Left Ventricular Mass Index Research Articles

Eccentric hypertrophy impairs outcome after TAVR.

Aortic stenosis (AS) induces cardiac remodeling upon chronic left ventricular (LV) pressure overload. Here, we analyzed the clinical outcome of patients undergoing transcatheter aortic valve replacement (TAVR) for symptomatic AS with regard to varying LV hypertrophy patterns. Moreover, we investigated the genetic influence on development of different hypertrophy patterns, measured by polygenic risk scores (PRS). 1703 patients with severe AS undergoing TAVR were categorized according to LV mass index and relative wall thickness in four subgroups: normal geometry (NG, n = 57), concentric remodeling (CR; n = 388), concentric hypertrophy (CH; n = 993) and eccentric hypertrophy (EH; n = 265). Data was analyzed retrospectively with regard to clinical outcome. In a substudy, 520 patients affected by CH (n = 237), EH (n = 139) or CR (n = 164) were analyzed using two PRS that have been previously associated with hypertrophic and dilated cardiomyopathy. 1year after TAVR, for EH, in contrast to the remaining groups (NG, CR, CH), a significant difference in all-cause mortality was observable (mortality 17.4% EH, 14.0% NG, 12.4% CR, 14.0% CH, p = 0.001). This difference was observed up to 4years (mortality 41.9% EH, 26.9% CH, 28.1% CR, 26.4% NG, p = 0.001). Of note, higher percentiles in a PRS for hypertrophic cardiomyopathy were associated with a reduced likelihood of EH in patients with AS (p = 0.046). The EH group had a statistically significant poorer 1-year and 5-year outcomes than the other groups. PRS might help predict myocardial reactions in patients with aortic stenosis in future.

Left Ventricular Hypertrophy in Aortic Stenosis: Early Cell and Matrix Regression 2 Months Post-Aortic Valve Replacement.

In aortic stenosis, the myocardium responds with left ventricular hypertrophy, which is characterized by increased left ventricular mass due to cellular hypertrophy and extracellular matrix expansion. Following aortic valve replacement (AVR), left ventricular hypertrophy regression occurs, but early cellular and extracellular dynamics are unknown. Patients with severe symptomatic aortic stenosis undergoing surgical or transcatheter AVR were prospectively recruited. Pre- and early post-AVR cardiac magnetic resonance imaging assessed left ventricular remodeling, global longitudinal strain, and T1 mapping to determine extracellular volume fraction and volume of cellular and extracellular compartments. In all, 39 patients (aged 71.4±9.8 years, male 79%, aortic valve peak velocity 4.4±0.5 m/s) underwent cardiac magnetic resonance before and at median 7.7 weeks post-AVR. Left ventricular mass index reduced significantly by 15.4% (P<0.001*), primarily driven by cellular compartment regression (18.7%, P<0.001*), with a smaller reduction in the extracellular compartment (7.2%, P<0.001*). This unbalanced regression led to an apparent increase in extracellular volume fraction (27.4±3.1% to 30.2±2.8%; P<0.001*). Although there was no significant change in global longitudinal strain post-AVR, an increase in extracellular volume fraction was associated with worsening of global longitudinal strain (Pearson r=0.41, P=0.01). Mode of intervention (transcatheter versus surgical) did not influence the above myocardial parameters post-AVR (all P>0.05). The asterisk in P values indicates a statistical significance of <0.05. Within 8 weeks of AVR for aortic stenosis, substantial left ventricular hypertrophy regression occurs involving both cellular and extracellular compartments, demonstrating the early myocardial adaptability to afterload relief. Cellular compartment regression is greater than extracellular regression, leading to an apparent increase in extracellular volume fraction. Mode of intervention did not affect degree of reverse remodeling, indicating that both are effective at resulting beneficial changes post-AVR. URL: https://www.isrctn.com; Unique identifier: NCT04627987.

Establishment of a nomogram that predicts the risk of heart failure in hemodialysis patients

Chronic kidney disease (CKD) is expected to become the fifth leading cause of death globally by 2040. Cardiovascular disease (CVD), particularly heart failure (HF), is a severe complication in CKD patients on hemodialysis. This study aimed to develop a nomogram to predict the risk of heart failure hospitalization in hemodialysis patients, providing a valuable tool for clinical decision-making. We retrospectively analyzed data from 196 patients at Kunming Yanan Hospital's hemodialysis center, including demographic, dialysis-related, and laboratory information. Significant HF predictors identified through univariate and multivariate logistic regression were age, diabetes, dialysis duration, left ventricular mass index (LVMI), albumin (ALB), and ejection fraction (EF). These predictors formed the basis of the nomogram, which demonstrated good discrimination (AUC = 0.728) and calibration (Hosmer-Lemeshow test, P = 0.463). Decision curve analysis confirmed the nomogram's clinical utility across various threshold probabilities. This study's findings can help clinicians identify high-risk patients, improving management strategies and potentially reducing HF-related hospitalizations in the hemodialysis population.

