Lower Left Ventricular Mass Research Articles

Low Left Ventricular Mass in Aortic Stenosis: A Distinct Mode of Adaptation to Pressure Overload Associated with Better Contractility?

Introduction About 10-30% of patients with severe aortic stenosis (AS) do not develop left ventricular hypertrophy (LVH). Intriguingly, the absence of LVH does not adversely affect outcome in AS, which challenges the classical notion of LVH as a beneficial compensatory response. Notably, only a few studies have attempted to characterize AS subjects with inadequately low LV mass (low-LVM) relative to afterload. We hypothesized that the low-LVM phenotype may be linked to myocardial function irrespective of AS severity. Aim: To assess relations between LV myocardial function and load in patients with low-LVM and moderate or severe AS. Methods We retrospectively analyzed hospital records of 227 patients with moderate or severe degenerative AS in sinus rhythm. Subjects with low-LVM were compared to those with appropriate or excessive LVM (ae-LVM), defined on the basis of the ratio of a measured LVM to the LVM predicted from an individual hemodynamic load. Circumferential end-systolic LV wall stress (cESS) and valvulo-arterial impedance (Zva), indices of LV afterload, were calculated from echocardiography and blood pressure. Assuming a constant LV wall volume during the cardiac cycle, we also computed LV midwall fractional shortening (mwFS), a better estimate of LV myocardial function than EF in concentric LV geometry. Results Patients with low-LVM and ae-LVM did not differ in aortic valve area, blood pressure, symptomatic status, prevalence of CAD or diabetes, end-diastolic LV diameter (a raw measure of LV preload), as well as Zva and cESS (estimates of LV afterload). Compared to ae-LVM, patients with low-LVM had higher mwFS (by 20−30%) in both moderate AS (p 0.5). Conclusions Subjects with low LVM maintain constant cESS during AS progression, probably due to higher LV contractility than in the majority of AS patients in whom the magnitude of LVH rises gradually over time. Thus, low LVM is associated with enhanced myocardial function, which may reflect a distinct mode of adaptation to chronic pressure overload, occurring already in less than severe AS. Whether better myocardial function contributes to favorable prognosis in AS without LVH, remains to be studied.

Clinical Differences between Methamphetamine and Non-Methamphetamine Associated Non-Ischemic Dilated Cardiomyopathy

Background Methamphetamine associated cardiomyopathy (MACM) is an increasingly recognized form of dilated cardiomyopathy around the globe which remains poorly characterized. Purpose To compare the clinical characteristics of MACM to those of non-MA associated dilated CM (NMACM). Methods Consecutive patients with MACM presenting to our institution between Jun 2018 and Jan 2019 were prospectively studied and compared to an age and gender matched cohort of dilated non-ischemic CM cases. Results Seventy patients were studied (35 MACM and 35 NMACM). Mean age was similar between groups (49±9 vs. 48±10 years, p=0.465) and 97% of patients were male. Median duration of MA use prior to cardiomyopathy diagnosis was 5 years (range 0-30). Patients were predominantly Hispanic in both groups (48% vs. 62%, p=0.229), but with a greater proportion of Caucasians in the MACM group compared to NMACM (26% vs 6%,p=0.045).MACM was characterized by lower left ventricular ejection fraction (LVEF) and greater left ventricular end diastolic volume (LVEDV) compared to NMACM. RV dilation was present more often in MACM cases (Table). Years of MA use was associated with greater LA volumes (R2= 0.13, p=0.048). Association with larger LVEDV and incidence of RV dilation were borderline significant (R2= 0.11, p=0.054 and p=0.058 respectively). The amount of MA used per week correlated with higher RVSP (R2=0.317, p=0.004). Polysubstance abuse was associated with greater LVEF (p=0.028), lower LVEDV (p=0.037) and lower LV mass (p=0.004). Conclusions MACM is associated with higher degree of LV and RV dilatation as well as LV systolic dysfunction when compared to matched NMACM cases. Years of MA use and amount MA consumed appear to influence severity of disease.

