmax (r = −0.53, p = 0.020). CONCLUSIONS Soccer players with LVMI ≥ 115 g/m2 values had lower RVJ performance compared to those with LVMI &amp;lt; 115 g/m2. Resistance training, which is common in soccer, leads to cardiac anatomic adaptations such as LVH. The utility of the RVJ performance as a prognostic component for cardiac remodeling is weak. Even though soccer is a mixed type sport, aerobic adaptations are still the key prognostic elements for LVH.

HYPERTENSION PHENOTYPES IN YOUNG INDIVIDUALS BASED ON COMBINED OR ISOLATED ELEVATION OF OFFICE, HOME AND AMBULATORY BLOOD PRESSURE MEASUREMENTS AND ASSOCIATION WITH ORGAN DAMAGE

Objective: To assess the prevalence of white-coat (WCH) and masked (MH) hypertension detected by only ambulatory or only home blood pressure (BP) monitoring (isolated), or both (dual), and their association with preclinical target organ damage (TOD). Design and method: Young individuals referred for elevated BP and healthy volunteers aged 6–25 years were evaluated with office (2–3 visits; triplicate measurements), home (7 days, duplicate morning and evening measurements) and 24-hour ambulatory BP monitoring. TOD assessment included echocardiographic left ventricular mass index (LVMI), carotid intima-media thickness (IMT) and pulse wave velocity (PWV; Complior). Normotension (NT) was defined as normal office, home and ambulatory BP and sustained hypertension (SH) as all measurements being elevated. WCH and MH phenotypes were identified based on isolated or combined (dual) home and ambulatory BP values. Results: Analysis included 320 individuals (mean age 13.8 ± 3.8 years, 66.6% males, 32.2% children, 55.9% adolescents, 11.9% young adults, BMI 24.1 ± 4.8 kg/m2), of whom 276 had LVMI, 212 IMT and 168 PWV assessment. 182 (56.9%) participants had NT and 39 (12.2%) SH. Among 54 (16.9%) participants with WCH, 35 had dual WCH (64.8%) and 19 (35.2%) isolated ambulatory or home WCH. Among 45 (14.1%) with MH, 17 had dual MH (37.8%) and 28 isolated ambulatory or home MH (62.2%). Participants with dual and isolated intermediate phenotypes didn’t differ according to age, sex and BMI. Individuals with SH had higher LVMI, IMT and PWV than NT (all P &lt; 0.05; Figure). Intermediate phenotypes based on selective or combined elevation of out-of-office BP presented intermediate values of indices of TOD between NT and SH. Isolated ambulatory or home WCH was associated with higher LVMI values than NT (P &lt; 0.05), whereas dual MH was associated with higher IMT than NT (all P &lt; 0.05). Conclusions: These findings suggest that in young individuals intermediate hypertension phenotypes with selective (isolated WCH) or combined elevation of BP (dual MH) in out-of-office measurement methods appear to carry an increased risk of preclinical TOD compared with NT.

Time-dependent cardiac structural and functional changes after kidney transplantation: a multi-parametric cardiac magnetic resonance study.

To map time-dependent cardiac structural and functional change patterns after renal transplantation (KT) using cardiac magnetic resonance (CMR). Fifty-three patients with pre-KT and post-KT CMR exams were retrospectively analyzed. Patients were divided into three groups according to the time of post-KT CMR: group 1 (3 months post-KT, n = 16), group 2 (6 months post-KT, n = 21), and group 3 (over 9 months post-KT, n = 16). Twenty-one age- and sex-matched healthy controls (HC) were recruited for the study. CMR-derived left ventricular (LV) volumes, LV mass index (LVMi), LV ejection fraction (LVEF), global radial strain (GRS), global circumferential strain (GCS), global longitudinal strain (GLS), and native T1 value were compared. The association between the changes of CMR parameters was assessed. LVMi post-KT decreased in groups 2 (p < 0.001) and 3 (p = 0.004) but both groups had higher LVMi values compared to HC (both p < 0.001). GLS post-KT was decreased in group 1 (p = 0.021), but slightly increased in group 2 (p = 0.728) and group 3 (p = 0.100) without significant difference. GLS post-KT in group 3 was not different from HC (p = 0.104). LVEF, GRS, and GCS post-KT in groups 2 and 3 significantly increased and showed no significant difference from HC. The post-KT native T1 value in all three groups significantly decreased; however, no group showed any significant difference from HC. The change of LVEF was associated with the change of GCS, GRS, and GLS. Although GRS, GCS, GLS, and native T1 values reversed to normal level, LVMi remained impaired in median 14 months after KT. • Kidney transplantation has favorable effects on cardiac structure and function. • In a median 14 months of follow-up after KT, left ventricle strain and native T1 value reversed to normal level while LV mass index (LVMi) did not. Left ventricular hypertrophy may help to explain why KT recipients are still at increased cardiovascular risk. • The reason for the decrease of native T1 value after KT may be more than myocardial fibrosis and needs to be further studied.

