Left Ventricular Relative Wall Thickness Research Articles

Cross-Sectional Association Between Left Ventricular Geometric Patterns, Cortical Cerebral Microinfarcts, and Cognition.

Left ventricular (LV) geometric patterns are associated with cognitive impairment and cerebral small vessel disease. As a novel magnetic resonance imaging marker of cerebral small vessel disease and a risk factor for cognitive dysfunction, cortical cerebral microinfarcts (CMIs) have been associated with heart disease through mechanisms including cardioembolism and cerebral hypoperfusion. Further investigation is required to determine whether cortical CMIs could arise from hemodynamic changes related to LV geometry, thus elucidating the connection between LV geometry and cognitive function. This study aims to investigate the cross-sectional relationship between LV geometric patterns, cortical CMIs, and cognition. A total of 261 patients, aged 75.3±6.8 years, were enrolled from a memory clinic study. LV dimensions were obtained using 2-dimensional echocardiography. LV mass index and relative wall thickness were determined to categorize LV geometric patterns. Cortical CMIs were graded on 3T magnetic resonance imaging. Cognition was assessed using neuropsychological tests and clinical diagnosis. Linear, zero-inflated Poisson, and logistic regression were employed for continuous, count, and binary outcomes, respectively. Mediation analysis was conducted to examine the mediation effect of cortical CMIs. A significant association was observed between concentric LV hypertrophy and cortical CMI counts (rate ratio, 3.85 [95% CI, 1.85-8.01]), as well as the odds of having dementia (odds ratio, 2.86 [95% CI, 1.07-7.89]), in the fully adjusted model. Cortical CMIs may partly explain the relationship between concentric LV hypertrophy and cognitive function. Concentric LV hypertrophy was associated with cortical CMIs and dementia. Further verification is warranted to determine the role of cortical CMIs in the association between LV geometry and cognition.

Effect of obesity on cardiovascular remodeling, and aerobic capacity in adults with coarctation of aorta.

We hypothesized that patients with coarctation of aorta (COA) and obesity would have more advanced cardiovascular remodeling and impaired aerobic capacity compared to COA patients without obesity. The purpose of this study was to assess the relationship between obesity, cardiovascular remodeling, and aerobic capacity in adults with repaired COA. The study comprised of 3 groups: (1) Obese COA group (n=177) (COA patients with body mass index [BMI] >30 kg/m2); (2) Non-obese COA group (n=572) (COA patients with BMI ≤30 kg/m2); (3) Control group (n=59) (subjects without structural heart disease and BMI ≤30 kg/m2). Cardiovascular remodeling was assessed using the following indices: (1) Arterial stiffness - total arterial compliance index (TACI). (2) Left ventricular hypertrophy - LV mass (LVM) and relative wall thickness (RWT). (3) LV diastolic function - Doppler-derived estimated LV end-diastolic pressure (LVEDP) and Tau. (4) Right ventricular (RV)-pulmonary artery coupling - RV free wall strain and RV systolic pressure (RVFW/RVSP). Aerobic capacity was assessed using predicted peak oxygen consumption (VO2). The obese COA group had higher LVM, RWT, LVEDP, and Tau, as well as lower RVFWS/RVSP, TACI and peak VO2 compared to non-obese COA group and controls. There was a correlation between BMI and LVM (r=0.39, p<0.001), RWT (r=0.47, p<0.001), LVEDP (r=0.43, p<0.001), tau (r=0.22, p=0.008), RVFWS/RVSP (r=- 0.24, p<0.001), and predicted peak VO2 (r=-0.48, p<0.001). These findings underscore the cardiovascular implications of obesity in the setting of COA, and provide opportunities for interventions to address obesity, and improve outcomes in this population.

Association between allostatic load and cardiac structural and functional abnormalities in young adults with serious mental disorders.

Allostatic load refers to the pathophysiological consequences of uncompensated adaptation to chronic stress. Few studies have investigated the effect of allostatic load on cardiac health in patients with serious mental disorders (SMDs), a population at high risk of cardiac mortality. Herein we evaluated associations between allostatic load and cardiac structure and function in young adults with SMDs. A total of 106 participants aged younger than 45years underwent echocardiographic study, blood biochemistry examination, and blood cell count analysis. Echocardiographic imaging was conducted in accordance with recommendations of the American Society of Echocardiography and European Association of Cardiovascular Imaging. Allostatic load index was calculated using 15 measures representing cardiovascular, metabolic, and inflammatory or oxidative stress markers. The SMD group exhibited a significantly higher allostatic load index than did control (Cohen's d=0.59). Additionally, they exhibited a greater left ventricular relative wall thickness (LVRWT, Cohen's d=0.39) and a less favorable mitral valve E/A ratio (Cohen's d=0.31), left ventricular ejection fraction (Cohen's d=0.51), and global longitudinal strain (Cohen's d=0.71). After demographic and clinical characteristics were adjusted for, multiple linear regression revealed that allostatic load index was positively associated with LVRWT (β=0.255) and negatively associated with mitral valve E/A ratio (β=-0.247) in the SMD group. This is the first study to suggest that allostatic load may play a critical role in accelerated adverse cardiac remodeling among young patients with SMDs. Future studies should elucidate the underlying mechanisms.