Deceleration of fetal growth rate as alternative predictor for childhood outcomes: a birth cohort study

BackgroundSmall for gestational age (SGA) is frequently used to define fetal growth restriction (FGR). However, FGR describes a slowdown in fetal growth and is not synonymous with SGA, which may introduce misclassification. We investigated the effect of both on delivery and childhood outcomes.MethodsFrom a prospective population-based cohort study we included 7959 live singleton births with data available on second trimester estimated fetal weight (EFW) and birth weight. We used a decrease in growth of > 40 percentiles between second trimester EFW and birthweight to define a deceleration in growth. SGA was defined as birthweight <p5.ResultsDeceleration of growth occurred in 27,2% in SGA neonates and in 10,3% of neonates with an appropriate for gestational age (AGA) birthweight. Of all fetuses with decelerated growth, 90% was born AGA. SGA neonates were more often delivered by instrumental delivery or cesarean section and admitted to NICU. Both decelerated growth and SGA were associated with accelerated growth at 2 years, a smaller aortic diameter and lower left ventricular mass at 6 years.ConclusionsBoth decelerated growth and SGA are associated with unfavorable clinical outcomes in childhood. In addition to SGA, neonates with deceleration of growth should be considered a high-risk group.

Placental Growth Factor as an Indicator of Maternal Cardiovascular Risk After Pregnancy.

Angiogenic placental growth factor (PlGF) concentrations rise during pregnancy, peaking at the end of midpregnancy. Low PlGF concentrations during pregnancy are associated with pregnancy complications with recognized later-life cardiovascular risk. We hypothesized that low PlGF concentrations, especially in midpregnancy, identify not only a subset of women at risk for pregnancy complications but also women with greater cardiovascular risk factor burden after pregnancy regardless of pregnancy outcome. In a population-based prospective cohort study of 5475 women, we computed gestational age-adjusted multiples of the medians of early pregnancy and midpregnancy PlGF concentrations. Information on pregnancy complications (preeclampsia, small for gestational age, and spontaneous preterm birth) was obtained from hospital registries. Six years after pregnancy, we measured maternal systolic and diastolic blood pressures, cardiac structure (aortic root diameter, left atrial diameter, left ventricular mass, and fractional shortening), carotid-femoral pulse wave velocity, and central retinal arteriolar and venular calibers. Blood pressure was also measured 9 years after pregnancy. Women were on average 29.8 (SD, 5.2) years of age in pregnancy, were mostly European (55.2%), and 14.8% developed a pregnancy complication. Quartile analysis showed that especially women with midpregnancy PlGF in the lowest quartile (the low-PlGF subset) had a larger aortic root diameter (0.40 mm [95% CI, 0.08-0.73]), left atrial diameter (0.34 mm [95% CI, -0.09 to 0.78]), left ventricular mass (4.6 g [95% CI, 1.1-8.1]), and systolic blood pressure (2.3 mm Hg [95% CI, 0.93-3.6]) 6 years after pregnancy than women with the highest PlGF. Linear regression analysis showed that higher midpregnancy PlGF concentrations were associated with a smaller aortic root diameter (-0.24 mm [95% CI, -0.39 to -0.10]), smaller left atrial diameter (-0.75 mm [95% CI, -0.95 to -0.56]), lower left ventricular mass (-3.9 g [95% CI, -5.5 to -2.3]), and lower systolic blood pressure (-1.1 mm Hg [95% CI, -1.7 to -0.46]). These differences persisted after the exclusion of women with complicated pregnancies. Women with low PlGF in midpregnancy have a greater aortic root diameter, left atrial diameter, and left ventricular mass and higher systolic blood pressure 6 and 9 years after pregnancy compared to women with higher PlGF, including women with uncomplicated pregnancies. The pathophysiological implications of lower PlGF concentrations in midpregnancy might provide insight into the identification of pathways contributing to greater cardiovascular risk factor burden.

Impact of Heart Rate and Left Ventricular Mass on Survival Following Heart Transplantation

