Marker Of Left Ventricular Hypertrophy Research Articles

Cardiac remodeling in patients with heart failure with mildly reduced ejection fraction and metabolic disorders: association with biomarkers and autonomic nervous system parameters

Aim. The high prevalence of obesity in a cohort of patients with heart failure and mildly reduced ejection fraction (HFmrEF) determines the relevance of clarifying the role of biomarkers and autonomic imbalance in myocardial remodeling, taking into account metabolic risk factors.Material and methods. We examined 19 men with postinfarction cardiosclerosis and class II HFmrEF (median age 62 years), overweight/class I-II obesity, type 2 diabetes in 53/47%, 48% of cases, respectively, who received therapy. The biomarker panel included N-terminal pro-brain natriuretic peptide (NT-proBNP), galectin-3, pro-collagen I C-terminal propeptide (PICP), N-terminal propeptide of procollagen type III (PIIINP), C-terminal telopeptide of type I collagen, matrix metalloproteinase-9 (MMP-9), tissue inhibitor of matrix proteinase-1 (TIMP-1), leptin and adiponectin. Heart rate variability (HRV) and turbulence were obtained using 24-hour Holter monitoring. We assessed the time and frequency domains of HRV (24 h) and 5 min recordings of wakefulness at rest, calculated TO (turbulence onset) and TS (turbulence slope).Results. Significant positive associations of leptin and TIMP-1 levels with left ventricular hypertrophy markers were confirmed. Positive correlations of peak e' with following HRV indicators were revealed: SDNN (r=0,68; p=0,02) and RMSSD (r=0,69; p=0,003). Lower TS values were associated with higher index parameters of left ventricular mass (p<0,05 for all). Associations of biomarkers with autonomic nervous system (ANS) were observed: MMP-9 with RMSSD (r=0,54) and pNN50 (r=0,51); TIMP-1 with TO (r=0,46); PICP/PIIINP ratio with HFn (5 min) (r=-0,49); NT-proBNP/adiponectin ratio with SDNN (r=-0,49); leptin level with TS (r=-0,54) (p<0,05 for all).Conclusion. In patients with HFmrEF of ischemic origin and additional metabolic risks, serum biomarkers of fibrosis, adipokines, and ANS parameters are associated mainly with markers of increased left ventricular filling pressure. The study results predetermine the further search for potential risk-stratification markers of unfavorable myocardial remodeling and prognosis in large samples of patients with metabolic deviations and HF with EF >40% against the background of modern drug therapy.

Cardio-Ankle Vascular Index as a Marker of Left Ventricular Hypertrophy in Treated Hypertensives: Findings From the Pamela Study.

Findings regarding the association between Cardio-Ankle Vascular Index (CAVI) and cardiac hypertension-mediated organ damage (HMOD), such as left ventricular hypertrophy (LVH) assessed by echocardiography, in elderly hypertensive patients are scanty. We sought to investigate this issue in the hypertensive fraction of the general population treated with anti-hypertensive drugs enrolled in the Pressioni Monitorate E Loro Associazioni (PAMELA) study. The study included 239 out of 562 participants who attended the second and third surveys of the PAMELA study performed after 10 and 25 years from the initial evaluation. Data collection included medical history, anthropometric parameters, office, home, ambulatory blood pressure (BP), blood examinations, echocardiography, and CAVI measurements. In the whole study sample (age 69 ± 9 years, 54% males), CAVI was positively correlated with age, office, home, ambulatory systolic BP, LV mass (LVM) index, and negatively associated with body mass index (BMI). In multivariate analysis, CAVI was associated with the LVM index (P < 0.05) independently of major confounders. The participants with LVH exhibited significantly higher CAVI (10.6 ± 2.8 vs. 9.2 ± 1.8 m/s P < 0.001), larger left atrial diameter, and lower LV ejection fraction values than their counterparts without it. The CAVI value of 9.4 m/s was the best cut-off for prediction of LVH in the whole sample. Our study provides new evidence of an independent association between CAVI and LVH in treated elderly hypertensive patients and suggests that the use of this metric of arterial stiffness could not only be used to evaluate vascular damage but also to stratify the risk of LVH.

Indoxyl sulfate induces left ventricular hypertrophy via the AhR-FGF23-FGFR4 signaling pathway.