Left Ventricular Reverse Remodeling After Successful Living Donor Kidney Transplantation: The VINTAGE Study.

The impact of kidney transplantation (KT) on left ventricular (LV) remodeling remains poorly understood. This study aimed to evaluate the effect of KT on LV reverse remodeling, utilizing echocardiographic LV geometric patterns as a key assessment tool. In 100 recipients who underwent living KT between 2012 and 2022, we evaluated changes in the distribution of LV geometric patterns (normal geometry, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy) between baseline and 1 year post-transplantation. These patterns were categorized based on LV mass index (LVMI) and relative wall thickness (RWT) assessed via echocardiography. Overall, LV geometric patterns improved or remained stable in 81% of recipients, with worsening in 19%. The proportion of normal geometry increased from 15% to 19%, and concentric remodeling from 30% to 45%, while eccentric hypertrophy decreased markedly from 20% to 3%. Concentric hypertrophy remained relatively stable at 33% (p=0.036). Subgroup analysis revealed that 47% of those with pre-KT normal geometry progressed to LV remodeling, while 77% with concentric remodeling remained stable. In contrast, 55% with eccentric hypertrophy experienced reverse remodeling, and 49% with concentric hypertrophy also showed reverse remodeling. These subgroup results suggest an interaction between the effect of KT on LV reverse remodeling and the pre-KT LV geometric patterns. Multivariable analysis identified E/e' > 9.5 (OR 2.01, 95% CI 1.10-3.67, p=0.024) and acute antibody-mediated rejection (OR 2.44, 95% CI 1.01-5.87, p=0.047) as independent predictors of LV remodeling progression. KT can lead to improvements in even advanced LV geometric patterns, although this effect may be diminished in the presence of pre-KT diastolic dysfunction or the occurrence of acute rejection. Since recipients rarely achieve complete renal recovery, echocardiographic monitoring remains crucial post-KT. Future studies are needed to establish whether these observed improvements in LV reverse remodeling directly translate into long-term reductions in cardiovascular events.

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.

Epicardial adipose tissue and subclinical alterations in cardiac structure and function in early adulthood

Abstract Background Epicardial adipose tissue (EAT) is the visceral fat depot surrounding the heart and coronary arteries and shares the same microcirculation with myocardium. Under normal physiologic conditions EAT contains important cardioprotective properties such as cushioning the heart against mechanical stress, thermoregulation of the myocardium in hypothermia as well as balancing myocardial fatty acid homeostasis. Higher accumulation of EAT has been reported to independently associate with deleterious alterations in cardiac structure and function. However, majority of previously addressed study results are derived from older study population and in presence of cardiovascular diseases. Data on the associations of EAT and cardiac echocardiograpghically derived structural and functional parameters in a young and middle-aged population without prevalent cardiovascular disease is scarce. Purpose We aimed to address this knowledge gap by investigating the associations of echocardiographically measured EAT thickness and possible adverse subclinical alteration in cardiac structure and function in a population cohort of young and middle-aged adults. Methods This study participants were examined as part of the ongoing multi-centre longitudinal cohort, focusing on cardiovascular risk factors from childhood through adulthood. EAT thickness was measured by manual delineation from parasternal long-axis echocardiograms at end systole. Transthoracic and Doppler echocardiograpghy was performed and data on cardiac structural and functional parameters were derived comprehensively in accordance with EAE/ASE guidelines. Results In this study population (N=1677, men=770, women=897 ; age range 34-49 years) mean EAT thickness was 4.0 mm in whole population. In multivariable regression analysis models adjusted for age, sex, waist circumference and systolic blood pressure, significant independent associations of EAT and left atrial dimension (P&amp;lt;.0001) and various measures of left ventricular (LV) wall thickness such as LV mean wall thickness (P&amp;lt;.001), LV relative wall thickness (P&amp;lt;.001) as well as LV posterior wall thickness (P&amp;lt;.001) were observed. We found no significant associations between EAT thickness and cardiac functional and hemodynamic parameters after covariate adjustments in multivariable analysis models. Conclusion The findings of this study highlight that larger EAT thickness is associated with subclinical alteration in cardiac wall thicknesses in young and middle-aged adults. However, we found no associations between EAT thickness and cardiac functional parameters, which is perhaps due to the high cardiac adaptation properties in our relatively young study population. Therefore, further follow-ups is required to address long-term probable alterations in cardiac hemodynamics when the participants are older.