Purpose Small studies suggest increased left ventricular (LV) mass and resting heart rate (HR)are associated with increased mortality following heart transplantation. We aimed to validate these prior findings and determine if resting HR is correlated with increased LV mass. Methods Retrospective chart review was conducted on 326 consecutive patients following heart transplantation at a single transplant center. Spearman correlation coefficient was used to evaluate correlation between HR and LV mass. Transplant free survival was estimated using the Kaplan-Meier method and survival was compared between groups using the log rank test. Results A total of 326 consecutive heart transplant patients between September 2005 and July 2018 were identified. The average age was 53.6 (± 14.3) years old, 238 patients (73%) were male, and the median follow-up time was 3.7 years. The average HR was 93 (12) beats per minute (BPM) at 1 month and 95 (12) BPM at 1 year. The average LV mass index was 87.1 g/m2 (21.8) at 1 month and 79.2 g/m2 (17.6) at 1 year. No correlation was present between HR and LV mass at 1 month (r=-0.25) or 1 year (r=-0.07). Stratification by resting HR at 1 year (HR ≥ 90 vs < 90) did reveal a trend toward reduced transplant-free survival in patients with an elevated HR (p=0.08) (Figure). Low LV mass index (<80g/m2) at 1-month post-transplant was associated with significantly reduced transplant-free survival (p=0.024) although this relationship was not present at 1 year. Conclusion Resting HR and LV mass following heart transplant were not correlated in our patient cohort. While a trend toward reduced survival in patients with a HR ≥ 90 bpm at 1 year was present, further research is needed to determine whether treatment targeting HR reduction would result in improved survival. Small studies suggest increased left ventricular (LV) mass and resting heart rate (HR)are associated with increased mortality following heart transplantation. We aimed to validate these prior findings and determine if resting HR is correlated with increased LV mass. Retrospective chart review was conducted on 326 consecutive patients following heart transplantation at a single transplant center. Spearman correlation coefficient was used to evaluate correlation between HR and LV mass. Transplant free survival was estimated using the Kaplan-Meier method and survival was compared between groups using the log rank test. A total of 326 consecutive heart transplant patients between September 2005 and July 2018 were identified. The average age was 53.6 (± 14.3) years old, 238 patients (73%) were male, and the median follow-up time was 3.7 years. The average HR was 93 (12) beats per minute (BPM) at 1 month and 95 (12) BPM at 1 year. The average LV mass index was 87.1 g/m2 (21.8) at 1 month and 79.2 g/m2 (17.6) at 1 year. No correlation was present between HR and LV mass at 1 month (r=-0.25) or 1 year (r=-0.07). Stratification by resting HR at 1 year (HR ≥ 90 vs < 90) did reveal a trend toward reduced transplant-free survival in patients with an elevated HR (p=0.08) (Figure). Low LV mass index (<80g/m2) at 1-month post-transplant was associated with significantly reduced transplant-free survival (p=0.024) although this relationship was not present at 1 year. Resting HR and LV mass following heart transplant were not correlated in our patient cohort. While a trend toward reduced survival in patients with a HR ≥ 90 bpm at 1 year was present, further research is needed to determine whether treatment targeting HR reduction would result in improved survival.

Association of Inadequately Low Left Ventricular Mass with Enhanced Myocardial Contractility in Severe Degenerative Aortic Stenosis.

Background: Left ventricular hypertrophy (LVH), traditionally considered an adaptive mechanism that is aimed at the maintenance of LV systolic function, is absent in 10%–35% of patients with severe aortic stenosis (AS). Our aim was to estimate the clinical and hemodynamic characteristics in patients with severe AS and absent LVH, or inadequately low LV mass (i-lowLVM) relative to an individual hemodynamic load. Methods: We retrospectively analyzed in-hospital records of 100 patients with pure severe degenerative AS, preserved LV systolic function and without relevant coexistent diseases, except for well-controlled hypertension or diabetes. Results: Clinical characteristics were similar in patients with and without LVH, as well as those with and without i-lowLVM, except for slightly lower GFR at i-lowLVM. When compared to their counterparts, subjects without LVH or with i-lowLVM had smaller LV cavities, decreased LV wall thicknesses and higher EF. There were no significant differences in stenosis severity and indices of afterload (valvulo-arterial impedance and circumferential end-systolic LV wall stress), according to the presence or absence of either LVH or i-lowLVM. However, LV fractional shortening at the midwall level was elevated only in patients with i-lowLVM, but not in those without LVH, compared to the remainder (15.8 ± 3.3 vs. 12.9 ± 3.2%, p < 0.001 for those with and without i-lowLVM, respectively; 13.7 ± 3.7 vs. 13.8 ± 3.6% for LVH presence and absence, p = 0.9). Conclusions: Inadequately low LVM relative to the individual hemodynamic load could potentially reflect a different mode of the LV response to severe AS, associated with enhanced load-independent LV systolic performance, i.e., better LV contractility. If confirmed in a large series of patients, our small preliminary study may add to the possible mechanisms of a previously reported counterintuitive tendency of a lower, not higher, risk of adverse outcome in patients with low LV mass despite severe AS. Prospective studies are warranted, in order to determine a potential utility of LVM inadequacy in the risk stratification of patients with AS.

Association Between Ambient Air Pollution and Cardiac Morpho-Functional Phenotypes: Insights From the UK Biobank Population Imaging Study.