Relationship Between Urinary Uranium and Cardiac Geometry and Left Ventricular Function: The Strong Heart Study

BackgroundUranium is a potentially cardiotoxic, nonessential element commonly found in drinking water throughout the United States. ObjectivesThe purpose of this study was to evaluate if urinary uranium concentrations were associated with measures of cardiac geometry and function among American Indian young adults from the Strong Heart Family Study. MethodsUrinary uranium was measured among 1,332 participants free of diabetes, cardiovascular disease, and <50 years of age at baseline (2001-2003). Transthoracic echocardiography and blood pressure were assessed at baseline and at a follow-up visit (2006-2009). We estimated adjusted mean differences in cardiac geometry and function measures at baseline and follow-up using linear mixed-effect models with a random intercept and slope over time. ResultsMedian (interquartile range) uranium was 0.029 (0.045) μg/g creatinine. In fully adjusted cross-sectional models, a log-doubling of urinary uranium was positively associated with left ventricular (LV) mass index (mean difference: 0.49 g/m2, 95% CI: 0.07-0.92 g/m2), left atrial systolic diameter (0.01 cm/m2, 0.01-0.02 cm/m2), and stroke volume (0.66 mL, 0.25-1.08 mL) at baseline. Prospectively, uranium was associated with increases in left atrial diameter (0.01 cm/m2, 0.01-0.02 cm/m2), pulse pressure (0.28 mm Hg, 0.05-0.52 mm Hg), and incident LV hypertrophy (odds ratio: 1.25, 95% confidence interval: 1.06, 1.48). ConclusionsUrinary uranium levels were adversely associated with measures of cardiac geometry and LV function among American Indian adults, including increases in pulse pressure and LV hypertrophy. These findings support the need to determine the potential long-term subclinical and clinical cardiovascular effects of chronic uranium exposure, and the need for future strategies to reduce exposure.

Effect of optimisation to contemporary HFrEF medical therapy with sacubitril/valsartan (Entresto) and dapaglifloziN on left Ventricular reverse remodelling as demonstrated by cardiac magnetic resonance (CMR) Imaging: the ENVI study

IntroductionHeart failure with reduced ejection fraction (HFrEF) guidelines recommend ‘four pillars’ of medical therapy and device therapy if left ventricular ejection fraction (LVEF) remains ≤35% after 3 months optimum medical...

EVALUATION OF THE RELATIONSHIP BETWEEN IRON LOAD, AGE, AND CARDIAC FUNCTION IN CHILDREN AND YOUNG ADULTS WITH THALASSEMIA MAJOR: A PULSED-WAVE DOPPLER AND TISSUE DOPPLER IMAGING STUDY

Objective: To determine the structural and functional cardiac differences in children and young adults with thalassemia major (TM) compared to healthy subjects using pulsed-wave Doppler and tissue Doppler imaging methods and determine the relationship between iron overload and these differences. Materials and Methods: We analyzed the data of pediatric and young adult TM patients (n = 44) aged 4–22 years and an age- and gender-matched control group (n = 40) in our hospital data system between Oct.01.2023 and Oct.01.2024. Height, weight, body mass index (BMI), systolic–diastolic blood pressure measurements, complete blood count, ferritin, cardiac T2* magnetic resonance imaging (MRI) values, and echocardiography results were recorded. In addition to comparisons between the two groups, correlation analysis was performed between ferritin–cardiac T2* MRI results and echocardiographic parameters and age in TM patients. Results: Our study showed growth retardation (low height standard deviation score (SDS), low weight SDS and low BMI SDS), dilatation of the left cavities (high left ventricular internal diameter end diastole (LVIDd)), increased left ventricular muscle mass (high left ventricular mass index (LVMI)), cardiac distinctive diastolic (restrictive pattern: left ventricular (LV) peak early diastolic flow (E)/peak late diastolic flow (A) and E/early diastolic myocardial peak flow (E') high), and subclinical systolic (LV peak systolic flow low and LV Tei index high) dysfunction. In addition, iron load (ferritin and cardiac T2* MRI) was correlated with LVMI, and cardiac diastolic and systolic function indicators. As age increased, ferritin value did not change, but cardiac T2* MRI value decreased and diastolic–systolic parameters worsened. Conclusion: Periodic cardiac T2* MRI and Doppler echocardiography examinations of patients with TM may detect subclinical myocardial dysfunction at an early stage, thus providing a window of opportunity for intervention.