Patients with chronic kidney disease (CKD) have a high risk of left ventricular hypertrophy (LVH). Fibroblast growth factor 23 (FGF23) and indoxyl sulfate (IS) are associated with LVH in patients with CKD, but the interactions between these molecules remain unknown. We investigated whether IS contributes to LVH associated with FGF23 in cultured cardiomyocytes and CKD mice. In cultured rat cardiac myoblast H9c2 cells incubated with IS, mRNA levels of the LVH markers atrial natriuretic factor, brain natriuretic peptide, and β-myosin heavy chain were significantly upregulated. Levels of mRNA of the polypeptide N-acetylgalactosaminyltransferase 3 (GALNT3), which regulates FGF23 O-glycosylation, and FGF23 were also upregulated in H9c2 cells. Intact FGF23 protein expression and fibroblast growth factor receptor 4 (FGFR4) phosphorylation were increased in cell lysates by IS administration. In C57BL/6J mice with heminephrectomy, IS promoted LVH, whereas the inhibition of FGFR4 significantly reduced heart weight and left ventricular wall thickness in IS-treated groups. While there was no significant difference in serum FGF23 concentrations, cardiac FGF23 protein expression was markedly increased in IS-injected mice. GALNT3, hypoxia-inducible factor 1 alpha, and FGF23 protein expression was induced in H9c2 cells by IS treatment and suppressed by the inhibition of Aryl hydrocarbon receptor which is the receptor for IS. This study suggests that IS increases FGF23 protein expression via an increase in GALNT3 and hypoxia-inducible factor 1 alpha expression, and activates FGF23-FGFR4 signaling in cardiomyocytes, leading to LVH.

Association between adipokines and cardiac remodeling in obese patients in preclinical heart failure

Introduction. Association of left ventricular hypertrophy (LVH) in obesity and accompanying metabolic risks with adipokines levels at the different stage of heart failure (HF) is still debatable.The aim of study was to investigate the relationship of circulating adipokines levels with LVH in obese patients at preclinical stage of HF.Materials and methods. The study included 74 obese patients: 43% had no markers of LVH (stage A HF, group 1); 57% had LVH (stage B HF, group 2). Transthoracic echocardiography, laboratory assessment of N-terminal fragment of the brain natriuretic peptide, soluble suppression of tumorigenesis-2 (sST2), circulating leptin and adiponectin levels, homeostasis model assessment of insulin resistance (IR) (HOMA-IR) were done. Matched-pairs analysis was applied.Results. Negative correlations of LVH with leptin levels in group 1 (stage A HF) and with adiponectin levels in group 2 (stage B HF) were detected (all p &lt; 0.05). Positive correlations of the sST2 / adiponectin ratio and HOMA-IR with the parameters of LVH were detected in group 2 (all p &gt;&lt; 0.05). Conclusion. The direction of the associations between circulating adipokines and LVH varies with the preclinical stage of HF. The data obtained may reflect a relationship between heart remodeling in response to molecular mechanisms of inflammation and IR in obese patients at the certain stage of cardiovascular continuum. Keywords: leptin, adiponectin, insulin resistance, HOMA-IR, inflammation, sST2, left ventricular hypertrophy&gt;˂ 0.05). Positive correlations of the sST2 / adiponectin ratio and HOMA-IR with the parameters of LVH were detected in group 2 (all p ˂ 0.05).Conclusion. The direction of the associations between circulating adipokines and LVH varies with the preclinical stage of HF. The data obtained may reflect a relationship between heart remodeling in response to molecular mechanisms of inflammation and IR in obese patients at the certain stage of cardiovascular continuum.

Serum Osteoprotegerin Is an Independent Marker of Left Ventricular Hypertrophy, Systolic and Diastolic Dysfunction of the Left Ventricle and the Presence of Pericardial Fluid in Chronic Kidney Disease Patients.

Background: Osteoprotegerin (OPG) is a molecule which belongs to the tumor necrosis factor receptor superfamily. OPG concentration is elevated in patients with left ventricle hypertrophy, heart failure and acute myocardial infarction. OPG concentrations rise in chronic kidney disease (CKD). The aim of this study was to investigate the association between OPG concentrations and cardiovascular complications, such as left ventricle hypertrophy, systolic and diastolic dysfunction of left ventricle and dysfunction of right ventricle in chronic kidney disease patients not treated with dialysis. The relation between OPG and the amount of pericardial fluid was also examined. Methods: One hundred and one men with CKD stage 3–5 not treated with dialysis were included in the study. Overhydration, body fat mass and lean body mass were measured using bioimpedance spectroscopy (BIS). Echocardiography was performed to evaluate the amount of pericardial fluid and to measure the thickness of the interventricular septum (IVS), systolic and diastolic function of left ventricle, as well as systolic function of right ventricle. Results: We observed a significant positive association between OPG and the thickness of the interventricular septum, the size of the left atrium (LA) and the presence of pericardial fluid. A negative relationship was observed between OPG and ejection fraction (EF). Conclusions: Our results suggest that OPG can be an independent marker of left ventricular hypertrophy, systolic and diastolic dysfunction of left ventricle and the presence of pericardial fluid in chronic kidney disease patients.