Exposure to ambient air pollution is strongly associated with increased cardiovascular morbidity and mortality. Little is known about the influence of air pollutants on cardiac structure and function. We aim to investigate the relationship between chronic past exposure to traffic-related pollutants and the cardiac chamber volume, ejection fraction, and left ventricular remodeling patterns after accounting for potential confounders. Exposure to ambient air pollutants including particulate matter and nitrogen dioxide was estimated from the Land Use Regression models for the years between 2005 and 2010. Cardiac parameters were measured from cardiovascular magnetic resonance imaging studies of 3920 individuals free from pre-existing cardiovascular disease in the UK Biobank population study. The median (interquartile range) duration between the year of exposure estimate and the imaging visit was 5.2 (0.6) years. We fitted multivariable linear regression models to investigate the relationship between cardiac parameters and traffic-related pollutants after adjusting for various confounders. The studied cohort was 62±7 years old, and 46% were men. In fully adjusted models, particulate matter with an aerodynamic diameter <2.5 μm concentration was significantly associated with larger left ventricular end-diastolic volume and end-systolic volume (effect size = 0.82%, 95% CI, 0.09-1.55%, P=0.027; and effect size = 1.28%, 95% CI, 0.15-2.43%, P=0.027, respectively, per interquartile range increment in particulate matter with an aerodynamic diameter <2.5 μm) and right ventricular end-diastolic volume (effect size = 0.85%, 95% CI, 0.12-1.58%, P=0.023, per interquartile range increment in particulate matter with an aerodynamic diameter <2.5 μm). Likewise, higher nitrogen dioxide concentration was associated with larger biventricular volume. Distance from the major roads was the only metric associated with lower left ventricular mass (effect size = -0.74%, 95% CI, -1.3% to -0.18%, P=0.01, per interquartile range increment). Neither left and right atrial phenotypes nor left ventricular geometric remodeling patterns were influenced by the ambient pollutants. In a large asymptomatic population with no prevalent cardiovascular disease, higher past exposure to particulate matter with an aerodynamic diameter <2.5 μm and nitrogen dioxide was associated with cardiac ventricular dilatation, a marker of adverse remodeling that often precedes heart failure development.

Left atrial size and function in a South Asian population and their potential influence on the risk of atrial fibrillation.

South Asians have a low prevalence of atrial fibrillation (AF) compared with Caucasians despite having a higher prevalence of conventional risk factors for the arrhythmia. The reason for this disparity is uncertain but may be due to ethnic differences in atrial morphology. This study examines the association between ethnicity and left atrial (LA) size and function in South Asian and Caucasian subjects using the reference technique of cardiovascular magnetic resonance imaging (MRI). South Asians have smaller LA size and therefore increased LA function. Retrospective case-control study of 60 South Asian and 60 Caucasian patients who had undergone a clinically indicated MRI between April 2010 and October 2017 and had been found to have a structurally normal heart. LA and left ventricular (LV) volume and function were assessed and compared between the ethnicities. In comparison with Caucasians, South Asians had significantly lower minimum (27.7 ± 11.1 mL vs 34.9 ± 12.3 mL, P = 0.002) and maximum LA volumes (64.7 ± 21.1 mL vs 80.9 ± 22.5 mL, P < 0.001), lower LV end-diastolic volume (P < 0.001), lower LV stroke volume (P < 0.001), and lower LV mass (P = 0.022) and these values remained significant after correcting for body surface area. Further analysis revealed that LA volume was independently associated with South Asian ethnicity. There was no difference in LA function between the ethnic groups. South Asians have reduced LA volumes and a proportionally smaller heart size in comparison to Caucasians. Smaller LA size may protect against the development of AF by reducing the risk of reentrant circuit formation and atrial fibrosis development.

Cardiac Adaption to Exercise Training: the Female Athlete.

The number of female athletes participating in sports has increased exponentially over the past century. While cardiac adaptations to exercise have been well described, female athletes have been underrepresented in many prior studies. More recently, important research has embraced gender as an important biologic variable. We will review this work in order to examine how gender influences the impact of exercise on the heart. Exercise-induced cardiac remodeling (EICR) manifests slightly differently in male and female athletes. Specifically, female athletes have fewer signs of EICR on the electrocardiogram than male athletes, though are more likely to have anterior T wave inversions in the absence of cardiac disease. Cardiac enlargement due to exercise follows a different pattern in female versus male athletes, with females having similar chamber size when adjusted for body size but lower left ventricular mass. Recent research also suggests that female masters athletes may be less likely to have excess coronary disease, atrial fibrillation, and myocardial fibrosis, all of which have been posited though not proven to be sequelae of long-term endurance exercise in males. Gender appears to be an important modifier of the relationship between exercise and associated cardiac remodeling. The biological mechanisms underlying gender-based differences in EICR are poorly understood and will be an important area of future research.