Association between Left Ventricular Geometry, Systolic Ejection Time, and Estimated Glomerular Filtration Rate in Ambulatory Patients with Preserved Left Ventricular Ejection Fraction

Plain Language SummaryCardiac function is important to quantify for risk stratification. Although left ventricular ejection fraction is commonly used, and identifies patients with poor systolic function, other easily acquired measures of cardiac function are needed. In this retrospective cohort study of 375 patients with increased left ventricular relative wall thickness, an easily derived measure from standard transthoracic echocardiography was independently associated with a surrogate of subclinical systolic dysfunction, left ventricular ejection time, and chronic kidney disease. Left ventricular geometry identifies clinically relevant subclinical systolic dysfunction and patients with worse kidney function.

P135 FITNESS INFLUENCES THE RELATIONSHIP BETWEEN EXERCISE BLOOD PRESSURE AND LEFT VENTRICULAR STRUCTURE: EVIDENCE FROM THE EXERCISE STRESS TEST COLLABORATION (EXERTION) STUDY

Background. A hypertensive response to exercise is associated with left ventricular (LV) remodelling, a principal sign of hypertensive heart disease. Fitness may modify this relationship, making clinical interpretation of peak exercise systolic blood pressure (SBP) challenging. This study examines the influence of fitness on the relationship between peak exercise SBP and LV structure. Methods. Cardiovascular structure and function (LV mass index (LVMI), LV relative wall thickness (RWT), cardiac output (CO) and total peripheral resistance (TPR)) were assessed at rest by echocardiography on 4,309 individuals (aged 58.6±12.7 years,52.0% male). SBP was measured at peak treadmill exercise, and fitness (exercise duration (minutes)) was grouped into thirds. Multiple regression analysis was conducted with fitness as an interaction term with peak exercise SBP, adjusted for age, sex, pre-exercise SBP, and cardiovascular disease (CVD) history. Results. Peak exercise SBP was similar across low (180±26.5mmHg), moderate (181±26.3mmHg) and high (182±24.5mmHg) fitness groups. Fitness modified the relationship between exercise SBP and LVMI; each 5mmHg increase in exercise SBP was associated with LVMI in moderate [0.27(0.10–0.43) and high [0.25(0.06–0.43)] fitness groups, which was not observed among those with low fitness [-0.05(-0.22–0.12)]. RWT increased with higher peak exercise SBP at all fitness levels (all p&lt;0.001), with higher values among those with low fitness. Prevalence of LV concentric remodelling was highest in those with low fitness (29.9%) and lowest in those with high fitness (10.8%). A lower CO and higher TPR were observed in the low fitness group (7.5±2.5L/min and 14.3±5.1mmHg min/L) compared to those with high fitness (10.9±3.1L/min and 9.2±2.09mmHg min/L). Conclusion. Whilst a small effect, fitness modified the peak exercise SBP-LV structure relationship, such that for similar peak exercise SBP, those with low fitness exhibit a more adverse LV remodelling, with lower CO and higher TPR, compared to those with higher fitness. Considering fitness when interpreting SBP and cardiac imaging results from exercise stress testing may be relevant in identifying CVD risk and optimal patient management.

Identification of Novel Independent Correlations between Cellular Components of the Immune System and Strain-Related Indices of Myocardial Dysfunction in CKD Patients and Kidney Transplant Recipients without Established Cardiovascular Disease.

The role of immune system components in the development of myocardial remodeling in chronic kidney disease (CKD) and kidney transplantation remains an open question. Our aim was to investigate the associations between immune cell subpopulations in the circulation of CKD patients and kidney transplant recipients (KTRs) with subclinical indices of myocardial performance. We enrolled 44 CKD patients and 38 KTRs without established cardiovascular disease. A selected panel of immune cells was measured by flow cytometry. Classical and novel strain-related indices of ventricular function were measured by speckle-tracking echocardiography at baseline and following dipyridamole infusion. In CKD patients, the left ventricular (LV) relative wall thickness correlated with the CD14++CD16- monocytes (β = 0.447, p = 0.004), while the CD14++CD16+ monocytes were independent correlates of the global radial strain (β = 0.351, p = 0.04). In KTRs, dipyridamole induced changes in global longitudinal strain correlated with CD14++CD16+ monocytes (β = 0.423, p = 0.009) and CD4+ T-cells (β = 0.403, p = 0.01). LV twist and untwist were independently correlated with the CD8+ T-cells (β = 0.405, p = 0.02 and β = -0.367, p = 0.03, respectively) in CKD patients, whereas the CD14++CD16+ monocytes were independent correlates of LV twist and untwist in KTRs (β = 0.405, p = 0.02 and β = -0.367, p = 0.03, respectively). Immune cell subsets independently correlate with left ventricular strain and torsion-related indices in CKD patients and KTRs without established CVD.

