Lower Left Ventricular Mass Index Research Articles

Association of inflammation with left ventricular mass index in patients with rheumatoid arthritis

Abstract Background Rheumatoid arthritis (RA) is an inflammatory autoimmune disease associated with cardiovascular organ damage. Purpose We explored the association of inflammatory markers with left ventricular (LV) mass index during 22 months of follow-up in patients with RA. Methods Eighty-three outpatients with RA (age 55±12 years, 71 % women) with indication for biological (b) or targeted synthetic (ts) disease modifying antirheumatic drug (DMARD) therapy were examined with echocardiography at baseline and after 22 months. LV mass was indexed for height in the allometric power of 2.7. Serum concentrations of the inflammatory markers, C-reactive protein (CRP), serum amyloid A (SAA) and calprotectin were measured by MALDI-TOF mass spectrometry. Results At baseline, 37% had hypertension, 6% diabetes, 21% obesity and 100% were using b/ts DMARDs. The inflammatory markers decreased during follow-up (all p<0.001), while the LV mass index did not change (33.1±8.1 g/m^2.7 vs. 33.5±7.3 g/m^2.7, p=0.57). The prevalence of hypertension, diabetes and obesity were unchanged at follow-up (p>0.05), but the percentage of patients using b/ts DMARDs had decreased to 83% (p<0.001). In multivariable analyses, higher CRP and SAA at baseline were associated with higher LV mass index at both baseline and follow-up independent of presence of obesity, hypertension, age, sex or treatment with b/ts DMARDs at follow-up (Table 1). Inflammatory markers at follow-up were not associated with LV mass index (Table 1), but use of b/ts DMARDs at follow-up were associated with lower LV mass index after adjusting for inflammatory markers, age, sex, presence of obesity and hypertension (Table 1). Conclusion Higher levels of inflammatory markers at baseline were associated with greater LV mass index in RA patients. The use of immunosuppressive treatment throughout the study period was associated with lower LV mass index at follow-up, pointing to a role of chronic inflammation in LV hypertrophy.

Relationship between renin, aldosterone, aldosterone-to-renin ratio and left ventricular mass index in young adults

Abstract Background Primary aldosteronism (PA), characterised by excessive aldosterone production and mineralocorticoid receptor activation, is associated with adverse cardiovascular outcomes including left ventricular hypertrophy and failure. Elevated cardiovascular risk is observed even in milder and subclinical forms of PA, especially in middle-aged and elderly populations. It is unclear if early changes in PA biomarkers can affect left ventricular mass index (LVMI), which is a strong predictor of cardiovascular diseases. Aim To evaluate the relationship between PA biomarkers, namely renin concentration, aldosterone concentration and aldosterone-to-renin ratio (ARR), and LVMI in young adults. Methods The Raine Study is a longitudinal, population-based cohort study in Western Australia that enrolled women during pregnancy. We analysed the data from the offspring of these women at age 27. Participants with PA biomarkers and LVMI measured by cardiac magnetic resonance imaging were included. Females who were on oral contraception were excluded due to its confounding effect on the ARR. We examined the relationship between LVMI and plasma renin, aldosterone, and ARR using multivariate-adjusted linear regression and used mediation analysis to test whether these relationships were dependent on systolic blood pressure (SBP). Results Of 758 participants, 252 (33.2%) were females and the mean (SD) age was 26.7 (0.4) years. Females had lower median plasma renin concentration (12.0 vs 15.4mU/L; p<0.001) and higher median ARR (21.0 vs 15.6; p<0.001) than males. There was no sex-difference in median plasma aldosterone concentration (257 vs 237pmol/L in males; p=0.143). Females had lower LVMI (52.2 vs 70.2 g/m²; p<0.001) than males. A significant association between LVMI and aldosterone was detected in males (β-coefficient 0.009; 95% CI 0.001 to 0.017; p=0.027), and between LVMI and ARR in females (β-coefficient 0.098; 95% CI 0.001 to 0.196; p=0.050) after adjusting for confounders. This relationship was not mediated by brachial SBP. Conclusion An elevated aldosterone concentration or ARR was associated with higher LVMI in young adults, independent of brachial SBP. Long-term follow-up is required to determine if the relationship persists over time and leads to reduced cardiac function. One may speculate that an intervention trial in young adults with subclinical PA is warranted to determine the role of aldosterone blockade in preventing future cardiovascular diseases.