Echocardiographic parameters and renal outcomes in patients with preserved renal function, and mild- moderate CKD

BackgroundEchocardiographic characteristics across the spectrum of chronic kidney disease (CKD) have not been well described. We assessed the echocardiographic characteristics of patients with preserved renal function and mild or moderate CKD referred for echocardiography and determined whether echocardiographic parameters of left ventricular (LV) and right ventricular (RV) structure and function were associated with changes in renal function and mortality.MethodsThis retrospective cohort study enrolled all adult patients who had at least one trans-thoracic echocardiography between 2004 and 2014 in our institution. The composite outcome of doubling of serum creatinine or initiation of maintenance dialysis or kidney transplantation was the primary outcome. Mortality was the secondary outcome.Results29,219 patients were included. Patients with worse renal function had higher prevalence of structural and functional LV and RV abnormalities. Higher estimated glomerular filtration rate (eGFR) was independently associated with preserved LV ejection fraction, preserved RV systolic function, and lower LV mass, left atrial diameter, pulmonary artery pressure, and right atrial pressure, as well as normal RV structure. 1041 composite renal events were observed. 8780 patients died during the follow-up. Pulmonary artery pressure and the RV, but not the LV, echocardiographic parameters were independently associated with the composite renal outcome. In contrast, RV systolic function, RV dilation or hypertrophy, LV ejection fraction group, LV diameter quartile, and pulmonary artery pressure quartile were independently associated with all-cause mortality.ConclusionsEchocardiographic abnormalities are frequent even in early CKD. Echocardiographic assessment particularly of the RV may provide useful information for the care of patients with CKD.

Cardiac and inflammatory biomarkers in perinatally HIV-infected and HIV-exposed uninfected children.

To compare distributions of serum cardiac and inflammatory biomarkers between perinatally HIV-infected (PHIV) and perinatally HIV-exposed uninfected (PHEU) children, to evaluate their associations with echocardiographic measures, and among PHIV youth, with antiretroviral therapy (ART) and HIV disease severity measures. Cross-sectional analysis of temporally paired serum samples for biomarkers and echocardiograms in a prospective multicenter cohort study of PHIV and PHEU youth. Serum samples were analyzed among 402 youth in the PHACS Adolescent Master Protocol (AMP) for high-sensitivity cardiac troponin-T (hs-cTnT, a cardiomyocyte injury marker), N-terminal-pro-brain natriuretic peptide (NT-proBNP, a myocardial stress marker), and inflammatory markers [high-sensitivity C-reactive protein, interleukin (IL)-1, IL-6, IL-8, IL-10, IL-18, tumor necrosis factor-α (TNF-α), and soluble TNF receptor II (sTNF-RII)]. Echocardiograms were centrally measured and parameters converted to z cores to account for differences in age and body size. Compared with PHEU (N = 156), PHIV youth (N = 246) more often had detectable hs-cTnT and higher levels of sTNF-RII and IL-18. Higher inflammatory biomarkers were generally associated with higher left ventricular (LV) wall stress and lower LV function and LV mass in the two groups. Among PHIV youth, the biomarkers were more strongly associated with current rather than historical immunologic and virologic status. PHEU and PHIV have modest, significant differences in serum levels of specific inflammatory and active myocardial injury biomarkers. Higher biomarker levels were associated with lower LV mass and shifts in LV structure. Further study is warranted on the longitudinal role of cardiac and inflammatory biomarkers for targeting interventions among PHIV and PHEU youth.

Higher plasma leptin levels are associated with reduced left ventricular mass and left ventricular diastolic stiffness in black women: insights from the Genetic Epidemiology Network of Arteriopathy (GENOA) study.

Our previous experimental animal data suggest a beneficial effect of leptin on LV structure and function. We hypothesized that leptin levels are associated with lower LV mass and myocardial stiffness which are important risk factors for the development of heart failure with preserved ejection fraction (HFpEF). We evaluated 1172 blacks, in which the prevalence of HFpEF is quite high, with preserved LV ejection fraction (EF > 50%) from the Genetic Epidemiology Network of Arteriopathy Study (mean age 62.9 years, 72% women), a community-based study to identify genes influencing blood pressure and target organ damage due to hypertension. Associations between leptin levels and indices of LV structure and function were evaluated using generalized estimating equations accounting for clustering in siblings. LV myocardial stiffness was evaluated using diastolic wall strain (DWS) measured by echocardiography. Analyses were stratified by sex because leptin levels were three times higher in women than men (p < 0.001). After adjustment for confounders, higher leptin levels were associated with lower LV mass (coefficient for 1 s.d. increase of leptin level: -5.825 g, 95% CI: -9.755 to -1.895 g, P = 0.004) and higher DWS (lower LV stiffness) (coefficient for 1 s.d. increase of leptin level: 0.009, 95% CI: 0.002-0.015, P = 0.007) in women. There were no statistically significant associations in men. In women, there were interactions between leptin levels and body mass index quartiles on LV mass and stiffness (p < 0.05 for both). Higher leptin levels were associated with lower LV mass and stiffness in obese but not lean black women.