Association of lipids and inflammatory markers with left ventricular wall thickness in patients with bipolar disorder

BackgroundIndividuals with bipolar disorder (BD) face a high risk of heart failure and left ventricular (LV) dysfunction. Despite strong evidence that high LV relative wall thickness (RWT) is a risk marker for heart failure, few studies have evaluated LV RWT and aggravating factors in individuals with BD. MethodsWe recruited 104 participants (52 patients with BD and 52 age- and sex-matched mentally healthy controls) to undergo echocardiographic imaging and biochemistry, high-sensitivity C-reactive protein (hs-CRP), and blood cell count measurements. LV RWT was estimated using the following equation: (2 × LV posterior wall end-diastolic thickness)/LV end-diastolic diameter. Clinical data were obtained through interviews and chart reviews. ResultsThe BD group exhibited a significantly greater LV RWT (Cohen's d = 0.53, p = 0.003) and a less favorable mitral valve E/A ratio (Cohen's d = 0.54, p = 0.023) and LV global longitudinal strain (Cohen's d = 0.57, p = 0.047) than did the control group. Multiple linear regression revealed that in the BD group, serum triglyceride levels (β = 0.466, p = 0.001), platelet-to-lymphocyte ratios (β = 0.324, p = 0.022), and hs-CRP levels (β = 0.289, p = 0.043) were all significantly and positively associated with LV RWT. LimitationsThis study applied a cross-sectional design, meaning that the direction of causation could not be inferred. ConclusionsPatients with BD are at a risk of heart failure, as indicated by their relatively high LV RWT. Lipid levels and systemic inflammation may explain this unfavorable association.

Abstract P437: Cumulative Effect of Early-Onset Type 2 Diabetes on Left Ventricular Geometry - The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Background: Type 2 diabetes (T2D) is increasingly common in young adults. Increases in left ventricular (LV) mass and wall thickness are early manifestations of myocardial involvement in T2D. The association between the cumulative burden of risk factors (RFs) and LV structural abnormalities in patients with early-onset T2D has not been well characterized. Objective: Investigate how metabolic RFs accumulated in a 25-year period among patients with early-onset T2D relate to LV mass index (LVMI) and relative wall thickness (RWT). Methods: We used data from the Coronary Artery Risk Development in Young Adults study (CARDIA, baseline to year 25). We defined early-onset T2D by self-reported T2D or anti-diabetic medication use, fasting glucose (FG) ≥126 mg/dL, or oral glucose ≥200 mg/dL at or before follow-up year 10 (age&lt;40). LV outcomes were measured by Doppler echocardiography (LVMI by Devereux formula indexed to body surface area; RWT = LV posterior wall thickness at end diastole x 2/LV internal dimension at end-diastole). Hypertrophy was defined by LVMI ≥115 g/m 2 in men or ≥95 g/m 2 in women. We used the area under the growth curve (AUC) that was derived from quadratic random-effects models of ≥4 repeated measures of RFs (BMI, SBP, DBP, LDL-c, HDL-c, triglycerides, fasting glucose, and fasting insulin) to estimate the cumulative burden of T2D through adulthood. We performed linear regressions to examine the associations of the total AUC of each RF with LVMI or RWT, accounting for sex, race, mid-life age, education, smoking, and control for hypertension, lipids, and diabetes. We assessed the associations by sex and race. Results: Among 227 patients with early-onset T2D, 39% had hypertrophy, and 13% had RWT&gt;0.42 at midlife. Each standard deviation (SD) increase in total AUCs of BMI, SBP, DBP, triglycerides, FG, and fasting insulin was significantly associated with increased LVMI (β coefficients =5.9, 11.5, 10, 7, 4.1, and 6.7, respectively), while high total AUC of HDL-c was inversely associated with LVMI (β = -5.1). Increased total AUC of triglycerides was associated with increased RWT (β = 0.2). Significant sex and race differences were shown in the cumulative effect of RFs on outcomes. The positive associations between AUC of RFs and LVMI were significant in both sexes, but the associations were stronger in male patients than in women. The inverse association between AUC of HDL-c and LVMI was only significant in male patients (P-interaction &lt;0.05). Women with early-onset T2D but not men exhibited significantly increased RWT related to the increase in AUCs of SBP, DBP, triglycerides, FG, and insulin (P-interaction &lt;0.05). The positive association between AUC of BMI and LVMI was significant in Whites but not Blacks (P-interaction &lt;0.05). Conclusion: Cumulative RFs alter mid-adulthood LV geometry in patients with early-onset T2D. This cumulative impact of early-onset T2D on LV geometry varies by sex and race.