Differences in target organ damage in individuals with intermediate hyperglycemia and type 2 diabetes identified by 1-hour plasma glucose during an oral glucose tolerance test

Aims: The International Diabetes Federation (IDF) has recently recommended determination of 1-hour glucose during an oral glucose tolerance test (OGTT) to diagnose intermediate hyperglycemia (IH) and type 2 diabetes (T2D). Herein, we investigated the implications of IDF recommendation for characterizing the risk of cardiovascular target organ damage including left ventricular mass normalized by body surface area (LVM index [LVMI]), and myocardial mechano-energetic efficiency normalized by LVM (MEEi) in individuals with IH and T2D. Methods: LVMI, and MEEi were assessed in 1847 adults classified on the basis of fasting, 1-hour and 2- hour glucose during an OGTT according to the IDF recommendation as having normal glucose tolerance (NGT, n = 736), isolated impaired fasting glucose (iIFG, n = 105), IH (n = 676), and newly diagnosed T2D (n = 330). Results: As compared with NGT group, individuals with either IH or T2D exhibited significantly higher LVMI (97 ± 26, 109 ± 30, and 116 ± g/m2, P < 0.001, respectively), and a decrease in MEEi (0.42 ± 0.11, 0.37 ± 0.10, and 0.35 ± 0.11 ml/sec*g-1, P < 0.001, respectively). LVMI, and MEEi did not differ between NGT and iIFG groups. Conclusion: The thresholds of 1-hour post-load glucose proposed by IDF as diagnostic criteria for IH and T2D are capable of detecting individuals at risk of cardiovascular target organ damage.

Transthoracic cardiac ultrasonic shear wave elastography for detecting myocardial stiffness in healthy and hypertrophic cardiomyopathy individuals

Objective: To explore the feasibility of transthoracic cardiac shear wave elastography (SWE) for non-invasive quantitative measurement of myocardial stiffness in healthy volunteers (HV) and hypertrophic cardiomyopathy (HCM) patients, and analyze the relationship between myocardial shear wave velocity (SWV) and left ventricular diastolic function. Methods: A total of 16 HV who underwent health check-ups and 5 HCM patients who visited the Cardiology Outpatient Clinic at Fujian Medical University Affiliated Union Hospital from September 2022 to October 2023 were prospectively recruited. The SWE technique was used to measure SWV of the basal segment of the interventricular septum, including left ventricular long-axis myocardial shear wave velocity (LA-SWV) and short-axis myocardial shear wave velocity (SA-SWV). The intraclass correlation coefficient (ICC) was employed to evaluate the intra-observer and inter-observer consistency of SWV measurements. Spearman's correlation analysis was performed to evaluate the correlation between baseline characteristics, echocardiography parameters and SWV. Quantitative data were expressed as median (interquartile range) [M (Q1, Q3)]. Results: The HV group had the age of 34.5 (24.0, 51.0) years, including 8 males (50%); the HCM group had the age of 34.0 (27.0, 46.0) years, including 3 males (60%). The intra-observer and inter-observer ICC (95%CI) for LA-SWV measurements were 0.806 (0.592-0.907) and 0.785 (0.471-0.949), respectively, indicating high consistency; the intra-observer and inter-observer ICC (95%CI) for SA-SWV measurements were 0.746 (0.359-0.862) and 0.602 (0.245-0.834), indicating moderate consistency. LA-SWV [1.74 (1.65, 1.77) vs 1.25 (1.22, 1.33) m/s, P<0.001] and SA-SWV [1.98 (1.96, 2.15) vs 1.52(1.46, 1.55) m/s, P<0.001] were significantly higher in HCM group than those in HV group. There was no significant correlation between SWV and gender, age or body mass index (all P>0.05). In the left ventricular long-axis view, interventricular septal end-diastolic thickness (IVSDT) (r=0.749, P<0.001), early diastolic mitral valve flow velocity/early diastolic mitral annular peak motion velocity (E/e') (r=0.669, P<0.001), and left ventricular mass index (LVMI) (r=0.679, P<0.001) were positively correlated with LA-SWV, while e' (r=-0.545, P<0.001) and late diastolic mitral annular peak motion velocity (r=-0.489, P=0.021) were negatively correlated with LA-SWV. In the left ventricular short-axis view, IVSDT (r=0.784, P<0.001), E/e' (r=0.657, P<0.001), and LVMI (r=0.660, P<0.001) were positively correlated with SA-SWV, while e' was negatively correlated with SA-SWV (r=-0.658, P<0.001). Conclusions: The use of SWE technique to measure myocardial SWV can be applied to assess the stiffness differences between normal myocardium and HCM myocardium. Additionally, SWV is correlated with left ventricular diastolic function indices and can effectively evaluate the diastolic dysfunction of the left ventricle caused by HCM.

