Median Left Ventricular Mass Index Research Articles

Left ventricular hypertrophy as a risk factor for accelerated brain aging: Results from the Study of Health in Pomerania.

Previous studies provided evidence for the importance of cardiac structure abnormalities, in particular greater left ventricular (LV) mass, for brain aging, but longitudinal studies are lacking to date. We included 926 individuals (median age 48 years; 53% women) from the TREND cohort of the Study of Health in Pomerania (SHIP) without reduced ejection fraction or a history of myocardial infarction. LV mass index (LVMI) was determined by echocardiography at baseline. Brain morphometric measurements were derived from magnetic resonance images at baseline and 7-year follow-up. Direct effects of baseline LVMI on brain morphometry at follow-up were estimated using linear regression models with adjustment for baseline brain morphometry. At baseline, median LVMI was 40 g/m2.7 and 241 individuals (26%) met the criterion of LV hypertrophy. After correction for multiple testing, baseline LVMI was directly associated with reduced global cortical thickness and increased cortical brain age at follow-up independent from hypertension and blood pressure. Exposure-outcome relations were nonlinear and significantly stronger in the upper half of the exposure distribution. Specifically, an increase in baseline LVMI from the 50% quantile to the 95% quantile was associated additional 2.7 years (95% confidence interval = [1.5 years, 3.8 years]) of cortical brain age at follow-up. Additional regional analyses yielded bilateral effects on multiple frontal cortical regions. Our findings highlight the role of cardiac structure in brain aging. LVMI constitutes an easily measurable marker that might help to identify persons at risk for cognitive impairment and dementia.

Aortic valve sclerosis, stenosis, and prognosis in the general population

Abstract Background The presence of aortic valve (AV) sclerosis and non-severe aortic stenosis has been a suggested marker of cardiovascular risk, but whether AV sclerosis and non-severe AV stenosis is independently associated with increased cardiovascular risk or a marker of coexistent risk factors remains to be clarified. Objective We examined clinical characteristics and prognosis associated with the presence of AV sclerosis and stenosis in the general population. Methods A total of 4,466 participants from a prospective cohort study of the general population were included. Patients with insufficient image quality (n=119) and known heart failure (n=130) were excluded, resulting in a population of 4,217 participants. Evaluation of AV sclerosis/stenosis was based on AV Doppler measurements, i.e., peak and mean AV velocity, and peak and mean AV gradient. The primary composite outcome was defined as major adverse cardiovascular events (MACE), including incident heart failure, myocardial infarction, or cardiovascular death. Multivariable Cox regression models were used to assess the association between AV sclerosis/stenosis by AV Doppler measurements and risk of the outcome. Results Mean age was 56.8 ± 17.5 years, and 56% were women. In total, 18.7% were smokers, 51% had hypertension (HTN), 5% had diabetes (DM), and 7% had ischemic heart disease (IHD). Mean left ventricular ejection fraction (LVEF) was 56.4 ± 6.4% with a median left ventricular mass index (LVMi) of 82.6 g/m2 (IQR 71.1; 96.8) and a mean AVA of 2.72 ± 0.72 cm2. Median AV peak velocity was 1.3 m/s (IQR 1.1; 1.4) and median AV peak gradient was 6.0 mmHg (IQR 5.0; 8.0). Median AV mean velocity was 0.9 m/s (IQR 0.8; 1.0) and median AV mean gradient was 3.0 mmHg (IQR 3.0; 4.0). During a median follow-up of 3.5 years (IQR 2.6; 4.3), 190 patients (4.5%) reached the composite outcome. The incidence rate per 1,000 person years in the fourth quartile of AV peak velocity (AV peak velocity >1.4 m/s) was more than double that of the first quartile (AV peak velocity ≤1.1 m/s) (26.6 [95% CI 21.1 – 33.6] versus 12.9 [95% CI 9.9 – 16.9], p<0.001). In univariable analysis, all AV measurements of sclerosis/stenosis were associated with the composite outcome (p<0.001 for all) (Figure 1). All AV measurements remained independent predictors of the outcome after adjustment for demographic, clinical and echocardiographic risk factors (age, gender, smoking, HTN, DM, IHD, eGFR, LVMi, LAVi, LVEF and E/e’); AV peak PG (HR 1.19 per 5 mmHg increase, 95% CI 1.06 – 1.33, p=0.002), AV peak velocity (HR 1.05 per 0.1 m/s increase [95% CI 1.01 – 1.20], p = 0.013), AV mean PG (HR 1.30 per 5 mmHg increase [95% CI 1.09 – 1.56], p=0.002), AV mean velocity (HR 1.08 per 0.1 m/s increase [95% CI 1.02 – 1.23], p=0.005). Conclusion A greater degree of AV sclerosis/stenosis was independently associated with a higher risk of MACE.Figure 1:Restricted cubic spline model

Abstract 18920: Left Atrial Function is Associated With Left Ventricular Mass in Women With Preserved Left Ventricular Ejection Fraction and Late Gadolinium Enhancement on Cardiac MRI