FEATURES OF THE MORPHO-FUNCTIONAL MYOCARDIUM STATE AND RELATIONSHIP WITH GALECTIN-3 IN PATIENTS WITH CHRONIC HEART FAILURE OF ISCHEMIC ORIGIN ON THE BACKGROUND OF METABOLIC PATHOLOGY

The aim. To evaluate the presence and nature of changes in the morpho-functional state of the myocardium in patients with coronary heart disease (CHD) with concomitant type 2 diabetes mellitus (T2DM) and obesity, depending on the functional class (FC) of chronic heart failure (CHF) and the relationship with the concentration of galectin-3 in blood serum.&#x0D; Materials and methods. The study involved 75 patients with CHD with concomitant metabolic diseases such as T2DM and obesity, who were treated in the cardiology department of the State Clinical Hospital No. 27. Patients were divided into groups according to the FC of CHF. Group 1 included 30 patients with CHF FC II, group 2 – 24 patients with CHF FC III, group 3 – 21 patients with CHF FC IV.&#x0D; Results. In patients with СHD and metabolic disorders with CHF FC III, the levels of end-systolic dimension (ESD) and end-diastolic dimension (EDD) were higher by 16.3 % and 17.9 %, respectively, compared with FC II, end-systolic volume (ESV) and end-diastolic volume (EDV) also increased significantly in patients of this cohort with FC III compared with CHF FC II by 35.8 % and 16.5 %, respectively. Significantly increased ESV, EDV by 42.9 % and 37.8 %, respectively, as well as the size of the left atrium by 14.3 % in patients of the study group who had CHF FC IV compared with FC III. The ejection fraction (EF) index decreased in patients of this cohort with CHF FC IV by 14.4 % compared with FC III. The size of the right ventricle was larger by 10.8 % in CHF FC IV than in FC III in patients with CHD on the background of comorbid metabolic pathology. Indicators of the thickness of the LV posterior wall, LV relative wall thickness and intraventricular septum were lower in patients with FC IV compared with FC II, left ventricle mass (LVM) and left ventricle mass index (LVMI) increased by 32 % and 33 %, respectively. Сomparing the levels of Ea/Es in patients with CHF FC II and IV in СHD with concomitant T2DM and obesity, a significant increase in this indicator was found in FC IV (p&lt;0.05). The level of galectin-3 in patients with CHF FC III and IV of ischemic origin against the background of concomitant metabolic disorders was higher than in patients with FC II. Сomparing the concentration of galectin-3 in patients with CHF FC III and IV in patients with CHD with comorbid metabolic pathology, significantly higher levels were found in FC IV (p&lt;0.05). The study of the relationship between the fibrosis factor galectin-3 and cardiohemodynamic parameters revealed probable links, namely direct links between galectinemia and ESV (r=0.52; p&lt;0.05), EDV (r=0.58; p&lt;0.05), Еа/Es (r=0.51; p&lt;0.05).&#x0D; Conclusions. The growth of the functional class of chronic heart failure is accompanied by dilatation of the left cavities of the heart, a decrease in the inotropic function of the left ventricle, an increase in myocardial-arterial stiffness, and an increase in the levels of the galectin-3 fibrosis factor in the studied patients.

Left ventricle hypertrophy and re-modeling in children with essential hypertension: does the race matter?

This is the first study to report on the impact of race on differences in the prevalence of echocardiographic left ventricular hypertrophy and left ventricular adaptation at the time of diagnosis of essential hypertension in children. This cross-sectional, single-centre study included patients aged 3-18 years who had newly diagnosed essential hypertension. Echocardiography was used to assess left ventricular mass index and left ventricular relative wall thickness. An left ventricular mass index > the 95th percentile for age and gender, and an left ventricular relative wall thickness > 0.42, were used to diagnose left ventricular hypertrophy and concentric adaptation. Various echocardiographic parameters were compared between African Americans and Caucasians. The study included 422 patients (289 African Americans and 133 Caucasians) diagnosed with essential hypertension at a median age of 14.6 (interquartile range; 12.1-16.3) years. Eighty-eight patients (20.9%) had left ventricular hypertrophy. There was no statistically significant difference in the prevalence of left ventricular hypertrophy between African Americans and Caucasians (22.5% versus 17.3%, p=0.22). The median left ventricular relative wall thickness was 0.35 (0.29-0.43), and 114 patients (27.0%) had an left ventricular relative wall thickness > 0.42. The presence of an left ventricular relative wall thickness > 0.42 was significantly higher among African Americans compared to Caucasians (30.1% versus 20.3%, p = 0.04). The African American race was a strong predictor for an left ventricular relative wall thickness > 0.42 (odds ratio 1.7, p = 0.04), but not for left ventricular mass index > the 95th percentile (p = 0.22). Overweight/obesity was a strong predictor for an left ventricular mass index > the 95th percentile. There was no difference in the prevalence of left ventricular hypertrophy in children with essential hypertension of different races. Obesity, rather than being African American, is associated with left ventricular hypertrophy.