Aortic valve sclerosis is not a benign finding but progressive disease associated with poor cardiovascular outcomes

BackgroundAortic valve sclerosis (AVS) shares risk factors with atherosclerosis. However, the relationship between AVS progression with cardiovascular (CV) risk has not been researched. This study investigates CV outcomes according to progression of AVS.MethodsThis study included 2,901 patients with AVS (irregular leaflet thickening and peak aortic jet velocity < 2 m/sec) who underwent serial echocardiograms at least 1 year apart during 2011–2020. The primary outcome was defined as CV death, myocardial infarction, stroke, or revascularization.ResultsDuring a median follow-up period of 3.9 years, 439 of 2,901 AVS patients (15.1%) progressed to mild or greater aortic stenosis. Patients with progression were older and more likely to have atrial fibrillation than those without. In a stepwise regression, age (odds ratio [OR] per 1-year increase, 1.04; 95% confidence interval [CI], 1.01–1.07), peripheral artery disease (OR, 9.07; 95% CI, 3.12–26.4), and left ventricular mass index (OR per 1-g/m2 increase, 1.01; 95% CI, 1.00–1.02) were associated with AVS progression. Over a median of 6.3 years, the primary outcome occurred in 858 of 2,901 patients (29.6%). Patients with progression had higher frequency of CV death, myocardial infarction, stroke, or revascularization than those without progression (P < 0.0001). In Cox proportional hazards regression, AVS progression (hazard ratio, 1.33; 95% CI, 1.10–1.61) was a significant determinant of CV mortality.ConclusionsThe progression to aortic stenosis in AVS patients is an independent risk factor for CV mortality. These findings suggest that patients with AVS progression may benefit from stricter CV risk monitoring.

Evaluation of Left Ventricular Systolic Functions of Patients with Exaggerated High Blood Pressure Response to Treadmill Exercise Test with Two-Dimensional Longitudinal Strain Imaging.

An exaggerated hypertensive response (EHR) during exercise is linked to increased cardiovascular risk and mortality. This study aims to assess structural and functional cardiac changes, along with subclinical myocardial damage, using transthoracic echocardiography (ECHO) and 2D longitudinal strain analysis in patients showing a hypertensive response to treadmill exercise. Patients without known chronic diseases, presenting to the Cardiology Department at Health Sciences University Gülhane Training and Research Hospital, were divided into 2 groups based on their blood pressure response during treadmill exercise: exaggerated hypertensive response (EHR, n = 42) and normal response (control, n = 44). Left ventricular longitudinal strain was assessed using transthoracic echocardiography, and global longitudinal strain (GLS) was calculated as the average from all segments. Data analysis was performed using SPSS 26. No significant differences were found between the groups regarding baseline demographic and laboratory parameters (P > .05 for all). However, the EHR group exhibited significantly higher interventricular septum thickness, mitral A velocity, and mitral annulus velocity (a'), while mitral annulus velocity (e') was significantly lower (P < .05 for all). Additionally, left ventricular (LV) mass index, left atrial volume index, mitral E/e' ratio, deceleration time, and relative wall thickness (RWT) were higher in the EHR group, while the mitral E/A ratio was lower (P < .05 for all). The GLS was also significantly lower in the EHR group (P < .05). Left ventricular geometry parameters, such as LV mass index and RWT, and GLS findings indicating subclinical cardiac damage, were significantly altered in the EHR group, suggesting a higher risk of LV hypertrophy and myocardial dysfunction.

Left Atrial Size and Strain in Hypertensive Children Compared to Age-, Sex-, and Race/Ethnicity-Matched Controls.

Left atrial (LA) volume and peak longitudinal strain (LA strain) are indicators of left ventricular (LV) diastolic function in adults, but little is known about LA volume and strain in pediatric patients with hypertension (HTN). We evaluated LA volume and strain in pediatric cases with HTN compared to age-, sex-, and race/ethnicity-matched controls. This was a retrospective matched case-control study of patients who presented to the HTN clinic at CHOP from 12/2011 to 9/2018. Coarctation of the aorta, cardiomyopathy or heart transplantation cases were excluded. HTN was defined by an abnormal ambulatory blood pressure result. LA volume was measured by biplane area-length method and indexed to body surface area (BSA). LA strain and strain rate were measured using TOMTEC® software. Left ventricular mass index (LVMI) was measured by M-mode and the 5/6 area-length method indexed to height2.7. LV global longitudinal strain (LV GLS) was measured during the echocardiographic examination on the GE ultrasound machine for cases and offline using TOMTEC® software for controls. Measurements were compared using Chi-square, McNemar, or Wilcoxon signed rank tests. We included 47 cases and 47 controls. There was no difference in LA volume z-scores (-1.9 vs. -0.9, p = 0.068), LA strain (37.8% vs. 38.0%, p = 0.735) or LA strain rate (1.4 vs. 1.5, p = 0.852) in cases compared to controls. LVMI by M-mode and 5/6 area-length method was higher in cases compared to controls (40.0 vs. 33.7g/m2.7, p < 0.001 and 29.9 vs 24.4g/m2.7, p = < 0.001, respectively). LV GLS was decreased (less negative) in cases compared to controls. In summary there was no difference in LA volume or LA strain in cases compared to controls. In cases, LVMI was significantly elevated and LV GLS was significantly decreased, which may be the first response to HTN, prior to affecting LA size.