Differential echocardiographic profiles in immunoglobulin light chain and transthyretin amyloid cardiomyopathy: insights from speckle tracking analysis

Abstract Background Amyloid cardiomyopathy is mainly caused by two main subtypes of amyloidosis; immunoglobulin light chains cardiomyopathy (AL-CM) and transthyretin cardiomyopathy (TTR-CM). Purposes The aim of the present study was to elucidate the differences in echocardiographic findings between AL-CM and TTR-CM using speckle tracking echocardiography. Methods The study included patients with a confirmed diagnosis of cardiac amyloidosis through cardiac biopsy and who underwent transthoracic echocardiography between March 2013 and October 2022. The relative apical sparing index (RASI) was calculated using speckle tracking echocardiography: mean apical strain value/(mean basal strain value + mean mid strain value). Results The final study population consisted of 50 patients with a confirmed diagnosis of cardiac amyloidosis diagnosed pathologically (AL-CM: 21 patients, TTR-CM: 29 patients). Mean age was 72 ± 11 years, 70% being male. AL-CM exhibited a lower left ventricular mass index compared to TTR-CM (124.5 ± 48.9 vs. 152.2 ± 39.2 g/m2, P = 0.001). In 35 patients available with longitudinal strain analysis, no significant difference was observed in left ventricular global longitudinal strain between the two subgroups (-9.9 ± 4.8 vs. -9.3 ± 2.4% , P = 0.63). However, RASI was significantly lower in AL-CM compared to TTR-CM as shown in Figure (0.92 ± 0.29 vs. 1.46 ± 0.53, P = 0.001). Receiver operating characteristic curve analysis shows a RASI cut-off value of <1.0 proved useful in differentiating the diagnosis of AL-CM from TTR-CM (sensitivity: 81%, specificity: 70%, AUC:0.82), and RASI <1.0 remained a significant association with the diagnosis of AL-CM, even after adjusted by conventional echocardiographic variables. Conclusion Apical sparing phenomenon was more remarkable in TTR-CM compared with AL-CM, although global longitudinal strain was comparable between the two groups. RASI was useful for the discrimination of cardiac amyloidosis subtypes.

Sex differences in severe aortic stenosis undergoing surgical replacement

Abstract Background Aortic stenosis (AS) is the most common valvular heart disease in developed countries. Sex differences have been described in AS pathophysiology and left ventricular (LV) remodelling, as well as clinical presentation and response to therapies (1). However, sex differences in LV function parameters, namely global longitudinal strain (GLS), have been scarcely explored so far. Purpose To investigate sex differences, taking into account GLS, in patients with severe AS referred to surgical aortic valve replacement (SAVR). Methods The study population was from a single centre, prospective registry of patients with severe native valve AS who were referred for SAVR between June 2020 to October 2022. Severe AS was defined by standard guideline criteria (2). All patients underwent an echocardiogram immediately before and at least 3 months after surgery. Results Table 1 recapitulates sex differences in our population (n=119, 43% women). No differences in age or cardiovascular (CV) risk factors were noted. Clinical presentation and AS etiology were also similar. At baseline, women had lower EuroSCORE (p=0.039), creatinine (p <0.001), and haemoglobin levels (p=0.001). The echocardiogram showed a higher mean aortic valve gradient in women (Gmean, 62 vs. 50 mmHg, p=0.002). Women also had higher relative wall thickness (RWT, 0.49 vs. 0.42, p=0.037), despite lower LV mass index (124.9 vs. 136.6 g/m², p=0.037). Regarding LV function, women showed higher EF (64% vs. 60%, p=0.002) and GLS (16.5% vs. 14.6%, p=0.006) values. This is partially explained by the higher prevalence of concomitant coronary artery disease (CAD) in men, more frequently subjected to a concomitant coronary artery bypass graft than women (CABG, 38% vs. 8%, p <0.001). Post-operative complications had similar rates in men and women. After a median follow-up of 16 (6-18) months, death from any cause (6.0% vs. 1.5%, p=0.186) and rehospitalization for CV causes (14.0% vs. 4.0%, p=0.055) tended to be more frequent among women. When considering patients with severe AS alone (n=89), women had higher Gmean (64 vs. 53 mmHg, p=0.035) and EF (65% vs. 62%, p=0.045) but similar GLS (16.9% vs. 16.6%, p=0.230) as compared to men (Figure 2). At follow-up, EF and GLS failed to improve in both sexes and no differences were noted between women and men (EF 60% vs. 60%, p=0.476; GLS 15.9% vs. 16.0%, p=0.976). Conclusions In a population of all-comers patients with severe AS undergoing SAVR, women showed higher Gmean, EF, and GLS values. This is partially due to the higher prevalence of a concomitant CAD in men. When considering patients with AS alone, women still had higher EF and Gmean than men, despite a similar GLS. Future larger prospective studies with longer follow-up are needed in order to further characterize such differences and correlate them with specific outcomes.