Echocardiographic characterization of patients with supranormal ejection fraction: pooled core laboratory analysis of the TOPCAT and PARAGON-HF trials

Abstract Background Patients with heart failure and supranormal ejection fraction (HFsnEF) may be phenotypically distinct from those with normal or below normal left ventricular ejection fraction (LVEF), and may demonstrate different prognostic trajectories or treatment responses. Purpose To characterize clinical features, cardiac structure and function among patients with HF with preserved EF (defined as 45% ≤ LVEF ≤ 65%) and supranormal EF (defined as LVEF&amp;gt;65%). Methods Baseline clinical characteristics and key echocardiographic parameters from patients enrolled in the echocardiographic substudies of TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist)-Americas and PARAGON-HF (Prospective Comparison of ARNI [angiotensin receptor–neprilysin inhibitor] with ARB [angiotensin-receptor blocker] Global Outcomes in Heart Failure with Preserved Ejection Fraction) were compared between patients with and without HFsnEF. Results Among 1,751 participants (mean age 73 years old, 51% women) in this pooled core laboratory analysis, 265 (15%) had HFsnEF. Participants in HFsnEF group were more likely to be women, and less likely to have prior myocardial infarction and atrial fibrillation (Table 1). Compared with those with LVEF ≤ 65%, those with LVEF &amp;gt; 65% had lower LV end-diastolic and end-systolic volume indices, lower LV mass index, higher LV relative wall thickness, and higher right ventricular fractional area change. LV geometry and measures of LV diastolic function were similar in both groups (Table 1). Global longitudinal strain (GLS) was abnormal (absolute GLS &amp;lt;16%) in 28% in those with HFsnEF compared with 53% in those with LVEF ≤ 65%. After adjusting for baseline LV ejection fraction and sex, and stratified by trial, abnormal GLS was associated with a higher risk of composite of first heart failure hospitalization or cardiovascular death (overall hazard ratio [HR] 1.56, 95% confidence interval [CI] 1.23 – 1.98, P &amp;lt; 0.001), cardiovascular death (overall HR 2.06, 95% CI 1.35 – 3.13, P = 0.001), and heart failure hospitalization (overall HR 1.49, 95% CI 1.15 – 1.93, P = 0.003) in both HFsnEF and non-HFsnEF groups (P-interaction &amp;gt; 0.05 for all, Figure 1). Conclusions Among participants in the TOPCAT-Americas and PARAGON-HF trials, those with LVEF &amp;gt; 65% were predominantly women, had less LV remodeling, and had better RV function based on echocardiographic measures. Nevertheless, despite supranormal LVEF, GLS was abnormal in over a quarter of patients and remained an important predictor of adverse clinical outcomes in this cohort.Table 1Figure 1

Abstract 14658: Echocardiographic Metrics Before Coronary Artery Bypass Grafting Are Associated With Postoperative Kidney Injury in Patients With Preserved Ejection Fraction, and Mean Perfusion Pressure May Mediate This Relationship

Introduction: Preserved left ventricular ejection fraction (LVEF) patients often suffer acute kidney injury (AKI) after coronary-artery bypass surgery (CABG). We studied the relationship of relative wall thickness (RWT) and LV filling pressure (E/e’), measured by preoperative transthoracic echocardiogram (TTE), with AKI in this population. As these markers may identify subclinical cardiac dysfunction, we also examined the role of intraoperative hypotension by mean perfusion pressure (MPP). Hypothesis: Are LV RWT and E/e’ from preoperative TTE associated with post-CABG AKI in preserved LVEF patients? Are LV RWT and E/e’ associated with hemodynamic instability measured by total minutes of MPP (MAP-CVP) &lt; 60mmHg (1 min. resolution)? Aims: We aim to identify novel preoperative TTE markers that provide mechanistic insight (low MPP) to AKI development in preserved LVEF patients undergoing CABG. This could lead to interventions during high-risk surgeries to reduce AKI. Methods: We accessed 1343 patient records and used multivariate logistic regression models adjusted for covariates (Fig. 1). Results: Mean (SD) age was 65 (10). 170/709 patients had AKI. RWT and E/e' are weakly correlated (r=.15, p=.0075, n=314). Each E/e’ increase associated with AKI, OR 1.11 (1.04-1.19, p=.003). Every 0.1 RWT increase associated with AKI, OR 1.21 (1.02-1.43, p=.031, n=518). Each minute MPP &lt; 60mmHg associated with 0.6% AKI increase (n=714). E/e’ associated with low MPP; RWT did not. Conclusion: In preserved LVEF patients, RWT and E/e’ are associated with higher AKI risk after CABG. E/e’ is also associated with intraoperative MPP&lt;60mmHg, which may partially mediate the E/e’-AKI relationship.