The Impact of Active Ascertainment on Sex-Specific Differences in the Prevalence and Phenotype of Transthyretin Cardiac Amyloidosis: The SCAN-MP Study

Transthyretin cardiac amyloidosis (ATTR-CA) is disproportionately diagnosed in older adult men. However, studies suggest that the true prevalence of ATTR-CA in women may be higher than previously reported. The Screening for Cardiac Amyloidosis with Nuclear Imaging in Minority Populations (SCAN-MP) study utilizes nuclear scintigraphy to identify ATTR-CA in self-identified Black and Caribbean Hispanic participants ≥60 years old with heart failure and left-ventricular hypertrophy. We characterized the sex distribution and phenotypic characteristics of ATTR-CA in this active ascertainment cohort in comparison to a population of ATTR-CA patients who were referred to a tertiary care academic center outpatient clinic. Compared to the referral clinic cohort, the active ascertainment SCAN-MP cohort had a greater proportion of women (31.3% vs 13.3%, p=0.016). This was mainly attributed to the higher proportion of women with wild-type disease [ATTRwt-CA] (27.8% vs 7.1%, p=0.012). Women with ATTR-CA in the active ascertainment cohort exhibited higher left ventricular ejection fraction than those in the referral cohort (61% vs 50%, p = 0.011); lower left ventricular mass index (110 g/m2 vs 148 g/m2, p = 0.014); and lower posterior wall thickness (1.4 cm vs 1.6 cm, p = 0.01). An active ascertainment strategy for ATTR-CA identification demonstrated a greater proportion of women than did a referral cohort, driven predominantly by the greater proportion of women with ATTRwt-CA, and echocardiographic evidence of a less severe phenotype. In conclusion, efforts for early identification of ATTR-CA in women are critical for reducing sex disparities in this clinically treatable disease.

Association of Coagulation Factor XI Level With Cardiovascular Events and Cardiac Function in Community-Dwelling Adults: From ARIC and CHS.

Coagulation factor XI (FXI) inhibitors are a promising and novel class of anticoagulants, but a recent animal study found that FXI inhibition exacerbated diastolic dysfunction and heart failure (HF). In the ARIC study (Atherosclerosis Risk in Communities), we investigated whether plasma FXI level was associated with cardiovascular events and cardiac function. ARIC was our primary analytic cohort. We included 4471 participants (median age, 75 years; 57% female; 17% Black) who attended visit 5 (2011-2013) with Somalogic-quantified plasma FXI levels and echocardiographic cardiac function. Prevalent HF and atrial fibrillation (AF) cases were defined as having HF or AF diagnosed at or before each participant's visit 5 exam date. Incident HF and AF events were ascertained through 2021. Associations were assessed using Cox, logistic, and linear regression models. Primary prospective associations were also validated in the CHS (Cardiovascular Health Study) using an orthogonal FXI assay (enzyme-linked immunosorbent assay). At ARIC visit 5, there were 665 and 419 participants with prevalent HF and AF, respectively. During a median follow-up of 9 years, there were 580 and 788 incident HF and AF events, respectively. Lower FXI level was associated prospectively with higher incidence of HF (hazard ratio [HR], 1.36 [for each 1-unit decrement of log2-transformed FXI level] [95% CI, 1.01-1.83]) but not incident AF, and cross-sectionally with increased odds of AF (odds ratio [OR], 1.96 [95% CI, 1.23-3.07]) but not HF. In age-stratified analyses, decreased FXI was associated with higher incidence of HF in participants ≥75 years of age (HR, 1.57 [95% CI, 1.08-2.28]) but not <75 years of age (HR, 1.11 [95% CI, 0.68-1.79]). The inverse FXI-HF association was validated in CHS (HR, 1.18 [95% CI, 1.02-1.36]). At ARIC visit 5, lower FXI level was also associated with higher prevalence of diastolic dysfunction and worse E/A ratio, left atrial (LA) volume index, LA function, and left ventricular mass index, but not left ventricular ejection fraction or global longitudinal strain. Decreased FXI level is associated with greater incidence of HF, especially in older adults. It is also associated with prevalent AF, worse diastolic function, worse LA function, and greater LA size. More research is needed to assess potential unwanted effects of FXI inhibition on the risk of cardiovascular events and cardiac function.