Radiological Cardiothoracic Ratio as a Potential Marker of Left Ventricular Hypertrophy Assessed by Echocardiography.

The aim of the study was to verify the usefulness of the radiological cardiothoracic ratio as a potential marker of left ventricular hypertrophy assessed by echocardiography. The study included 96 patients (mean age: 49.52 ± 9.64 years). Chest radiograph in the PA projection and echocardiography were performed. In CR the measurement of the cardiothoracic ratio (CTR) was performed. Assuming CTR > 0.50, heart silhouette enlargement was diagnosed. In echocardiography, four types of left ventricular geometry were assessed: normal geometry (NG), concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH). It was shown that patients with an enlarged heart silhouette were characterized by a significantly more frequent occurrence of left ventricular hypertrophy (LVH) on echocardiography than patients with a nonenlarged heart silhouette. In the subgroup of patients with LVH compared to the subgroup of patients with normal left ventricular geometry, CTR values are statistically significantly higher, and heart silhouette enlargement is significantly more frequent. The criterion “CTR > 0.49” estimates LVH with a sensitivity of 93.3% and specificity of 82.7%, which translates into a high accuracy of 84.4%. By analyzing the prediction of left ventricular geometry types, high accuracy of CH prediction was obtained using the “CTR > 0.49” criterion of 80.2% (with a high sensitivity of 84.0% and a satisfactory specificity of 60.0%) and a high accuracy of EH prediction using the “CTR > 0.52” criterion of 71.9% (with high sensitivity 80.5% and low specificity 36.8%), as well as low CR prediction accuracy of only 57.3% (with low sensitivity 36.7%, even if high specificity 78.7%). In summary, the radiological cardiothoracic ratio may be a moderate marker of left ventricular hypertrophy assessed according to standard echocardiographic criteria, provided that its cut-off point is standardized in each population of subjects.

Transthyretin Amyloid Cardiomyopathy: Impact of Transthyretin Amyloid Deposition in Myocardium on Cardiac Morphology and Function.

Background: Transthyretin (TTR) amyloid cardiomyopathy (ATTR-CM) is increasingly being recognized as a cause of left ventricular (LV) hypertrophy (LVH) and progressive heart failure in elderly patients. However, little is known about the cardiac morphology of ATTR-CM and the association between the degree of TTR amyloid deposition and cardiac dysfunction in these patients. Methods: We studied 28 consecutive patients with ATTR-CM and analyzed the relationship between echocardiographic parameters and pathological features using endomyocardial biopsy samples. Results: The cardiac geometries of patients with ATTR-CM were mainly classified as concentric LVH (96.4%). The relative wall thickness, a marker of LVH, tended to be positively correlated with the degree of non-cardiomyocyte area. The extent of TTR deposition was positively correlated with enlargement of the non-cardiomyocyte area, and these were positively correlated with LV diastolic dysfunction. Additionally, the extent of the area containing TTR was positively correlated with the percentage of cardiomyocyte nuclei stained for 8-hydroxy-2′deoxyguanosine, a marker of reactive oxygen species (ROS). ROS accumulation in cardiomyocytes was positively correlated with LV systolic dysfunction. Conclusion: Patients with ATTR-CM mainly displayed concentric LVH geometry. TTR amyloid deposition was associated with cardiac dysfunction via increased non-cardiomyocyte area and ROS accumulation in cardiomyocytes.

Gender characteristics of retinal parameters in patients with uncomplicated hypertension

Aim. To establish gender specificities of retinal arteriolar and venular diameters, foveal avascular zone (FAZ) area, subfoveal choroid thickness (SCT), and to determine their association with cardiovascular risk and prognosis in patients with uncomplicated hypertension (HTN).Material and methods. The study included 70 patients (56 males and 14 females) aged 45-59 years with stage I or II HTN. There were following exclusion criteria: diabetes, liver failure, clinically relevant ophthalmic pathology. We assessed routine hemodynamic parameters, biochemical profile, serum N-terminal procollagen-III peptide, urinary albumin-creatinine ratio, 24-hour urinary albumin excretion, retinal parameters. All patients underwent electrocardiography and echocardiography. Ten-year risk of fatal cardiovascular disease (SCORE) was estimated. Based on scanning laser ophthalmoscopy, central retinal arterial (CRAE) and venous (CRVE) equivalents, arteriovenous ratio (AVR) were calculated. Using optical coherence tomography angiography, we determined FAZ area and SCT. Data processing was performed using StatSoft Statistica 10.Results. Hypertensive women were characterized by significantly larger FAZ area (p&lt;0,001), CRVE (p=0,005), CRAE (p=0,012) compared with men. SCT values (p&gt;0,05) were comparable. CRVE was associated with Cornell voltage product (r=0,3) in the male group. In women, age was negatively correlated with SCT (r=-0,54); SCORE value was inversely associated with SCT (r=-0,56), AVR (r=-0,53), CRAE (r=-0,3).Conclusion. In patients with uncomplicated HTN, the gender specificities of retina are manifested by a relative decrease of arteriolar diameters in males and a relative increase of venular diameters and FAZ in females. SCT decreases most clearly with age among hypertensive women. Men are characterized by a direct association of retinal venular diameters with a quantitative electrocardiographic marker of left ventricular hypertrophy. In women, there are an inverse association of SCT and arteriolar diameters with a ten-year risk of fatal cardiovascular disease.