O99 RELATIONSHIP BETWEEN RENIN, ALDOSTERONE, ALDOSTERONE-TO-RENIN RATIO AND LEFT VENTRICULAR MASS INDEX IN YOUNG ADULTS

Background and Objective: Primary aldosteronism (PA), characterised by excessive aldosterone production and mineralocorticoid receptor activation, is associated with adverse cardiovascular outcomes including left ventricular hypertrophy and failure. Elevated cardiovascular risk is observed even in milder and subclinical forms of PA, based on studies primarily conducted in middle-aged and elderly populations. It is unclear if the biomarkers of PA, including renin, aldosterone, and aldosterone-to-renin ratio (ARR), are associated with left ventricular mass index (LVMI), which is a strong predictor of cardiovascular diseases, in young adults. Methods: The Raine Study is a longitudinal, population-based cohort study in Western Australia that enrolled women during pregnancy. We analysed the data from the offspring of these women at age 27 years. Participants with elevated high-sensitivity C-reactive protein (>10 mg/L) and females who were on oral contraception were excluded. LVMI was measured by cardiac magnetic resonance imaging. We examined the relationship between LVMI and plasma renin, aldosterone, and ARR using multivariate-adjusted linear regression and used mediation analysis to test whether these relationships were dependent on systolic blood pressure (SBP). Results: Of 758 participants, 252 (33.2%) were females. Females had lower median plasma renin concentration (12.0 vs 15.4mU/L; p<0.001) and higher median ARR (21.0 vs 15.6; p<0.001) than males. There was no sex-difference in median plasma aldosterone concentration (257 vs 237pmol/L in males; p=0.143). Females had lower LVMI (52.2 vs 70.2 g/m2; p<0.001) than males. A significant association between LVMI and aldosterone was detected in males (β-coefficient 0.009; 95% CI 0.001 to 0.017; p=0.027), and between LVMI and ARR in females (β-coefficient 0.098; 95% CI 0.001 to 0.196; p=0.050) after adjusting for confounders. This relationship was not mediated by brachial SBP. Conclusions: An elevated aldosterone concentration or ARR was associated with higher LVMI in young adults, independent of brachial SBP. Long-term follow-up is required to determine if the relationship persists over time and leads to reduced cardiac function.

Abstract P536: The Association of Adipokines With Cardiac Structure and Function Among Older Adults Without Clinical Cardiovascular Disease

Background: Heart failure (HF) is a growing public health concern. While dysfunctional adipose tissue is a key driver of HF risk in the population, the role of altered adipokine production by adipose tissue in the development of cardiac dysfunction is unknown. Methods: We conducted a cross-sectional analysis of ARIC Visit 5 (2011-13) participants free of coronary heart disease and HF. Using linear regression, we assessed the adjusted associations between the adipokines adiponectin, leptin, apelin, and resistin (per 1-SD) and echocardiographic parameters indicative of cardiac structure and function. Results: We included 3244 participants (mean age 75±5 years, 61% female, 16% Black, 31% with obesity). After adjusting for sociodemographic/lifestyle factors and eGFR, 1-SD higher adiponectin was associated with lower (worse) LV ejection fraction (LVEF), but a more negative (better) longitudinal strain (LS). Higher adiponectin was also associated with higher lateral and medial e’ and lower E/e’, reflecting better diastolic function. Conversely, higher leptin was associated with worse systolic and diastolic function, indicated by a less negative LS, lower lateral and medial e’, and higher E/e’. Higher leptin/adiponectin ratio was associated with better LVEF (β: 1.73, 95% CI: 0.04, 3.41), but worse LS (β: 1.87, 95% CI: 1.17, 2.57), as well as uniformly worse diastolic function (lateral e’ [β: -2.39, 95% CI: -2.99, -1.79], medial e’ [β: -1.43, 95% CI: -1.86, -0.99], E/e’ [β: 2.61, 95% CI: 1.56, 3.67]). Adjustment for clinical variables and BMI attenuated some associations, but resulted in associations of adiponectin with greater LV mass index, and leptin with lower LV mass index. Apelin and resistin had weak associations with cardiac function. Conclusion: Adiponectin and leptin are differentially associated with systolic and diastolic function. Further investigation of the adipokines’ opposing roles in the development of cardiac dysfunction may help elucidate the effect of dysfunctional adipose tissue on myocardium.