Abstract EP09: Empiric Dietary Inflammatory Potential Is Associated With Elevated Left Ventricular Mass

Background: Recent studies have shown associations between proinflammatory diets and several cardiovascular diseases. Whether a proinflammatory diet, assessed using the empirical dietary inflammatory potential (EDIP), is also associated with elevated left ventricular mass index (LVMI) in the general population is unknown. Methods: This analysis included 5,869 participants (55.9 ± 10.5 years; 48.5% male, 71.8% whites) from the Third National Health and Nutrition Examination Survey. EDIP score was calculated from the Food Frequency Questionnaire. LVMI was estimated using a validated electrocardiographic (ECG) model utilizing digitally recorded ECG data, which were processed automatically at a central core laboratory. Elevated left ventricular mass was defined as LVMI values ≥95th percentile (≥149 g/m2). Multivariable logistic regression was used to examine the association between EDIP score (tertiles and per 1-standard deviation (1-SD) increase, separately) and LVMI. Results: In multivariable logistic regression models, each 1-SD increase in EDIP score (0.259) was associated with 25% increased odds of elevated LVMI. Higher odds of elevated LVMI were observed with higher levels (tertiles) of EDIP suggesting a dose-response relationship (Table). These results were consistent in subgroups of the participants stratified by demographics and comorbidities. Conclusions: Dietary patterns with high proinflammatory properties are associated with an elevated LVMI. Given the association between cardiovascular mortality and an elevated LVMI, there needs to be a greater emphasis on the reduction of proinflammatory diet patterns.

Значение N-концевого пропептида натрийуретического гормона B-типа в развитии диастолической дисфункции левого желудочка при сахарном диабете типа 2