The relationship between the indicators of the retina condition and other target organ changes in uncomplicated essential hypertension

Background. Changes in retinal microcirculation are considered a subtle indicator of the other target organ damage in hypertension and might have prognostic value. Objective. To establish the relationship between diameters of retinal arterioles and venules, foveal avascular zone (FAZ) area, subfoveal choroid thickness with parameters of left heart and kidneys in middle-aged patients with essential hypertension (EH) stage I-II. Design and methods . A total of 115 people (86 males, 29 females) aged 45-59 years were examined and divided into 2 groups. The main group consisted of 70 patients with EH stage I or II. The control group comprised 45 normotensive practically healthy individuals. Patients with diabetes mellitus, impaired liver function, clinically significant ophthalmic pathology were not included. The following data were analyzed: anamnesis including smoking status; routine blood hemodynamic and biochemical parameters, serum procollagen III N-terminal propeptide (PIIINP); albumin-creatinine ratio in a single morning portion of urine, diurnal albuminuria; parameters of 24-h ambulatory blood pressure monitoring; quantitative electrocardiography (ECG) markers of left ventricular hypertrophy; transthoracic echocardiography; fundus state. Based on the scanning laser ophthalmoscopy, the central retinal arterial (CRAE) and venous (CRVE) equivalents, arteriovenous ratio (AVR) were calculated. Using the method of optical coherence tomography angiography, we determined the FAZ area and subfoveal choroid thickness. Statistical data were processed using the StatSoft Statistica 10. Results. Compared with normotensive individuals, patients with hypertension were characterized by lower values of CRAE (p = 0,009), larger FAZ area (p = 0,019), and comparable values of CRVE, AVR, subfoveal choroid thickness (p > 0,05 for each indicator). Correlation analysis showed that in hypertensive AVR correlated with low-density lipoprotein cholesterol level (r = -0,3; p < 0,05); FAZ area with female gender (r = 0,42; p < 0,05); FAZ area with PIIINP level (r = 0,3; p < 0,05); FAZ area with diurnal albuminuria (r = 0,37; p < 0,05); CRVE with R wave amplitude in aVL lead of ECG (r = 0,31; p < 0,05); CRAE with left atrial volume index (r = -0,3; p < 0,05); subfoveal choroid thickness with age (r= -0,3; p = 0,01). Conclusions. Middle-aged patients with uncomplicated EH are characterized by the lower CRVE values and larger FAZ area compared to normotensive individuals. In EH stage I-II, retinal microcirculation parameters are associated with indicators reflecting the other target organ damage, in particular, the left atrial volume index, R wave amplitude in aVL lead of the standard ECG, diurnal albuminuria, and serum PIIINP concentration.

Evaluation of the Role of Fibroblast Growth Factors 23(FGF23) as a Marker for Left Ventricular Hypertrophy in Adults with Hypertension

Evaluation of the Role of Fibroblast Growth Factors 23(FGF23) as a Marker for Left Ventricular Hypertrophy in Adults with Hypertension

Cardiac Remodeling Biomarkers as Potential Circulating Markers of Left Ventricular Hypertrophy in Heart Failure with Preserved Ejection Fraction.