Membranous Septum Length Predicts New Conduction Abnormalities in Surgical Aortic Valve Replacement: A Novel Predictor for Permanent Pacemaker Implantation After Surgical Aortic Valve Replacement

IntroductionThe membranous septum (MS) length measured by cardiac computed tomography (CT) is useful for the prediction of permanent pacemaker implantation (PPMI) and new left bundle branch block (LBBB) after transcatheter aortic valve replacement. However, its predictive value for patients undergoing surgical aortic valve replacement (SAVR) is unknown. MethodsA total of 2531 consecutive patients were registered in the institutional Society of Thoracic Surgeons database between July 2017 and June 2020. Patients who underwent non-SAVR procedures, had prior pacemaker/implantable cardioverter defibrillator, prior SAVR, no preprocedural CT assessment, or suboptimal CT imaging were excluded. ResultsA total of 126 SAVR with preprocedural CT assessment were analyzed. Bicuspid aortic valve morphology was confirmed on CT in 59.5% of patients. There were three new PPMIs and five new LBBBs observed after SAVR at the time of discharge. In-hospital mortality was 0.8%. Low left ventricular (LV) ejection fraction (<50%), LV mass index >120 g/m2, large right coronary artery height, and MS length <1.5 mm predicted new PPMI/LBBB. Multivariate analysis showed LV mass index >120 g/m2 (odds ratio: 9.165; 95% confidence interval: 1.644-51.080; P = 0.011) and MS length <1.5 mm (odds ratio: 14.449; 95% confidence interval: 1.632-127.954; P = 0.016) were independent predictors for new PPMI/LBBB. ConclusionsShort MS length on preoperative cardiac CT is a powerful and novel predictor for the risk of new PPMI/LBBB after SAVR. Special care should be taken in patients with short MS length to avoid suture-mediated trauma.

Cardiovascular Effects of Chronic Hormone Therapy: Study on Olympic Female Athletes

Female physiology is regulated after puberty by the menstrual cycle, whose hormonal fluctuations create a multitude of effects on several systems, including the cardiovascular one. The use of hormone therapy (HT) is quite common in female athletes and data on cardiovascular effects in this population are lacking. We sought to investigate the effects of HT in highly trained athletes to assess any difference associated with HT on cardiac remodelling, exercise capacity and clinical correlates. We studied 380 female elite athletes (mean age 25.5 ± 4.8) competing in endurance and mixed sports. 67 athletes (18%) were in chronic HT therapy. All athletes underwent baseline ECG, exercise ECG stress test, transthoracic echocardiogram, complete blood tests including lipid profile and inflammation indexes. The echocardiographic study showed a characteristic left ventricular (LV) remodelling, defined by lower LV mass index (86.2 vs. 92.5 g/m2, p<0.006), end-diastolic LV diameter (28.3 vs. 29.4 mm/m2, p<0.004) and end-diastolic LV volume (61.82 vs. 67.09 mL/m2, p<0.010) compared to controls, without changes in systolic function and diastolic relaxation/filling indexes. A lower burden of ventricular arrhythmias on exercise was observed in HT athletes (1.5% vs 8.6% in those without therapy, p=0.040). Linear regression analysis showed that HT had independent effect on LVEDDi (p=0.014), LVEDVi (p=0.030) and LVMi (p=0.020). In conclusion, chronic treatment with HT in female athletes is associated with less cardiac remodelling, including a lower LV cavity, volume and mass, with preserved systolic and diastolic function, and decreased burden of exercise-induced ventricular arrhythmias. HT, therefore, appears to be responsible for a more economic, but equally efficient, cardiac adaptation to intensive athletic conditioning.