Cinnamon Polyphenols Ameliorate the Dysregulation of Cardiac Energy and Autophagic Homeostasis in Rats with Diabetic Cardiomyopathy via the mTOR/PGC1α Pathway

Background Inflammation mediated by hyperglycemia, lipid metabolism disorders, abnormal myocardial energy metabolism, myocardial cell damage, and changes in ventricular structure are important mechanisms in the occurrence and development of diabetic cardiomyopathy (DCM). Cinnamon polyphenols (CP) are extracted from the traditional Chinese medicine cinnamon, which is believed to have cardioprotective effects and has been used in China for hundreds of years. Purpose This study aimed to investigate the therapeutic effects of CP on DCM and its possible mechanisms. Methods The DCM model was established by a single intraperitoneal injection of 85 mg/kg 1% streptozotocin in rats. The treatment group was orally administered 135 mg/kg CP for 28 consecutive days, a dosage verified by experiments on AC16 myocardial cells and detecting liver and kidney injury markers. Results CP could reduce high blood sugar, high blood lipids, left ventricular mass index, levels of myocardial injury markers, adenosine diphosphate (ADP), and cyclic adenosine monophosphate (cAMP) in the model group. It also improved weight loss, and increased myocardial adenosine triphosphate (ATP), adenosine monophosphate (AMP), phosphocreatine (PCr), and ATP/ADP, AMP/ATP, and PCr/ATP ratios. The expression of p-mTOR/mammalian target of rapamycin (mTOR), p62, and peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC1α) in the myocardium of the CP group was enhanced, while the expression of LC3II/LC3I was inhibited. Conclusion CPs can alleviate myocardial damage by reducing blood sugar, blood lipids, and abnormal autophagy levels while promoting the restoration of myocardial energy metabolism homeostasis.

Blood Pressure Control and Clinical Outcomes After Renal Denervation Through Irrigated Catheter Radiofrequency Ablation in Patients with Resistant Hypertension: A Case Series with Up to 10 Years of Follow-Up.

The long-term efficacy of renal denervation (RDN) has not been extensively documented. To describe the long-term follow-up of patients after RDN. We evaluated patients with resistant hypertension (RH) who underwent RDN with irrigated catheter from 2012 to 2014 at a single centre. Office blood pressure (BP) and 24-hour ambulatory BP were assessed. Clinical event (stroke, myocardial infarction, need for dialysis, or death from any cause), left ventricular mass index (LVMI), estimated glomerular filtration rate (eGFR), and urine albumin-to-creatinine ratio (uACR) were evaluated. The analysis included 20 individuals (age 51 ± 10 years, 75% female, ambulatory systolic BP [SBP] 168 ± 22 mmHg, ambulatory diastolic BP [DBP] 101 ± 19 mmHg, taking 7 [IQR: 6-8] antihypertensive medications). The median follow-up period was 8.5 (IQR: 5.6-9.4) years. Mean (± SD) changes from baseline were: -47 ± 41 mmHg for office SBP, -25 ± 20 mmHg for office DBP, -29 ± 26 mmHg for ambulatory SBP, and -15 ± 16 mmHg for ambulatory DBP. The number of antihypertensive drugs markedly decreased one month after RDN and a gradual upward trend was observed over time. A clinical event occurred in 9 (45%) participants. LVMI decreased from 152 ± 37 to 120 ± 31g/m2 (p = 0.015), the eGFR declined from 88.9 ± 15.6 to 73.1 ± 24.2 mL/min/1.73 m2 (p = 0.034), and the uACR did not significantly change from baseline to follow-up. In this observational study of patients with uncontrolled RH, RDN with an irrigated catheter was associated with a sustained BP reduction for up to a decade. However, a potential waning efficacy was suggested by the increasing use of antihypertensive medications over time.