Soluble suppressor of tumorigenicity 2 (sST2), galectin-3, growth differentiation factor (GDF)-15 and syndecan-1 represent biomarkers of cardiac remodeling, involved in heart failure (HF) progression. We hypothesize that their plasma concentrations, together with brain natriuretic peptide (BNP), are different in HF stratified by ejection fraction (EF), demonstrating correlations with echocardiographic parameters that indicate left ventricular (LV) hypertrophy; LV mass index (LVMI) and posterior wall and septum diameters. HF patients (n = 77) were classified according to EF: reduced EF < 40% (HFrEF), mid-range EF = 40-49% (HFmrEF), preserved EF > 50% (HFpEF). We found that plasma concentrations of four cardiac remodeling biomarkers were highest in HFrEF and lowest in HFpEF, p < 0.001. In HFpEF, remodeling biomarkers independently correlated with LVMI: sST2 (p = 0. 002), galectin-3 (p < 0.001), GDF-15 (p = 0.011), and syndecan-1 (p = 0.006), whereas galectin-3 correlated after multivariable adjustments (p = 0.001). Independent correlates of septum and posterior wall diameters, in HFpEF, were sST2 (p = 0.019; p = 0.026), galectin-3 (p = 0.011; p = 0.009), GDF-15 (p = 0.007; p = 0.001), and syndecan-1 (p = 0.005; p = 0.002). In HFrEF, only sST2, adjusted, correlated with LVMI (p = 0.010), whereas BNP correlated with LVMI (p = 0.002) and EF (p = 0.001). GDF-15 correlated with diastolic dysfunction in HFpEF (p = 0.046) and HFrEF (p = 0.024). Cardiac remodeling biomarkers are potential circulating indicators of LV hypertrophy in HFpEF, which may ensure timely recognition of disease progression among high-risk patients.

P6376The role of circulating lymphocytes on hypertensive heart disease

Abstract Aims and background Hypertension is a disease accompanied by moderate inflammation. Physical activity and pharmacological intervention protect the organisms against hypertension-dependent end-organ damage. They should therefore interfere with the mobilization of lymphocytes. Different subsets of lymphocytes should specifically interfere with vascular and cardiac remodeling. In this study we correlated the amount of circulating lymphocytes with the expression of vascular and cardiac specific genes in the aorta and left ventricle to identify the tissue-specific effects of these cells. Methods 50 female spontaneously hypertensive rats (SHR) and 6 female normotensive Wistar rats (Wis) were analyzed. They were grouped in 7 subgroups exposed to different treatment regimes (modification of activity, type of activity, aldosterone blockade, and a combination thereof. Indicator genes of mal-adaptive vascular and cardiac remodeling were quantified by qRT-PCR. Results SHRs had an increased number of circulating NK cells and monocytes, but lower numbers of T cells. T cells inversely correlated with the vascular expression of p22phox, a member of the NADPH oxidase complex. Thus, lower number of T-cells favors the vascular expression of p22phox and thereby oxidative stress. In the left ventricle, T cells are inversely correlated with the expression of arginase-1 and UCP-2 but positively correlated with Glut-4 expression. The lower number of T cells in SHR therefore favors the expression of proteins often associated with oxidative stress and glucose metabolism. Monocytes are positively correlated with key markers of left ventricular hypertrophy (such as ANP, collagen-1, and β-MHC). Thus, the increased number of monocytes in SHRs supports cardiac hypertrophy. NK cells are inversely correlated with the expression of anti-inflammatory cytokines in the aorta (IL-10, IL-15). Thus, high number of circulating NK cells seems to favor a pro-inflammatory phenotype in the vasculature. Conclusion In a standard model of essential hypertension the profile of circulating lymphocytes differs from that in normotensive rats. The different subsets of lymphocytes specifically interfere with specific processes in the ventricle and vessel. Collectively, the difference between hypertensive and normotensive rats (less T cells, more NK cells and monocytes) supports a mal-adaptive role under hypertensive conditions.

Abstract 213: Prevalence and Regression of Left Ventricular Hypertrophy by Sokolow-lyon and Cornell Electrocardiogram Voltage Criteria After Transcatheter Aortic Valve Replacement

Background and Hypothesis: Left Ventricular Hypertrophy (LVH) due to critical aortic stenosis is expected in TAVR patients. ECG markers of LVH were associated with a significant increase in all-cause mortality in a large prospective study (ARIC) of the general, middle-aged population. However, the sensitivity of LVH by ECG voltage criteria in patients with severe aortic valve stenosis undergoing trans-catheter aortic valve replacement (TAVR) has not yet been studied. The regression of LVH by ECG voltage criteria after TAVR also has not been evaluated. Methods: A retrospective chart review was conducted in 388 consecutive TAVR patients (57.7% females, transfemoral approach in 59.3%, 77.9% with Sapien valve) without ventricular-paced rhythm. ECG data was collected and analyzed by Sokolow-Lyon and Cornell Voltage criteria. Results were compared to transthoracic echocardiogram. Analyses of variation, correlation, chi-square, and logistic regression were used. The study was approved by the institutional IRB. Results: Pre-TAVR LVH by echocardiographic criteria was present in all patients. Sokolow-Lyon and Cornell criteria for LVH were present and concordant in 15% of patients; and in 53% of patients, neither ECG criteria was suggestive for LVH. Concordance between these two citeria was poor, with 37% of patients had LVH only by Cornell and 25% only by Sokolow-Lyon criteria (p&lt;0.0001). One hundred forty one of 388 patients had follow up ECG’s at least 6 months (9.0+/-12.8 months) post-TAVR, with 13% no longer indicating LVH by Sokolow-Lyon criteria (p=0.005). Post-TAVR LVH by SL criteria was more likely in women (83 vs. 17%, p=0.015). Other co-morbidities and demographic variables were not predictive of LVH regression by ECG criteria. Conclusion: The presence of LVH by Sokolow-Lyon and Cornell ECG voltage criteria poorly correlates with the presence of LVH in critical aortic stenosis patients undergoing TAVR. Despite significant variability in pre-TAVR LVH manifestation by traditional ECG criteria, LVH regression by ECG criteria may be observed fairly soon after TAVR. Additional research is needed to clarify clinical implications and long-term outcomes associated with post-TAVR LVH regression.