Sex differences in aortic stenosis progression and myocardial response

Abstract Background Aortic stenosis (AS) produces an increased afterload and consequently left ventricular (LV) remodeling. While current guidelines recommend the same echo-doppler criteria for diagnosis and grading of AS for men and women, different sex-specific patterns of cardiac remodeling, and eventually damage, have been reported. Whether these different patterns are caused by sex-related AS progression rate or myocardial response is less well known. Aim We aim to compare longitudinal changes in aortic valve and cardiac function between women and men with AS to investigate sex-related differences in AS progression and cardiac remodeling. Methods Patients with mild-to-severe AS and LV ejection fraction (LVEF) ≥ 50 % at least in 2 transthoracic echocardiograms (TTE) were retrospectively identified. Prosthetic and bicuspid valves were excluded. Serial TTEs provided a multiparametric framework to compare AS severity, progression rate and induced cardiac changes between sexes. Results 914 patients were included (median follow-up time of 6.8 years) and 52 % (473) were female. Both sexes had similar baseline aortic peak velocities (APV) (2.9±0.9 m/s), mean pressure gradient (MPG) (27±13 mmHg) and LVEF (60±5 %). Women were older (75±9 vs 73±8 years; p&amp;lt;0.001), had smaller body surface area (BSA) (1.70±0.15 vs 1.88±0.16 m2, p&amp;lt;0.001), proportionally lower stroke volume (SV) (82±19 mL vs 91±22 mL, p&amp;lt;0.001), lower indexed LV mass (iLVM) (118±33 g/m2 vs 125±28 g/m2, p&amp;lt;0.001) and higher indexed left atrial (LA) volume (39±13 vs 49±20 mL/m2, p&amp;lt;0.001). The average annual progression rate of APV and MPG was similar for both groups (2 mmHg/year and 0.14 m s-1 year-1). After multivariate adjustment including time-dependent aortic valve replacement, women had a higher incidence of severe LV hypertrophy as measured by iLVM (HR=1.16, CI=1.08-1.91, p&amp;lt;0.01), moderate-to-severe tricuspid valve regurgitation (HR=2.03, CI=1.01-4.07, p&amp;lt;0.05) and pulmonary hypertension (PHT) (HR=1.49, CI=1.02-2.18, p=0.04) at 5 years. Similar incidence rates were seen for LV dilation, LVEF reduction and mitral valve regurgitation. All-cause mortality rates were similar between groups (p=0.30). Conclusion This study suggests that under similar static and dynamic loading conditions, women will develop severe LV hypertrophy and PHT earlier than men, possibly reflecting sex-specific response differences intrinsic to the myocardium. This suggests that the definition of AS severity may benefit from a shift from a valve-focused to a myocardial-integrative approach taking gender into account.

Sex-related differences in the association between septal wall thickness and survival

Abstract Background Septal hypertrophy is associated with increased morbidity and mortality but data regarding the effect of sex on the association between septal wall thickness and survival is limited and uniform cutoffs in men and women are often used in clinical practice and research. Objective To investigate the differences between men and women in the association between septal wall thickness and survival. Methods A retrospective analysis of consecutive unselected patients undergoing echocardiography between March 2010 and February 2021 in a large tertiary referral center. Echocardiography studies were performed according to standard protocol. Survival data was validated against the ministry of health records. Cox regression analysis was used to evaluate the association between septal thickness and mortality. Results A total of 71,965 individuals were included. There were 32,419 (46%) female and 38,546 (54%) male examinees. Females were older than males (65 + 18 vs. 62 + 18, p &amp;lt; 0.001), less likely to have diabetes (16% vs. 19%, p&amp;lt;0.001) or ischemic heart disease (11% vs. 25%, p&amp;lt;0.001) but more frequently had atrial fibrillation (11% vs. 10%, p&amp;lt;0.001). Females had lesser septal wall thickness than males (10.3 + 2 vs. 11.1 + 2, p &amp;lt; 0.001), lower left ventricular mass index (89 + 29 vs. 102 + 33, p&amp;lt;0.001), lower left ventricular end diastolic and end systolic diameter index. Men had lower ejection fraction than women (55% + 9 vs. 58% + 6, p &amp;lt; 0.001). Over a mean follow-up of 59.1 ± 37 months there were 9631 (25%) and 8429 (26%) deaths in the male and female groups, respectively. In multivariate cox regression analysis, septal thickness was an independent predictor for all-cause mortality in both sexes (Table). When using a uniform cutoff of 12mm for septal thickness for both sexes, the multivariate adjusted HR was 1.00 (CI 95%: 0.94-1.08, p=0.83) for males and 1.15 (CI 95%: 1.07-1.25, p&amp;lt;0.001) for females. The Kaplan–Meier mortality-free survival curve by septal thickness and sex is shown (figure). Septal thickness had an incremental prognostic significance in both sexes. On multivariate analysis it became statistically significant in females at 11mm with HR 1.51 (CI95%:1.06-1.24, p&amp;lt;0.001) and in males at 13mm with HR 1.21 (CI95%: 1.12-1.36, p&amp;lt;0.001). When using indexed septal thickness for BSA, the statistically significant cutoff was 6mm/BSA for women, HR 1.08 (CI 95%: 1-1.17, p=0.04) and 6.2mm/BSA for men, HR 1.07 (CI 95%: 1-1.15, p=0.05). Conclusions In an large unselected cohort of patients, septal hypertrophy had an incremental prognostic significance in both sexes and was associated with increased mortality at a lower threshold in women than in men. This may at least partially explain the delayed diagnosis and worse prognosis reported in females in many conditions characterized by septal hypertrophy. Applying a lower absolute value or using indexed measurements may facilitate early diagnosis and improve prognostication in females.