Abstract 12856: Electrocardiographic T Wave Inversion and Cardiac Structure and Function

Background: Electrocardiographic T wave inversion (TWI) has been associated with incident heart failure (HF) in Black Americans without known coronary heart disease (CHD). The aim of this study was to investigate the relationship between TWI and left ventricular (LV) structure and function to evaluate cardiac changes that may precede symptomatic disease among Black Americans. Methods: Among 4134 Black American participants in the Jackson Heart Study without prevalent HF or CHD at baseline. We defined TWI as having negative T wave amplitudes in each lead of the 12-lead electrocardiogram. Outcomes of interest included echocardiographic LV structure (LV mass index, LVMI, LV diastolic dimension, LVDd and relative wall thickness, RWT) and LV function (LV ejection fraction, LVEF). We investigated the associations between TWI and LV structure and function using multiple linear regression analysis. For participants with missing values in any covariate of interest, values were imputed using multiple imputation by chained equations. Results: In this cohort with median age 55 years and 65% women. The depth of the inverted T wave in leads I and aVL were positively associated with RWT (Figure). The depth of the inverted T waves in leads II, III, and aVF were associated with LVDd. The depth of the inverted T waves in all the leads except V1 and V2 were associated with LVMI, while T wave inversions in only aVF were associated with LVEF. Conclusion: The depth of inverted T waves in leads I and aVL (which were associated with incident HF with preserved EF) were associated with LV concentricity while T wave amplitudes in leads II, III, and aVF (which were associated with incident HF reduced EF) were associated with LV eccentricity. Simple electrocardiographic information may be useful for identifying patients at risk of HF (stage B/pre HF).

Left Ventricular Geometric Patterns in Newly Diagnosed Hypertension: An Echocardiographic Study

Objective: To investigate patterns of left ventricular (LV) geometric patterns in patients diagnosed with new-onset hypertension using transthoracic echocardiography. The LV diastolic function was also evaluated in these patients. Materials and Methods: The present study was a cross-sectional study that clinically evaluated patients diagnosed with new-onset hypertension at Burapha University Hospital. To classify LV geometric patterns, electrocardiogram, and transthoracic echocardiography to measure LV mass index and relative wall thickness were performed. Other relevant assessments were also conducted, including the diastolic function. Results: Fifty-five patients diagnosed with new-onset hypertension were enrolled, their mean age was 55.3 years, with a standard deviation of 11.8 years. Of all participants, 70.9% (95% CI 57.1 to 82.4) had concentric remodeling, 16.4% (95% CI 7.8 to 28.8) had concentric hypertrophy, 10.9% (95% CI 4.1 to 22.3) had normal geometry and 1.8% (95% CI 0.1 to 9.7) had eccentric hypertrophy. Of all participants, 81.8% were detected to have abnormal LV diastolic dysfunction. Abnormal relaxation pattern was the most common format. Conclusion: In the present study, approximately 10.9% of patients diagnosed with new-onset hypertension had normal LV geometry, whereas 89.1% had abnormal geometry in different patterns. Concentric remodeling was found to be the predominant abnormal geometrical format. Understanding LV geometric patterns helps clinicians stratify risk, predict prognosis, and make informed decisions about treatment strategies for these patients. Keywords: Hypertension; Left ventricular geometric pattern; Diastolic dysfunction

CORRELATION OF ECHOCARDIOGRAPHIC INDICATORS AND CLINICAL-LABORATORY PARAMETERS TAKING INTO ACCOUNT THE AGT GENE (RS4762) IN PATIENTS WITH ARTERIAL HYPERTENSION