Variation in lung function and alterations in cardiac structure and function-Analysis of the UK Biobank cardiovascular magnetic resonance imaging substudy.

BackgroundReduced lung function is common and associated with increased cardiovascular morbidity and mortality, even in asymptomatic individuals without diagnosed respiratory disease. Previous studies have identified relationships between lung function and cardiovascular structure in individuals with pulmonary disease, but the relationships in those free from diagnosed cardiorespiratory disease have not been fully explored.MethodsUK Biobank is a prospective cohort study of community participants in the United Kingdom. Individuals self-reported demographics and co-morbidities, and a subset underwent cardiovascular magnetic resonance (CMR) imaging and spirometry. CMR images were analysed to derive ventricular volumes and mass. The relationships between CMR-derived measures and spirometry and age were modelled with multivariable linear regression, taking account of the effects of possible confounders.ResultsData were available for 4,975 individuals, and after exclusion of those with pre-existing cardiorespiratory disease and unacceptable spirometry, 1,406 were included in the analyses. In fully-adjusted multivariable linear models lower FEV1 and FVC were associated with smaller left ventricular end-diastolic (−5.21ml per standard deviation (SD) change in FEV1, −5.69ml per SD change in FVC), end-systolic (−2.34ml, −2.56ml) and stroke volumes (−2.85ml, −3.11ml); right ventricular end-diastolic (−5.62ml, −5.84ml), end-systolic (−2.47ml, −2.46ml) and stroke volumes (−3.13ml, −3.36ml); and with lower left ventricular mass (−2.29g, −2.46g). Changes of comparable magnitude and direction were observed per decade increase in age.ConclusionsThis study shows that reduced FEV1 and FVC are associated with smaller ventricular volumes and reduced ventricular mass. The changes seen per standard deviation change in FEV1 and FVC are comparable to one decade of ageing.

Abstract P124: Neighborhood Density of Hispanic/Latinos and Left Ventricular Structure: ECHO-SOL and SOL-CASAS

Introduction: Heart failure represents a significant public health problem because of increasing prevalence and lack of effective medical treatment. Hispanic/Latinos have a high burden of cardio-metabolic comorbidities and adverse socioeconomic conditions that place them at risk for heart failure. However, some literature indicates that among Hispanics/Latinos, residing in areas with high Hispanic/Latino ethnic density is associated with better health outcomes. There is a paucity of data on the effect of Hispanic/Latino ethnic density and risk markers for heart failure. Therefore, we evaluated the association between Hispanic/Latino ethnic concentration and several echocardiographic measures of left ventricular structure and function. Methods: Data on baseline characteristics from the Hispanic Communities Health Study/Study of Latinos (HCHS/SOL), echocardiographic measures of cardiac structure and function (ECHO-SOL), and neighborhood Hispanic/Latino ethnic density (San Diego SOL-CASAS) were analyzed. Hispanic/Latino ethnic density was calculated for each person based on an 800-m buffer around their home. Hispanic/Latino ethnic density was then calculated using data from the 2010 Census as the percent of Hispanic/Latinos divided by the total population at the Census block level and calculating an average value for all Census blocks that overlapped with the participant's address. Multivariable linear regression analysis adjusting for personal demographics and cardiovascular risk factors was conducted. Results: A total of 350 participants with data from all three databases were included in the analysis. The mean age was 55±7 years, 69% were female, and 26%, 38%, and 43% had diabetes, hypertension, and dyslipidemia, respectively. Thirty-six percent had less than high school education, and 58% were low income. In models adjusting for age, sex, education level, income, acculturation, and cardiovascular risk factors, a 1-percent higher Hispanic/Latino ethnic density was associated with lower left ventricular mass (0.47, p-value = 0.02). Other echocardiographic measures of cardiac structure and function were not significantly related to Hispanic/Latino ethnic density. Conclusion: Higher Hispanic/Latino ethnic density was associated with lower LVM independent of personal SES and common cardiovascular risk factors. These findings suggest that Hispanic/Latinos residing in areas with higher Hispanic/Latino ethnic density might have a lower risk of future HF. However, further research to understand the specific factors that mediate the observed associations are necessary.