Atherosclerotic renal artery stenosis, mediating biomarkers, and risk of cardiac among individuals with hypertension: A real-world study

BackgroundAtherosclerotic renal artery stenosis (ARAS) is commonly associated with cardiovascular diseases(CVD). Patients with ARAS typically present with cardiac structural and functional abnormalities, and the differences in cardiac structure and function compared to hypertensive patients without ARAS remain to be explored. MethodsA total of 499 hypertensive patients were included, of whom 134 had ARAS and 365 had no renal artery stenosis (RAS). Parameters about cardiac function and structure detected by echocardiography and other clinical data are collected. Univariate and multivariate binary logistic regression and mediation analysis were performed on the collected data. ResultsCompared to hypertensive patients without ARAS, those with ARAS had significantly increased left ventricular (LV) internal diameter (LVIDd), posterior wall thickness (PWTd), LV geometric abnormalities, diastolic dysfunction, and a higher prevalence of LV hypertrophy (LVH). After adjustment, ARAS was significantly associated with LV diastolic dysfunction (LVDF) (OR = 1.12, 95 %CI = 1.03–1.3), LVIDd (OR = 1.07, 95 %CI = 1.02–1.13), LV geometry (OR = 1.24, 95 %CI = 1.12–1.36), PWTd (OR = 1.2, 95 %CI = 1.09–1.31), and LV mass index (OR = 1.31, 95 %CI = 1.18–1.47). Mediation analysis identified hypersensitive C-reactive protein (Hs-CRP) and serum creatinine (Scr) as significant mediators, accounting for 10.80 % to 59.54 % of the ARAS impact on LV abnormalities. ConclusionARAS appears to be an independent risk factor for abnormalities in cardiac function and structure, potentially mediated by Hs-CRP and Scr. Hypertensive patients with ARAS demonstrate a higher prevalence of left ventricular hypertrophy (LVH) and diastolic dysfunction, underscoring the importance of vigilant monitoring in this population.

Phase 1 Study of AAV9.LAMP2B Gene Therapy in Danon Disease.

Danon disease is a rare, X-linked, monogenic cardiomyopathy caused by mutations in the lysosomal-associated membrane 2 gene (LAMP2), which encodes the LAMP2 protein. In male patients, the predominant phenotype is progressive cardiac hypertrophy, cardiac dysfunction, and early death. There are no directed therapies for the disease. In this phase 1 study, we evaluated the safety and efficacy of a single infusion of RP-A501, a recombinant adeno-associated virus serotype 9 containing the transgene LAMP2B, which encodes an isoform of LAMP2. The primary outcomes were the safety and toxic effects of RP-A501, myocardial LAMP2 transduction and protein expression, stabilization of or reduction in heart-failure symptoms, and stabilization of or improvement in cardiac structure and function. Key secondary outcomes were sustained reduction in or stabilization of symptoms, immunologic response to RP-A501, end-stage heart failure, and overall survival. Exploratory outcomes included improvement in serologic markers of cardiac disease, patient-reported outcomes, and quality-of-life assessments. RP-A501 infusion was administered to seven male patients with Danon disease: five who were 15 years of age or older and two who were between 11 and 14 years of age. All the patients received a transient immunomodulatory regimen of prednisone, tacrolimus or sirolimus, and rituximab. Phase 1 data over 24 to 54 months, including interim data from a long-term follow-up study, are reported here. One patient had complement-mediated thrombotic microangiopathy (grade 4) with thrombocytopenia and acute kidney injury. Three patients had glucocorticoid-related exacerbation (grade 3) of Danon disease-related skeletal myopathy. One patient with left ventricular systolic dysfunction at baseline had progressive heart failure and underwent transplantation 5 months after infusion. In the six patients with normal left ventricular ejection fraction at baseline, we observed cardiac LAMP2 protein expression and a reduction from baseline in or stabilization of the left ventricular mass index, preservation of left ventricular ejection fraction, and reduction in or stabilization of the levels of cardiac troponin I and N-terminal pro-B-type natriuretic peptide. At 24 to 54 months, all the patients were alive, with complete resolution of side effects. A single infusion of RP-A501 appeared to be safe and was associated with cardiac LAMP2 expression and evidence of clinical improvement over a period of 24 to 54 months. (Funded by Rocket Pharmaceuticals; ClinicalTrials.gov number, NCT03882437.).

Assessing coronary artery stenosis exacerbated impact on left ventricular function and deformation in metabolic syndrome patients by 3.0 T cardiac magnetic resonance imaging