The аim of the research – to assess the relationship between echocardiographic indices and clinical- laboratory parameters, taking into account genetic markers AGT (rs4762) in patients with essential arterial hypertension (EAH).&#x0D; &#x0D; Material and methods. The case-control study involved 100 patients with EAH stage II, 1-3 degrees of blood pressure (BP) increase, high and very high cardiovascular risk. Among the patients there were 21 % men, 79 % women. The middle age of the patients was 59.86±6.22y.o. The control group consisted of 60 practically healthy individuals, relevant in age (49.13±6.28y.o.) and gender distribution (63 % – women, 37 % – men). To study polymorphism of AGT (rs4762) and GNB3 (rs5443) genes a qualitative polymerase chain reaction (PCR) was performed in real time. The lipidogram indices were investigated in the blood plasma using diagnostic kits «Accent 200» firm (Poland). All patients were tested for levels of fasting glucose, ionized calcium, parathyroid hormone (PTH), 25-hydroxyvitamin D. The patients were performed echocardiography to determine the left ventricle hypertrophy. Results. The structural parameters of the myocardium, which determine the size of the LVH and the type of its geometric model, in patients with essential arterial hypertension (EAH) are influenced by the following indicators with a moderate strength of connection: concentric hypertrophy (CH LV) develops at a low level of high-density lipoprotein cholesterol (LPHD) (r= –0.59; р=0.008), ionized blood Ca2+ (r= –0.50; р=0.03) and increased PTH content (r=0.40; р=0.05) and high EchoCG indicators: increase in the size of the left atrium (LA), posterior wall thickness (PWT), interventricular septum in diastole (IVSd), left ventricle mass (LVM), left ventricular mass index (LVMI) and the relative left ventricular wall thickness (RWT) (r=0.47-0.65; p≤0.04-0.002). Conclusions. Structural and functional changes of the myocardium are correlated with a number of clinical, anthropometric, metabolic indicators and depend on polymorphic variants of the AGT gene (rs4762).

Diagnostic challenges of heart failure with preserved ejection fraction: focus on echocardiography

Aim. To assess the features of diagnosing heart failure with preserved ejection fraction (HFpEF) using echocardiographic markers and diastolic stress test (DST) according to a survey of ultrasound and functional diagnostics specialists in the Russian Federation.Materials and methods. As part of the study, an anonymous survey of 155 ultrasound and functional diagnostic specialists from various Russian regions was conducted. We proposed to answer whether they routinely assess certain echocardiographic parameters necessary for diagnosing HFpEF. The specialists also indicated whether they conduct DST and whether they have the opportunity to refer the patient to this study.Results. A frequency analysis of the responses received was carried out. In routine practice, 83,2% of specialists measure the left ventricular (LV) ejection fraction by Simpson method, 76,1% — by Teichholz method. In addition, 80% of responders analyses LV mass index, 76,1% — relative LV wall thickness, 60% — tricuspid annular plane systolic excursion, 56,8% — left atrial volume index, 51.6% — E/e´ ratio, 94,8% — pulmonary artery systolic pressure, left ventricular global longitudinal strain — 16,1%, 7,7% — left atrial longitudinal strain. Also, 9,7% of specialists conduct DST on their own, while 41,3% have the opportunity to refer patients.Conclusion. The low assessment rate of some ultrasonic HFpEF mar­kers and DST among functional diagnostics specialists in the Russian Federation reduces the detection rate of HFpEF. It is necessary to develop diagnostic algorithms based mainly on clinical and anam­nestic data and available for use by doctors of any specialty.

Cardioprotective Effects of Paraoxanase 3 in a Dahl Salt-Sensitive Rat Model of Chronic Kidney Disease

Objective: Paraoxanases (Pon) are hydrolytic enzymes with three distinct isoforms. Decreased circulating Pon activity is associated with increased oxidant stress and adverse clinical outcomes in the setting of chronic kidney disease (CKD), yet the mechanism of action is unknown. We tested the hypothesis that Pon-3 is cardioprotective in a Dahl salt-sensitive model of hypertensive renal disease.&#x0D; Methods: Ten week old, age-matched, Dahl salt-sensitive wildtype and Pon3 mutant male and female rats were maintained on eight percent high salt diets for eight weeks to initiate the salt-sensitive hypertensive renal disease characteristic of this model. After eight weeks, animals were euthanized and hearts were processed for histology. Echocardiography was performed to measure left ventricular function.&#x0D; Results: By 8 weeks, mortality was observed in 18.2% of male SS-Pon3 KO rats on high salt; no mortality was observed in male SS male rats on high salt. In female rats, by 8 weeks 100% mortality was observed in SS-Pon3 KO rats on high salt diet while no mortality was observed in SS rats on high salt. High salt fed SS-Pon3 KO male rats that survived the echocardiography study demonstrated significantly decreased left ventricular end-systolic diameter and end-diastolic diameter, as well as significant increases in left ventricular relative wall thickness compared to age matched SS rats. Furthermore, SS-Pon3 KO rats demonstrated significantly increased heart-weight-to-body-weight ratio compared to age matched SS rats. &#x0D; Conclusion: These findings suggest a cardioprotective role for PON-3 in the setting of salt-sensitive hypertensive renal disease.