Introduction. Left ventricular diastolic dysfunction (LV DD) is associated with the development of chronic heart failure (CHF) with preserved ejection fraction. This CHF phenotype is most common in patients with type 2 diabetes mellitus (T2DM). It is relevant to study the relationship between LV DD in patients with T2DM and the level of N-terminal pro-B-type natriuretic peptide (NT-proBNP), as a CHF biomarker, and other clinical, laboratory and echocardiographic parameters. Aim. To determine the significance of NT-proBNP and other factors in the development of LV DD in T2DM in the long-term follow-up period. Materials and methods. The study included 94 patients with T2DM aged 40 to 65 years (65% women). All patients had arterial hypertension (AH), obese or overweight and had no signs of NYHA class III–IV CHF, LV ejection fraction (EF) &lt; 50%. 37 patients had stable coronary artery disease (SCAD). Patients underwent clinical and laboratory examination, echocardiography. The concentration of NT-proBNP was determined. After 8.8 ± 0.72 years, 41 patients with T2DM were examined again with an assessment of clinical, biochemical and echocardiographic parameters. At baseline the 2009 National Guidelines of the Society of Cardiology of the Russian Federation and the Society of Heart Failure Specialists for the diagnosis and treatment of CHF were used for the diagnosis of LV DD. After 8.8 ± 0.72 years, the 2020 Clinical Guidelines of the Russian Society of Cardiology (RSC) for CHF were used for the diagnosis of LV DD. The search for factors that determine the presence of LV DD in the long-term period was carried out using logistic regression and ROC analysis. Results. At baseline LV DD was detected in 81.9% of cases in patients with T2DM and correlated with the presence of SCAD and the duration of AH. T2DM patients with LV DD compared with patients without LV DD did not differ in the level of NT-proBNP (30.6 pg/ml [20; 83.4] vs 36.7 pg/ml [20; 71.1]), p = 0.7). After 8.8 ± 0.72 years, LV DD was detected in 51.2% of patients with T2DM according to the 2020 Clinical Guidelines of the RSC. Patients with T2DM were divided into 2 groups: with LV DD (group 1) and without LV DD (group 2). Patients of the first and second groups differed in duration of diabetes (20 years [16; 25] vs 17.5 years [14.5; 20.5], р = 0.04), body mass index (BMI) (33.9 kg/m2 [31.2; 37.4] vs 32.2 kg/m2 [27.4; 34.7], р = 0.03), left ventricular mass index (LVMI) (94.8 g/m2 [82.5; 107] vs 73.9 g/m2 [71; 82.7], p &lt; 0.01) and were comparable in terms of carbohydrate, lipid metabolism, and kidney function. Compared to the second group, the first group had the higher baseline level of NT-proBNP (47.3 pg/ml [23.4; 111] vs 20 pg/ml [20; 20.3], p &lt; 0.01), higher baseline BMI (34.6 kg/m2 [30; 38] vs 31.2 kg/m2 [29.6; 33.7], р = 0.04) and higher baseline LVMI (101.1 ± 1 g/m2 vs 86.3 ± 14.1 g/m2, р = 0.02). The logistic regression revealed that in patients with T2DM the presence of LV DD in the long-term period is associated with the level of NT-proBNP (p = 0.03), baseline BMI (p = 0.04), baseline LVMI (p = 0.01). The baseline level of NT-proBNP &gt; 31.2 pg/ml showed a sensitivity of 66.7% and a specificity of 100% for the presence of LV DD in patients with T2DM after 8.8 ± 0.72 years of follow-up. Conclusion. In the long-term follow-up period the presence of LV DD in patients with type 2 diabetes mellitus is associated with the increased baseline level of NT-proBNP, especially in combination with the increased baseline LVMI and BMI values, while the level of NT-proBNP &gt; 31.2 pg/ml can be considered as a prognostic marker of LV DD in patients with T2DM after 8.8 ± 0.72 years of follow-up with a sensitivity of 66.7% and a specificity of 100%.

Distribution and maturation state of peripheral blood dendritic cells in children with primary hypertension.

Dendritic cells (DCs) play an important role in T cell alterations in primary hypertension (PH). We determined the numbers and maturation markers of peripheral blood total DCs (tDCs), myeloid cells (mDCs), and plasmacytoid cells (pDCs) and their association with hypertension-mediated organ damage (HMOD) markers and selected immune parameters in 30 adolescents with white coat hypertension (WCH), 25 adolescents with PH and a group of 35 age- and sex-matched children with normotension. Using multicolor flow cytometry, expression of maturation markers (CD86 and CD83) in tDCs (Lin1-/HLA-DR+), myeloid DCs (Lin1-/HLA-DR+/CD11c+) (mDCs), and plasmacytoid DCs (Lin1-/HLA-DR+/CD123+) (pDCs) and the distribution of peripheral Th17-bearing and T-reg cells were defined. In subjects with hypertension, carotid intima-media thickness (cIMT), left ventricular mass index (LVMI), and pulse wave velocity (PWV) were assessed. Compared with WCH and subjects with normotension, subjects with hypertension had reduced tDC and pDC numbers, an increased percentage of mDC subsets, an elevated mDC/pDC ratio, an increased population of mature mDC and pDC subsets bearing CD83 of high density, a decreased subset of CD86-bearing pDCs, and increased expression of DC activation markers (HLA-DR, CD86), as well as CD11c (mDCs) and CD123 (pDCs). PWV, LVMI, and cIMT values correlated negatively with tDCs and pDCs and positively with mDC numbers. Expression of DC maturation/activation markers (CD83, CD86, HLA-DR, CD11c, and CD123) correlated positively with PWV. Certain DC characteristics of WCH subjects resembled those of PH subjects (decreased tDC frequency and upregulation of activation marker expression). These changes correlated with HMOD. WCH subjects presented a DC phenotype that was intermediate between the normotensive and hypertensive phenotypes.

Lower B-type natriuretic peptide levels predict left ventricular concentric remodelling and insulin resistance.