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 14928: Coronary Artery Disease Impacts Cardiac Remodeling in Patients Treated for Severe Aortic Stenosis in the PARTNER Trials

Introduction: Coronary artery disease (CAD) is common in patients with severe aortic stenosis (AS), but the impact on cardiac remodeling and outcomes after AS treatment is unknown. Hypothesis: We hypothesize that greater CAD burden will be associated with less beneficial remodeling and increased adverse events. Methods: Patients with severe AS in the PARTNER (Placement of Aortic Transcatheter Valves) 1, 2 or 3 trials, with baseline and 1 year echoes, were categorized as: 1. Obstructive CAD (coronary stenosis ≥50% on invasive angiography, prior myocardial infarction (MI) or previous revascularization); or 2. Non-obstructive or no CAD (all stenosis &lt;50% and no prior MI or revasc). Clinical and imaging characteristics were compared and changes in cardiac structure and function were assessed at 1 year. Associations between CAD, cardiac remodeling and cardiovascular (CV) events at 2 years were examined. Results: Among 5552 patients with severe AS, 1598 (28.8%) had non-obstructive or no CAD and were more likely to be female (67.1%), have fewer CAD risk factors, and receive SAVR (28% vs. 19%) compared to those with obstructive CAD (all p&lt;0.0001). Despite lower LV mass index (LVMi), patients with non-obstructive or no CAD had higher aortic valve velocities, gradients, ejection fraction (EF) and stroke volume index compared to those with obstructive CAD. After 1 year, the decrease in LVMi was similar between groups (p=0.91), but patients with obstructive CAD were more likely to increase EF by ≥5% (p=0.006), reduce LV dimensions (p=0.04), or decrease mitral regurgitation (p=0.01). After adjustment for baseline factors and AS treatment, CV death or heart failure (HF) hospitalization was higher among patients with obstructive CAD (HR 1.16, 95% CI: 1.03-1.30, p=0.01). When LV remodeling at 1 year was also adjusted for, the point estimate was similar but there was no significant difference in the landmarked rate of CV death or HF hospitalization between year 1 and 2 (HR 1.22, 95% CI: 0.95-1.56, p=0.12). Conclusions: Nearly a third of patients with severe AS did not have obstructive CAD and had a better prognosis after treatment for AS. However, patients with obstructive CAD and LV remodeling were not at greater risk for CV events compared to those with non-obstructive or no CAD.

Prevalence and Risk Factors of Mitral, Tricuspid, and Aortic Regurgitation: A Population-Based Study from Rural Northeast China

The population-based studies on the epidemiologic features of valvular regurgitation in Northeast China are scarce. We aim to estimate the prevalence and risk factors of mitral regurgitation (MR), tricuspid regurgitation (TR), and aortic regurgitation (AR) in a general population from rural Northeast China. Valvular regurgitation was assessed by color flow Doppler echocardiography in a population-based survey of 11,278 participants aged ≥35years in rural areas of Liaoning Province during 2012 to 2013. The prevalence of mild or greater MR and TR were 1.6% and 1.5%, respectively. Trace or greater AR was present in 4.1% of the participants. In the multivariable regression model, older age, left atrial dimension, low left ventricular (LV) ejection fraction, and fasting plasma glucose were associated with higher risk of MR in men, whereas only older age and left atrial dimension increased the risk in women. Body mass index was found to be a protective factor for MR in women (odds ratio 0.847, 95% confidence interval 0.741 to 0.969). TR was independently associated with age, heart rate, low LV ejection fraction, current drinking status, and high-density lipoprotein cholesterol. The risk for AR significantly increased with age in both genders. LV mass index and aortic dimension increased the risk of AR in males, and females with higher LV mass index and high-density lipoprotein cholesterol had an increased risk for AR. In both genders, systolic blood pressure presented as a risk factor for AR, while diastolic blood pressure as a protective factor. In this large Chinese population-based study, we found remarkably low prevalence of valvular regurgitation, adding evidence for estimating disease burden and making policy strategies in Northeast China.