The Predictors of Left Ventricular Hypertrophy in Kidney Transplant Recipients

Background: Cardiovascular disease (CVD) is one of the leading causes of mortality among kidney transplant (KTx) recipients. Left ventricular hypertrophy (LVH) is a known important risk factor for CVD in KTx recipients. The current study aimed at evaluating the association of LVH with hypertension, carotid intima media thickness (CIMT), and serum biomarkers. Methods: The current cross sectional study included KTx recipients; ambulatory blood pressure monitoring, echocardiography, and CIMT measurement were performed. In addition to standard laboratory investigations, high sensitivity C-reactive protein (CRP) and serum homocysteine were measured. Results: A total of 30 KTx recipients (20 male, 10 female, mean age: 44.53 ± 13.59 years) were enrolled. One-third had diabetes and 73.3% hypertension. Their mean systolic and diastolic blood pressure (BP) was 132.0 ± 14.4 and 77.8 ± 11.3 mmHg, respectively. BP was well controlled, albeit with more antihypertensive agents of 1.5 (interquartile range (IQR): 0 - 4). Their baseline serum creatinine and eGFR were 108.3 (IQR: 66-319) μM/L and 69.8 ± 20.8 mL/min/1.73 m2, respectively. Seven patients had LVH and predominantly had diabetes, a higher pulse pressure, and elevated serum homocysteine. Predictors of left ventricular mass index (LVMI) were the incidence of diabetes, higher pulse pressure, serum homocysteine, and the number of antihypertensive agents prescribed. On multivariate analysis, diabetes and pulse pressure were the main predictors of left ventricular mass index. Conclusions: LVH is common in patients with KTx, especially in the ones with diabetes. Serum homocysteine is a surrogate marker for LVH.

Diagnostic Utility of High Sensitivity Troponins for Echocardiographic Markers of Structural Heart Disease.

The conventional use of high-sensitivity troponins (hs-troponins) is for diagnosing myocardial infarction however they also have a role in chronic disease management. This pilot study assessed the relationship of hs-troponins with echocardiographic markers of left ventricular hypertrophy (LVH) and structural heart disease (SHD). Patients undergoing computer gomography (CT) coronary angiogram for low-intermediate risk chest pain and healthy volunteers were recruited. Hs-troponins Singulex I, Abbott I and Roche T and N-terminal pro-brain natriuretic peptide (NT-proBNP) were evaluated in relation to SHD parameters including left ventricular hypertrophy (LVHEcho) and left atrial enlargement (LAEEcho) on echocardiography. 78 subjects who underwent echocardiography were included in this study. C-statistics (95% confidence interval) of the four biomarkers for predicting LVHEcho were 0.84 (0.72–0.92), 0.84 (0.73–0.92), 0.75 (0.63–0.85) and 0.62 (0.49–0.74); for LAEEcho 0.74 (0.6–0.85), 0.78 (0.66–0.88), 0.55 (0.42–0.67) and 0.68 (0.62–0.85); and composite SHD 0.79 (0.66–0.88), 0.87 (0.75–0.94), 0.62 (0.49–0.73) and 0.74 (0.62–0.84) respectively. Optimal cut points for SHD were >1.2 ng/L, >1.6 ng/L, >8 ng/L and >18 pmol/L respectively. These results advocate the potential role of hs-troponins as screening tools for structural heart disease with theranostic implications.