CARDIAC AND INFLAMMATORY BIOMARKERS IN PERINATALLY HIV-INFECTED AND HIV-EXPOSED UNINFECTED CHILDREN

OBJECTIVES To compare distributions of serum cardiac and inflammatory biomarkers between perinatally HIV-infected (PHIV) and perinatally HIV-exposed uninfected (PHEU) children, to evaluate their associations with echocardiographic measures, and among PHIV youth, with antiretroviral therapy (ART) and HIV disease severity measures. DESIGN Cross-sectional analysis of temporally paired serum samples for biomarkers and echocardiograms in a prospective multicenter cohort study of PHIV and PHEU youth. METHODS Serum samples were analyzed among 402 youth in the PHACS Adolescent Master Protocol (AMP) for high-sensitivity cardiac troponin-T (hs-cTnT, a cardiomyocyte injury marker), N-terminal-pro-brain natriuretic peptide (NT-proBNP, a myocardial stress marker), and inflammatory markers [high-sensitivity C-reactive protein, interleukin (IL)-1, IL-6, IL-8, IL-10, IL-18, tumor necrosis factor-α (TNF-α), and soluble TNF receptor II (sTNF-RII)]. Echocardiograms were centrally measured and parameters converted to z cores to account for differences in age and body size. RESULTS Compared with PHEU (N = 156), PHIV youth (N = 246) more often had detectable hs-cTnT and higher levels of sTNF-RII and IL-18. Higher inflammatory biomarkers were generally associated with higher left ventricular (LV) wall stress and lower LV function and LV mass in the two groups. Among PHIV youth, the biomarkers were more strongly associated with current rather than historical immunologic and virologic status. CONCLUSION PHEU and PHIV have modest, significant differences in serum levels of specific inflammatory and active myocardial injury biomarkers. Higher biomarker levels were associated with lower LV mass and shifts in LV structure. Further study is warranted on the longitudinal role of cardiac and inflammatory biomarkers for targeting interventions among PHIV and PHEU youth.

Cyanidin 3-O-glucoside prevents the development of maladaptive cardiac hypertrophy and diastolic heart dysfunction in 20-week-old spontaneously hypertensive rats.

The present study investigated the effects of cyanidin 3-O-glucoside (C3G) in cardiomyocytes (CM) and fibroblasts exposed to endothelin 1 (ET1), as well as in the spontaneously hypertensive rat (SHR) model, alone or in combination with hydrochlorothiazide (HCT). Adult rat CM and cardiac fibroblasts (CF) were pretreated with C3G and co-incubated with ET1 (10-7 M) for 24 hours. Five-week-old male SHR and their normotensive controls, Wistar-Kyoto rats (WKY), received one of 4 treatments via oral gavage daily for 15 weeks: (1) water (control); (2) C3G (10 mg per kg per day); (3) HCT (10 mg per kg per day); (4) C3G + HCT (10 mg per kg per day each). Blood pressure (BP) was measured at 1, 8 and 15 weeks. Echocardiography measurements were performed at 15 weeks. C3G prevented ET1-induced CM death and hypertrophy. Stimulating CF with ET1 did not induce their phenoconversion; nevertheless, C3G inhibited un-stimulated CF differentiation. HCT slowed the rise of systolic BP (SBP) in the SHR over time (week 1: SHRs control = 161 ± 6.3 mmHg, SHRs HCT = 129 ± 6.3 mmHg; week 15: SHRs control = 201 ± 7.3 mmHg, SHRs HCT = 168 ± 7.3 mmHg), but C3G had no effect on SBP (week 1: SHRs control = 161 ± 6.3 mmHg, SHRs C3G = 126 ± 6.3 mmHg; week 15: SHRs control = 201 ± 7.3 mmHg, SHRs C3G = 186 ± 7.3 mmHg). SHRs treated with C3G, HCT, and C3G + HCT had lower left ventricular mass and shorter isovolumetric relaxation time compared to control SHRs. C3G ameliorated cardiac hypertrophy and diastolic dysfunction in SHRs.

The relation between blood pressure components and left atrial volume in the context of left ventricular mass index