Assessment of Prevalence, Clinical Characteristics, and Risk Factors Associated With “Low Flow State” Using Cardiac Magnetic Resonance

ObjectiveTo assess prevalence, clinical characteristics, and risk factors associated with low flow state (LFS) in a multiethnic population with normal left ventricular ejection fraction (LVEF). Patients and MethodsThe study included 4398 asymptomatic participants undergoing cardiac magnetic resonance from July 17, 2000, to August 29, 2002. Left ventricular (LV) mass, volume, and myocardial contraction fraction were assessed. Low flow state was defined as stroke volume index (SVi of <35 mL/m2). Clinical characteristics, cardiac risk factors, and cardiac magnetic resonance findings were compared between LFS and normal flow state (NFS) groups (NFS: SVi of ≥35 mL/m2). ResultsThere were significant differences in the prevalence of LFS in different ethnic groups. Individuals with LFS were older (66±9.6 vs 61±10 years; P<.0001). The prevalence of LFS was 19% in the group aged older than 70 years. The logistic multivariable regression analysis found that age was independently associated with LFS. The LFS group had significantly higher prevalence of diabetes (30% vs 24%; P=.001), LV mass-volume ratio (1.13±0.22 vs 0.91±0.15; P<.0001), inflammatory markers, a lower LV mass index (59±10 vs 65±11 kg/m2; P<.001), lower myocardial contraction fraction (58.1±10.6% vs 75.7±13%; P<.001), and a lower left atrial size index (32.2±4.6 vs 36.7±5.9 mm/m2; P<.0001) than NFS. ConclusionLow flow state may be considered an under-recognized clinical entity associated with increasing age, multiple risk factors, increased inflammatory markers, a lower LV mass index, and suboptimal myocardial performance despite the presence of normal LVEF and absence of valvular disease.

Long term reduction of cardiovascular risk factors associated with three hour daily dialysis: A prospective, cohort study.

Daily hemodialysis (DHD) compared to conventional hemodialysis (CHD) leads to improvements in left ventricular hypertrophy and mineral metabolism at 1-year follow-up. However, there is no information from prospective studies on the long terms effects of DHD on these key cardiovascular risk factors. We conducted a 4 year, prospective cohort study of 26 DHD and 51 matched CHD patients on the effect of DHD (six sessions/week × 3 h) versus CHD (three sessions/week × 4 h), 15 DHD, and 26 CHD patients completed 4-years follow-up. Measures of left ventricular mass index (LVMI), blood pressures, hemoglobin, and mineral metabolism markers were performed. Systolic and diastolic blood pressures were significantly lower in the DHD group than the CHD group at 4-year follow-up, 128 mmHg (95% CI, 111-143) versus 148 mmHg (95% CI, 137-158) (p < 0.05) and 60 mmHg (95% CI, 56-63) versus 71 mmHg (95% CI, 64-76) (p < 0.05). DHD was associated with fewer patients taking any anti-hypertensive drug therapy than CHD, 50% versus 80% (p < 0.05). DHD was associated with improved attainment of mineral metabolism goals for phosphorus (adjusted HR 3.6, p = 0.002) and calcium × phosphorus product (adjusted HR 3.66, p = 0.001) at 4-years follow-up compared to CHD. At 4 years, there was a nonsignificant trend toward lower LVMI in the DHD than in the CHD group: 116 g/m2 (95% CI, 97-136) versus 138 g/m2 (95% CI, 115-172) (p = 0.23). Similarly, improvements in hemoglobin also persisted at 4 years follow-up. DHD is associated with long-term (4 year) improvements in key cardiovascular risk factors: blood pressure, mineral metabolism, and anemia with trends toward improved LVMI.

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.

Blood pressure measurement modalities and indexed left ventricular mass in men with low-risk hypertension confirmed by ambulatory monitoring.