Frontal QRS-T Angle as a Marker of Left Ventricular Hypertrophy in Patients with Essential Hypertension

Amac: Onceki calismalarda sol ventrikul hipertrofisi (SVH) bulunan hipertansif hastalarda, SVH bulunmayan hastalara gore miyokardiyal repolarizasyon belirteclerinin uzamis oldugu gosterilmistir. Ortalama QRS ve T dalgasi eksenleri arasindaki aci olarak tanimlanan frontal QRS-T acisi da miyokard repolarizasyonunun yeni bir gostergesidir. Calismamizin amaci, hipertansif hastalarda frontal QRS-T acisi ile SVH arasindaki iliskiyi incelemektir. Gerec ve Yontem: Calismamiza toplam 187 hipertansif hasta dâhil edildi. Frontal QRS-T acisi, EKG cihazinin otomatik raporlarindan elde edildi. Sol ventrikul kitle indeksinin (SVKI) erkeklerde > 115 g/m 2 , kadinlarda > 95 g/m 2 olmasi SVH olarak tanimlandi. Bulgular: SVH bulunan hastalarda, SVH bulunmayan hastalara gore QT dispersiyonu (p = 0,028), duzeltilmis QT dispersiyonu (p = 0,010) ve Tp-e araligi (p = 0,045) daha uzun, frontal QRS-T acisi (p < 0,001) ise daha genisti. Korelasyon analizinde, SVKI QT dispersiyonu (r= 0,150, p= 0,041), duzeltilmis QT dispersiyonu (r= 0,167, p= 0,022), Tp-e araligi (r= 0,160, p= 0,046) ve frontal QRS-T acisi (r= 0,360, p < 0,001) ile pozitif bir sekilde korele idi. Cok degiskenli analizle, frontal QRS-T acisi SVH'nin tek bagimsiz prediktoru olarak bulundu (OR: 1,04, 95% CI: 1,02-1,06, p < 0,001). ROC curve analizinde frontal QRS-T acisinin SVH'yi gostermedeki en iyi kesme degeri 28 o idi. Bu kesme deger, SVH'yi %70,5 sensitivite ve %54,5 spesifite ile ongordu. Sonuc: Frontal QRS-T acisi, basit, ucuz ve 12 derivasyonlu yuzey elektrokardiyografiden kolaylikla elde edilebilen bir parametredir. Bu aci, hipertansif hastalarda SVH'nin basit bir gostergesi olarak kullanilabilir.

Genetic background influences cardiac phenotype in murine chronic kidney disease.

Levels of fibroblast growth factor 23 (FGF23) increase early in chronic kidney disease (CKD) and are independently associated with left ventricular hypertrophy (LVH), heart failure and death. Experimental models of CKD with elevated FGF23 and LVH are needed. We hypothesized that slow rates of CKD progression in the Col4a3 knockout (Col4a3KO) mouse model of CKD would promote development of LVH by prolonging exposure to elevated FGF23. We studied congenic Col4a3KO and wild-type (WT) mice with either 75% 129X1/SvJ (129Sv) or 94% C57Bl6/J (B6) genomes. B6-Col4a3KO lived longer than 129Sv-Col4a3KO mice (21.4 ± 0.6 versus 11.4 ± 0.4 weeks; P < 0.05). 10-week-old 129Sv-Col4a3KO mice showed impaired renal function (blood urea nitrogen 191 ± 39 versus 34 ± 4 mg/dL), hyperphosphatemia (14.1 ± 1.4 versus 6.8 ± 0.3 mg/dL) and 33-fold higher serum FGF23 levels (P < 0.05 versus WT for each). Consistent with their slower CKD progression, 10 week-old B6-Col4a3KO mice showed milder impairment of renal function than 129Sv-Col4a3KO mice and modest FGF23 elevation without other alterations of mineral metabolism. At 20 weeks, further declines in renal function in B6-Col4a3KO mice was accompanied by hyperphosphatemia and 8-fold higher FGF23 levels (P < 0.05 versus WT for each). Only the 20-week-old B6-Col4a3KO mice developed LVH (LV mass 125 ± 3 versus 98 ± 6 mg; P < 0.05 versus WT) in association with significantly increased cardiac expression of FGF receptor 4 (FGFR4) messenger RNA and protein and markers of LVH (Atrial natriuretic peptide (ANP), B-type natriuretic peptide (BNP), beta-myosin heavy chain (β-MHC); P < 0.05 versus WT for each). In conclusion, B6-Col4a3KO mice manifest slower CKD progression and longer survival than 129Sv-Col4a3KO mice and can serve as a novel model of cardiorenal disease.