BackgroundMetabolic syndrome (MetS) and coronary artery stenosis (CAS) independently increase the risk of cardiovascular events, while the impact of CAS on left ventricular (LV) function and deformation in MetS patients remains unclear. This study investigates how varying degrees of CAS exacerbate LV function and myocardial deformation in MetS patients.MethodsOne hundred thirty-one MetS patients who underwent CMR examinations were divided into two groups: the MetS(CAS−) group (n = 47) and the MetS(CAS+) group (n = 84). The MetS(CAS+) group was divided into MetS with non-obstructive CAS(NOCAS+) (n = 30) and MetS with obstructive CAS(OCAS+) group (n = 54). Additionally, 48 age- and sex-matched subjects were included as a control group. LV functional and deformation parameters were measured and compared among subgroups. The determinants of decreased LV global peak strains in all MetS patients were identified using linear regression. The receiver operating characteristic (ROC) curve and logistic regression model (LRM) evaluated the diagnostic accuracy of the degree of CAS for identifying impaired LV strain.ResultsCompared to MetS(CAS−), MetS(NOCAS+) showed a significantly increased LV mass index (p < 0.05). Global longitudinal peak strain was decreased gradually from MetS(CAS−) through MetS(NOCAS+) to MetS(OCAS+) (− 13.02 ± 2.32% vs. − 10.34 ± 4.05% vs. − 7.55 ± 4.48%, p < 0.05). MetS(OCAS+) groups showed significantly decreased LV global peak strain (GPS), PSSR and PDSR in radial and circumferential directions compared with MetS(NOCAS+) (all p < 0.05). The degree of CAS was independently associated with impaired global radial peak strain (GRPS) (β = − 0.289, p < 0.001) and global longitudinal peak strain (GLPS) (β = 0.254, p = 0.004) in MetS patients. The ROC analysis showed that the degree of CAS can predict impaired GRPS (AUC = 0.730) and impaired GLPS (AUC = 0.685).ConclusionBesides traditional biochemical indicators, incorporating CAS assessment and CMR assessment of the LV into routine evaluations ensures a more holistic approach to managing MetS patients. Timely intervention of CAS is crucial for improving cardiovascular outcomes in this high-risk population.

Association between Proenkephalin A and cardiovascular outcomes in ambulatory Veterans

Proenkephalin (PENK) is a novel biomarker of kidney function associated with cardiovascular risk in patients with cardiovascular disease. Its association with cardiovascular outcomes in ambulatory individuals is less described. In an observational study of 199 ambulatory Veterans enrolled from April to September 2010, we assessed PENK’s association with major adverse cardiac events (MACE − cardiovascular death, heart failure [HF] hospitalization, myocardial infarction [MI], or stroke) and individual outcomes of all-cause mortality, incident HF, and cardiovascular death using Cox regression. We also assessed the association of PENK with left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), and left ventricular mass index (LVMi) with linear regression. The mean age was 66 ± 12 years, 99 % were men, and 76 % were White, with median follow-up of 12.7 years. Each two-fold higher PENK was associated with a 73 % higher risk of MACE in unadjusted analysis (HR 1.73; 95 % CI 1.00, 2.99; p = 0.043), though this association lost significance after adjusting for confounders (HR 1.69; 95 % CI 0.90–3.15; p = 0.098). PENK was not associated with all-cause mortality, incident HF or cardiovascular death, although risk estimates were elevated with wide confidence intervals for incident HF and cardiovascular death. PENK was not associated with LVMi or LVEDd but had a non-linear relationship with LVEF with low and high PENK associated with lower LVEF. In conclusion, PENK may be associated with a higher risk of MACE in ambulatory Veterans with diverse health statuses; however, further studies are needed.Abbreviations: PENK: Proenkephalin A; MACE: Major Adverse Cardiac Events.

Correlation between indole-3-acetic acid and left ventricular hypertrophy in hemodialysis patients.

Among hemodialysis patients, left ventricular hypertrophy (LVH) is a prevalent cardiac abnormality. The uremic toxin indole-3-acetic acid (IAA) is elevated in uremia patients, but the connection between IAA and LVH in individuals undergoing hemodialysis remains uncertain. Hence, the objective of this research was to examine the correlation between blood IAA levels and LVH in individuals undergoing hemodialysis. In total, 205 individuals undergoing hemodialysis were chosen and categorized into two groups, with (143 patients) and without LVH (62 patients). Patient clinical data were collected, and serum creatinine, calcium, phosphorus, hemoglobin, and IAA levels were measured. Compared to the non-LVH group, the LVH group had higher IAA and serum phosphorus but lower hemoglobin. The serum IAA concentration was positively correlated with both left ventricular mass (LVM) and left ventricular mass index (LVMI) but negatively correlated with both left ventricular ejection fraction (LVEF) and the ratio of left ventricular transmitral early peak flow velocity to left ventricular transmitral late peak flow velocity (E/A). Logistic regression analysis indicated that increased IAA levels are a risk factor for LVH and are not influenced by other factors. In addition, we exposed primary neonatal cultured mouse cardiomyocytes to varying concentrations of IAA in a controlled environment. Cardiomyocyte hypertrophy was induced by IAA in a concentration-dependent manner. Serum IAA is correlated with alterations in both the function and structure of the left ventricle. The serum IAA concentration is an independent risk factor for LVH. IAA may be a novel biomarker of LVH in hemodialysis patients.