Blood pressure (BP) measurement modalities such as ambulatory monitoring (ABPM) and noninvasive central aortic systolic pressure (CASP), have been reported to improve prediction of hypertension-mediated organ damage (HMOD) compared with conventional clinic BP. However, clinic BP is often confounded by poor measurement technique and 'white-coat hypertension' (WCH). We compared prediction of cardiac MRI (cMRI)-derived left ventricular mass index (LVMI) by differing BP measurement modalities in young men with elevated BP, confirmed by ABPM. One hundred and forty-three treatment-naive men (<55 years) with hypertension confirmed by ABPM and no clinical evidence of HMOD or cardiovascular disease (37% with masked hypertension) were enrolled. Relationships between BP modalities and cMRI-LVMI were evaluated. Men with higher LVMI (upper quintile) had higher clinic, central and ambulatory SBP compared with men with lower LVMI. Regression coefficients for SBP with LVMI did not differ across BP modalities ( r = 0.32; 0.3; 0.31, for clinic SBP, CASP and 24-h ABPM, respectively, P < 0.01 all). Prediction for high LVMI using receiver-operated curve analyses was similar between measurement modalities. No relationship between DBP and LVMI was seen across measurement modalities. In younger men with hypertension confirmed by ABPM and low cardiovascular risk, clinic SBP and CASP, measured under research conditions, that is, with strict adherence to guideline recommendations, performs as well as ABPM in predicting LVMI. Prior reports of inferiority for clinic BP in predicting HMOD and potentially, clinical outcomes, may be due to poor measurement technique and/or failure to exclude WCH.

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

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

PS-C13-11: EFFECT OF HYPOKALEMIA ON LEFT VENTRICULAR STRUCTURE AND FUNCTION IN PATIENTS WITH ESSENTIAL HYPERTENSION

Object: Analyzing the changes of left ventricular structure and function in essential hypertension patients with hypokalemia, we want to provide an evidence for clinical diagnosis and treatment of early heart damage caused by hypertension and hypokalemia. Methods: 413 patients with hypertension who were hospitalized in the Hypertension Center of Lanzhou University Second Hospital from January 2015 to June 2021 were selected, including 270 cases of essential hypertension and 143 cases of essential hypertension with hypokalemia. Collect patient general information, biochemistry, urine routine, office blood pressure, 24 h ambulatory blood pressure, left atrial diameter, left ventricular end diastolic diameter, left ventricular end systolic diameter, ventricular septal thickness, left ventricular posterior wall thickness and other indicators. After propensity score matching, 108 cases in the essential hypertension group and the essential hypertension with hypokalemia group were each, and statistical analysis was performed. Results: Albumin, and urea-creatinine ratio levels of the essential hypertension with hypokalemia group were significantly reduced, and the ratios of sodium ions and sodium potassium were lower than those of the primary hypertension group. Correlation analysis shows that the left ventricular mass index was positively correlated with and the course of hypertension, systolic blood pressure, diastolic blood pressure, mean arterial pressure, creatinine, sodium-to-potassium ratio, mean systolic blood pressure during the day, mean diastolic blood pressure during the day, mean systolic blood pressure at night, mean night diastolic blood pressure. Multiple linear regression analysis showed that the left ventricular mass index was independently positively correlated with systolic blood pressure, hypertension course, creatinine, sodium-to-potassium ratio, night systolic blood pressure, 24 h average systolic blood pressure, and 24 h systolic blood pressure load rate; potassium ion, low density Lipoprotein, angiotensin II and left ventricular mass index are independently and negatively correlated. Conclusion: There are more obvious ventricular structural changes in essential hypertension patients with hypokalemia; serum potassium ion concentration and sodium-to-potassium ratio are independent risk factors for left ventricular mass index in essential hypertension patients with hypokalemia.

Passive Smoking Exposure Modifies Cardiovascular Structure and Function: Beijing Child Growth and Health Cohort (PROC) Study.

Passive smoking exposure in children is prevalent worldwide and exposes children to respiratory and systemic toxins. In this study, we enrolled 568 children to study how secondhand smoke (SHS) might affect children's cardiovascular health in China. The measurement of nicotine and its metabolites in urine showed that 78.9% of children were exposed to SHS. Children exposed to SHS had greater interventricular septum thickness (p = 0.005) and left ventricular mass index (p = 0.008) than nonexposed children. Urinary norcotinine levels were associated with increased ascending aorta diameter (β = 0.10, 95%CI 0.02-0.17) and decreased left ventricular end systolic diameter (β = -0.10, 95%CI -0.19 to -0.01). The effects of SHS exposure on cardiovascular function: norcotinine levels associated with lower left ventricular mass index (β = -0.32, 95%CI -0.59 to -0.05), left ventricular end diastolic volume index (β = -0.43, 95%CI -0.85 to -0.02), and left ventricular end systolic volume index (β = -0.20, 95%CI -0.37 to -0.03). Moreover, there no no significant associations of nicotine, cotinine, and trans-3'-hydroxycotinine with cardiovascular health. Overall, SHS exposure in children remains prevalent in Beijing and may affect children's cardiovascular development, in both structure and function. It suggests that stricter and practical measures are needed toward the elimination of tobacco use in children's environments.