AimsNatriuretic peptides have reportedly been associated with cardiac hypertrophy and insulin resistance; however, it has not been established if B‐type natriuretic peptide (BNP) is associated with either insulin resistance or cardiac remodelling in a population with normal plasma BNP levels. We investigated the relationship among plasma BNP levels, insulin resistance, and left ventricular (LV) remodelling in a population with normal physiological plasma BNP levels.Methods and resultsAmong 1632 individuals who participated in annual health checks between 2005 and 2008 in Arita‐cho, Saga, Japan, 675 individuals [median (interquartile range) for age 62 (51–69) years; 227 men (34%)] with LV ejection fraction 50% and BNP level <35 pg/mL were enrolled in this study. Insulin resistance was assessed using homeostatic model assessment of insulin resistance (HOMA‐IR). LV geometry, including LV concentric remodelling, was classified based on relative wall thickness (RWT) and LV mass index values derived from echocardiographic findings. Factors associated with insulin resistance and LV geometry were investigated using multiple logistic regression analysis. Tertiles of BNP were inversely associated with HOMA‐IR [1st tertile, 1.33 (0.76–1.74); 2nd tertile, 1.05 (0.72–1.59); 3rd tertile, 0.95 (0.66–1.58), P = 0.005]. Lower BNP was associated with the prevalence of insulin resistance, defined as HOMA‐IR ≥1.37, even after full multivariate adjustment [1 SD increment in BNP = adjusted odds ratio (aOR) 0.740; 95% confidence interval (CI) 0.601–0.912; P = 0.005]. LV concentric remodelling (RWT >0.42; LV mass index ≤115 g/m2 in men and ≤95 g/m2 in women) was observed in 107 (16%) participants, while normal LV geometry (RWT ≤0.42; LV mass index ≤115 g/m2 in men and ≤95 g/m2 in women) was seen in 423 (63%), and LV hypertrophy (LV mass index >115 g/m2 in men and >95 g/m2 in women) in 145 (21%). Both low BNP level and higher insulin resistance were independently linked to LV concentric remodelling after multivariate adjustment (1 SD increment in BNP = aOR 0.714, 95% CI 0.544–0.938, P = 0.015; HOMA‐IR ≥ 1.37 vs. <1.37: aOR 1.694, 95% CI 1.004–2.857, P = 0.048, respectively).ConclusionsLower BNP levels are linked to either insulin resistance or LV concentric remodelling in a population with normal plasma BNP levels, suggesting that participants with lower natriuretic peptide level might be vulnerable to the development of metabolic disorders and LV morphological abnormalities.

MO735INTERPLAY BETWEEN GDF-15 AND LEFT VENTRICULAR HYPERTROPHY IN END-STAGE RENAL DISEASE PATIENTS ON DIALYSIS

Abstract Background and Aims Cardiovascular disease (CVD) is the major cause of mortality and morbidity in chronic kidney disease (CKD), especially in end-stage renal disease (ESRD) patients. Left ventricular hypertrophy (LVH) is a common cardiovascular complication in CKD. Growth differentiation factor (GDF)-15 increases in tissue injury and inflammatory states associated with cardiometabolic risk. GDF-15 and N-terminal pro B-type natriuretic peptide (NT-proBNP) are both synthesized by cardiomyocytes and may be associated with cardiorenal dysfunction. Our aim was to study the association of GDF-15 with LVH in ESRD patients on dialysis. Method This study included 196 ESRD patients on dialysis (hemodiafiltration and high-flux hemodialysis). Left ventricular mass (LVM) was evaluated through echocardiographic studies, corrected for body surface area and the values are presented as LVM index (LVMI). LVH was defined by a value of LVMI &amp;gt; 115 g/m2 in men and &amp;gt; 95 g/m2 in women. Patients were divided into two groups - LVH (n=131) and non-LVH (n=65). LVMI, clinical and analytical variables (age, body mass index, dialysis vintage, dialysis adequacy, GDF-15, NT-proBNP and pentraxin (PTX) 3 were evaluated. Results ESRD patients with LVH presented significantly higher levels of NT-proBNP and GDF-15, and a trend towards higher PTX3 values. In LVH patients, GDF-15 correlated positively and significantly with NT-proBNP and PTX3; LVMI correlated positively and significantly with pro-BNP and PTX3 levels; pro-BNP correlated significantly and positively with PTX3. Conclusion Our data show that in ESRD patients on dialysis with LVH, GDF-15 is raised and shows a strong association with NT-proBNP, PTX3 and LVMI. Further studies are needed to clarify if the rise in GDF-15 is a cause or a consequence of LVH development. Acknowledgments This work was supported by Applied Molecular Biosciences Unit-UCIBIO, financed by national funds from FCT/MCTES (UIDB/04378/2020), by North Portugal Regional Coordination and Development Commission (CCDR-N)/NORTE2020/Portugal 2020 (Norte-01-0145-FEDER-000024) and by REQUIMTE-Rede de Química e Tecnologia-Associação in the form of a researcher (S. Rocha) – project Dial4Life co-financed by FCT/MCTES (PTDC/MEC-CAR/31322/2017) and FEDER/COMPETE 2020 (POCI-01-0145-FEDER-031322).