ECG markers associated with ischemic stroke at young age – a case-control study

Introduction: Certain electrocardiographic (ECG) abnormalities are associated with ischemic stroke (IS), especially cardioembolic subtype. Besides atrial fibrillation, markers of left ventricular hypertrophy (LVH) or atrial pathology also reflect elevated risk. We studied the association of ECG markers with IS in young adults.Methods: We performed a case-control study including 567 consecutive IS patients aged 15–49 years (inclusion period: 1994–2007) and one or two age- and sex-matched control subjects enrolled during 1978–1980 (n = 1033), and investigated also the stroke aetiologic subgroups. We studied ECGs of all participants for markers of atrial abnormality, i.e. P-terminal force (PTF) on lead V1, interatrial blocks (IAB; P-wave duration ≥110 ms), and LVH. Conditional logistic regression analyses were used.Results: IAB (hazard ratio [HR]: 1.57, 95% confidence interval [CI]: 1.16–2.13) and PTF combined with LVH (HR: 6.83, 95% CI: 1.65–28.31), were independently associated with IS. LVH, abnormal P-wave (HR: 6.87, 95% CI: 1.97–135.29), PTF, IAB, and combinations of these P-wave abnormalities with LVH – were associated with cardioembolic subtype. Abnormal P-wave and IAB were associated with cryptogenic stroke subtype. In unadjusted analysis, LVH was associated with small-vessel disease subtype.Conclusion: P-wave abnormalities on ECG were associated with cardioembolic but also with a cryptogenic subtype of IS.Key messagesECG patterns associated with atrial pathology are markers of increased risk of ischemic stroke in young adults.The ECG markers reflecting atrial pathology were seen in patients with cardioembolic and cryptogenic subtypes of ischemic stroke.

Microalbuminuria as an early marker of left ventricular hypertrophy in type 2 diabetes mellitus

Background: Microalbuminuria and left ventricular hypertrophy (LVH) have both been shown independently to be associated with increased cardiovascular (CVS) mortality in type 2 diabetes mellitus (DM) patients. This cross-sectional study was conducted to examine whether microalbuminuria is associated with LVH in non-hypertensive type 2 DM patients with early or no diabetic nephropathy.Methods: 100 patients of type 2 DM were studied. Patients with Hypertension (BP &gt;140/90 mm hg or on anti-hypertensive medication), history of coronary artery disease or valvular heart disease, estimated glomerular filtration rate (eGFR) &lt; 60 ml/min/1.73 m2, known thyroid disease or active urinary tract infection (UTI) were excluded from the study. All patients were subjected to spot urine test for microalbuminuria by urinary albumin creatinine ratio (UACR), 12 lead ECG to detect LVH, 2D echocardiography to calculate LV mass index (LVMI), anthropometry, urine routine examination, kidney function test, fasting lipid profile and HbA1c.Results: Of the 100 enrolled patients, 39 were found to have normoalbuminuria, 39 had microalbuminuria &amp; 22 patients had macroalbuminuria. The correlation between increased albuminuria and LVMI was found to be statistically significant (P value &lt; 0.001) and the LV mass significantly increased as albuminuria increased along the continuum of normoalbuminuria to macroalbuminuria. UACR showed a statistically significant correlation with age, eGFR, duration of diabetes (P value &lt; 0.01) and HbA1c (P value &lt; 0.05).Conclusions: Microalbuminuria is associated with LVH in non-hypertensive type 2 DM patients and thus may serve as an early marker of LVH and help identify patients at high CVS risk.

Echocardiographic assessment and N-terminal pro-brain natriuretic peptide in hypertensives with metabolic syndrome.

N-terminal pro-brain natriuretic peptide (NT-proBNP) release is associated with left ventricular expansion and pressure overload. Elevation of serum levels of natriuretic peptides is observed in patients with impaired as well as preserved left ventricular systolic function. High NT-proBNP has been shown to be related not only to preload but also to increased afterload, especially blood pressure and arterial stiffness. The aim of the study was to evaluate the association of NT-proBNP and echocardiographic parameters in hypertensives with metabolic syndrome. The study group comprised 133 patients (99 men; mean age 45.9 ± 9.4 years) with at least a 3-month history of arterial hypertension (stages 1 and 2) and fulfilling the diagnostic criteria for metabolic syndrome. Following initial clinical assessment, which included NT-proBNP levels, they underwent two-dimensional echocardiography. Echocardiographic abnormalities were observed in 60 subjects (45.1%), including left ventricular diastolic dysfunction (LVDdf) in 41 (30.8%) and left ventricular hypertrophy (LVH) in 35 (26.3%). Higher NT-proBNP concentrations were observed in patients with LVH, especially in the presence of LVDdf. Further analysis demonstrated that NT-proBNP correlated negatively with septal E' (r = -0.38; p = 0.015) and heart rate (r = -0.42; p = 0.006) in patients with LVDdf, and positively with left ventricular end diastolic diameter (r = 0.46; p = 0.006) and left ventricular mass index (r = 0.49; p = 0.005) in subjects with LVH. However, the analysis of ROC curves revealed no NT-proBNP level of good sensitivity and specificity in diagnosing LVDdf/LVH (maximal area under the curve 0.571). Even a relatively low NT-proBNP concentration can be a useful marker of left ventricular hypertrophy and end-diastolic wall stretch. However, in the present study there was no NT-proBNP level of satisfactory predictive value to diagnose LV abnormalities.