Left atrial enlargement (LAE) is a risk factor for cardiovascular complications and death. In hypertensive patients, LAE is usually due to left ventricular (LV) hypertrophy and diastolic dysfunction. We aimed to identify factors associated with LAE in patients with increased and normal left ventricular mass index (LVMI) with reference to pulsatile and steady components of blood pressure (BP).The study was carried out as a cross-sectional observation. In a group of inhabitants of suburban area of Cracow, Poland, we measured office, ambulatory and central BP, carotid-femoral pulse wave velocity (PWV), as well as echocardiographic indices and gathered anthropometric data, information on habits and relevant medical history. Further, with division according to sex-stratified dichotomised LVMI, we performed correlation analysis to identify possibly significant relations between measures of left atrial volume and other studied parameters. We also fitted regression models in order to assess the respective value of steady and pulsatile BP components as factors related to measures of left atrial volume.The mean age of 205 patients (136 females—66%) was 53.6 ± 8.3 years. We found higher values of PWV, office, ambulatory and central BPs in the group of LVMI above median value. This group had also greater left atrial volume index (LAVI), which correlated with LVMI (r = 0.36, P < .001) and ratio of early diastolic mitral peak flow velocity to early diastolic mitral annulus mean velocity in tissue Doppler imaging (E/e′) (r = 0.24, P = .04).In the group of LVMI below the median, LAVI correlated with pulsatile and steady BP components. LAVI was independently predicted by mean arterial pressure (MAP) obtained from both ambulatory (MAP24h, β= 0.15; P = .045) and office measurements (MAPoffice, β = 0.35; P = .004), but not by pulse pressure.LV mass and function are the main determinants of LAVI. However, in persons with lower LV mass, LAVI depends on the steady component of blood pressure, but not pulsatile one. Increased LAVI reflects early changes in response to systemic blood pressure elevation.

Childhood thyroid function, body composition and cardiovascular function.

The cardiovascular system is a known target for thyroid hormone. Early-life cardiovascular alterations may lead to a higher risk of cardiovascular disease in adulthood. Little is known about the effects of thyroid hormone on cardiovascular function during childhood, including the role of body composition in this association. Population-based prospective cohort of children (n = 4251, median age 6 years, 95% range: 5.7-8.0 years). Thyroid-stimulating hormone (TSH) and free thyroxine (FT4) concentrations were measured to assess thyroid function. Left ventricular (LV) mass was assessed with echocardiography. Arterial stiffness was assessed with carotid-femoral pulse wave velocity (CFPWV). Systolic and diastolic blood pressure (BP) was measured. Body composition was assessed by dual-energy X-ray absorptiometry scan. FT4 was inversely associated with LV mass (P = 0.002), and with lean body mass (P < 0.0001). The association of FT4 with LV mass was partially mediated through variability in lean body mass (55% mediated effect). TSH was inversely associated with LV mass (P = 0.010), predominantly in boys. TSH was positively associated with systolic and diastolic BP (both P < 0.001). FT4 was positively associated with CFPWV and diastolic BP (P < 0.0001, P = 0.008, respectively), and the latter association attenuated after adjustment for CFPWV. At the age of 6 years, higher FT4 is associated with lower LV mass (partially through effects on lean body mass) and with higher arterial stiffness, which may lead to higher BP. Our data also suggest different mechanisms via which TSH and FT4 are associated with cardiovascular function during early childhood.

Impact of stroke volume on cardiovascular risk during progression of aortic valve stenosis

ObjectiveIn severe aortic valve stenosis (AS), low left ventricular (LV) stroke volume has been associated with increased cardiovascular (CV) mortality, but this association has not been explored during progression of...

Early Infant Growth Velocity Patterns and Cardiovascular and Metabolic Outcomes in Childhood

ObjectiveTo evaluate the impact of infant growth on childhood health, we examined the associations of detailed longitudinal infant weight velocity patterns with childhood cardiovascular and metabolic outcomes.Study DesignIn a population-based prospective cohort study among 4,649 children, we used repeated growth measurements between 0 and 3 years to derive peak weight velocity (PWV), age at adiposity peak (AGEAP) and body mass index at adiposity peak (BMIAP). At the age of 6 years, we measured blood pressure, left ventricular mass, and cholesterol, triglycerides and insulin concentrations and define children with clustering of risk factors. We assessed the associations using two multivariable linear regression models.ResultsA 1-standard deviation score (SDS) higher infant PWV was associated with higher diastolic blood pressure (0.05 SDS (95% Confidence Interval (CI) 0.02, 0.09)), and lower left ventricular mass (-0.05 SDS (95% CI -0.09, -0.01), independently of body size. A 1-SDS higher BMIAP was associated with higher systolic (0.12 (95% CI 0.09, 0.16) and diastolic blood pressure (0.05 (95% CI 0.01, 0.08)), but these associations were explained by childhood BMI. We did not observe associations of PWV, BMIAP and AGEAP with cholesterol and insulin concentrations. Higher PWV and AGEAP were associated with higher risk of clustering of cardiovascular risk factors in childhood (p-values<0.05).ConclusionInfant weight velocity patterns are associated with cardiovascular outcomes. Further studies are needed to explore the associations with metabolic outcomes and long-term consequences.