Contradictory Effect of Coronary Collateral Circulation on Regional Myocardial Perfusion That Assessed by Quantitative Myocardial Perfusion Scintigraphy.

BackgroundPrevious studies showed conflicting results about the contribution of coronary collateral circulation (CCC) to myocardial perfusion and function. The aim of this study was to investigate these contradictory problems by gated myocardial perfusion scintigraphy (gated MPS) for the first time.MethodsThe current cohort was retrospectively selected among patients who underwent gated MPS and coronary angiography within 2 months. Two different groups including 96 patients were assessed by gated MPS to detect the understanding of the miscellaneous effect of CCC on myocardial perfusion. Group 1 consisted of those who had collateral arteries that were not-well-developed (Rentrop grade 0 - 1) (n = 58), while group 2 consisted of those who had collateral arteries that were well-developed (Rentrop grade 2 - 3) (n = 38).ResultsThere was no statistically significant difference between groups 1 and 2 in terms of perfusion and functional parameters obtained from gated MPS. Furthermore, no statistically significant difference was found in the phase analysis parameters which is a novel technique to evaluate left ventricular synchronization. On the other hand the left ventricular mass index values were high and quite close to the statistically significant value (P = 0.059) in group 2.ConclusionsThe current results that obtained by using the gated MPS technique for the first time in the evaluation of CCC showed that the well-developed collateral circulation has a positive effect on myocardial perfusion and function, but this effect was not statistically significant. Results need to be supported by large scale of patients’ size.

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.

Left-ventricular diastolic dysfunction in Korean children with chronic kidney disease: data from the KNOW-Ped CKD study

BackgroundCardiovascular disease (CVD) is the most common cause of mortality in pediatric chronic kidney disease (CKD) patients. Left ventricular (LV) hypertrophy (LVH) is associated with LV diastolic dysfunction (LVDD) development and is used as an early marker of CVD in pediatric CKD. This study aimed to assess the prevalence and risk factors of LVDD and the association between LVH and LVDD in Korean pediatric CKD patients.MethodsData were collected using the baseline data of the Korean cohort study for outcome in patients with pediatric chronic kidney disease, a nationwide, 10-year, prospective, observational cohort study of pediatric CKD. A total of 244 patients were included in the final analysis. Two-dimensional echocardiography and tissue Doppler images were used to evaluate LVH and LVDD. LVH was defined as an LV mass index (LVMI) ≥38 g/m2.7 and LV-wall thickness z-score > 1.64. LVDD was defined as a mitral peak velocity of early filling to early diastolic mitral annular velocity (E/E’) > 14. Univariate and multivariate logistic regression analyses were performed to evaluate risk factors of LVDD.ResultsIn this study, the male-to-female ratio was 2.2 (168:76) and median age was 11.2 years. The average estimated glomerular filtration rate was 57.4 ml/min/1.73 m2, and no patients received renal replacement therapy. The mean value of LVMI and E/E’ was 37.0 g/m2.7 and 7.4, respectively. The prevalence of LVH was 40.1 and 17.4% by LVMI ≥38 g/m2.7 and LV-wall thickness z-score, respectively. The prevalence of LVDD was 4.5%, and patients with LVH showed greater risk of LVDD (odds ratio 7.3, p = 0.012). In the univariate analysis, young age, low hemoglobin level, higher LVMI, and higher LV-wall thickness z-score were associated with LVDD. In the multivariate analysis, young age, low hemoglobin level, and higher LV-wall thickness z-score were independently associated with LVDD.ConclusionThis study shows that LVH patients have a greater risk of LVDD and that anemia is the only modifiable risk factor for LVDD in Korean pediatric CKD patients.