Introduction: Myocardial fibrosis detected by late gadolinium enhancement (LGE) on cardiac MRI may be related to conditions with increased left ventricular (LV) mass and diastolic dysfunction. Women have an increased incidence of LV diastolic dysfunction and poorer clinical outcomes compared to men. Aim: To examine gender-based associations between LV mass and left atrial total emptying fraction (LATEF), a surrogate for diastolic function, in patients with LGE on cardiac MRI. Methods: We analyzed 134 consecutive patients undergoing cardiac MRI and LGE sequences on a 1.5T GE scanner. LV mass and LV/LA volumes (indexed by BSA) were measured offline from cine SSFP images using Precession software. Presence of LGE was reported. Nonparametric analyses were performed. Results: 40 patients with more than mild mitral regurgitation, pericardial disease, or LVEF <50% were excluded. 94 patients studied (49% women) had a median age of 51 years [IQR 38-67] with no gender-based difference. Median LV mass index (LVMi) for all patients was 69.5 g/m2 [IQR 57-82] and was higher in LGE vs no-LGE patients (p<0.001) and higher in men vs women (p<0.05). Median LATEF for all patients was 0.50 [IQR 0.41-0.54] and was lower in LGE vs no-LGE patients (p<0.001) with no gender-based difference. LVMi had a strong inverse correlation with LATEF for all patients and for the LGE group (r=-0.58, p<0.001 and r=-0.51, p<0.001 respectively). LVMi had a very strong inverse correlation with LATEF (r=-0.74, p<<0.001) in women with LGE and moderate inverse correlation in women with no-LGE (r=-0.45, p=0.02). LVMi had a moderate inverse correlation with LATEF in men with LGE (r=-0.48, p. <0.01) and no correlation in men with no-LGE (Figure). Conclusions: LA function inversely correlates with indexed LV mass, most strongly in women with LV LGE. Further exploration of these parameters may allow earlier detection of LV diastolic dysfunction and improved risk stratification.

Improvement of hypertension control and left-ventricular function after cure of primary hyperparathyroidism.

Cardiovascular mortality is significantly higher in patients with primary hyperparathyroidism (PHPT) compared to the general population. The role of the renin-angiotensin-aldosterone system (RAAS) as a mediator of cardiovascular pathology in PHPT is unclear, as is the question whether successful parathyroidectomy (PTX) mitigates hypertension (HT), and left-ventricular (LV) dysfunction. In 45 consecutive, hypercalcemic PHPT patients (91% female, 20 normotensive, mean age 54.6 ± 14.6), laboratory examinations, and 24h ambulatory blood pressure monitoring (ABPM) were performed before, one and six months after successful PTX, while transthoracic echocardiography (TTE) pre- and six months post-PTX. Both in patients with normotension (NT) and HT, lower calcemia and parathyroid hormone (PTH) as well as higher phosphatemia were observed on follow-up, while B-type natriuretic peptide, aldosterone, plasma renin activity, and aldosterone-to-renin ratios were comparable. Six months post-PTX, only in patients with HT, median 24-hour SBP/DBP decreased by 12/6 mmHg, daytime SBP by 10, and nighttime DBP by 5 mmHg. Improvement in BP was observed in approximately 78% of patients with HT. Six months post-PTX, TTE revealed: 1) decrease in median LV mass index (by 2 g/m2) and end-diastolic dimension (by 3mm) among patients with HT; 2) normalization of global longitudinal strain in 22% of patients (comparable between those with NT and HT); 3) a mean 12.7% reduction in left-atrium volume index among patients with HT, which underlay normalization of indeterminate diastolic function in 3 out of 6 patients with HT, who exhibited it at baseline (dysfunction persisted in 2). PTX was shown to significantly reduce BP, LV hypertrophy and diastolic dysfunction parameters in PHPT patients with HT, and improve systolic function in all PHPT patients.

55. The Duration of Hypertension does not Affect Left Atrial Volume Index and Left Ventricular Mass Index in Hypertensive patients at Regional Referral Hospital

Background: Increased left atrial size and volume and left ventricular hypertrophy can be used as prognostic indicators of cardiovascular morbidity and mortality. Enlargement of left atrium and hypertrophied of LV are already known associated with several factors, but many of them studied in mild-hypertension case in primary/secondary health care. The objective of this study was to evaluate the effect of hypertension duration on Left Atrial Volume Index (LAVi) and Left Ventricular Mass Index (LVMi) in hypertensive patient at Regional Referral Hospital. Methods: Data from hypertension registry at Dr Hasan Sadikin General Hospital, Bandung, from March to December 2022 were collected. Patients with reduced left ventricular systolic function, moderate to severe valvular heart disease, professional athlete, pregnancy, congenital heart disease, pulmonary arterial hypertension were excluded. Patients’ hypertension duration, gender, age, echocardiographic measurement was collected. Linear regression analysis was conducted to evaluate effects of hypertension duration on LAVi and LVMi from echocardiographic evaluation. Results: A total of 94 patient's was studied with median age: 60.5 (22–75) years old and male: 50%. The median duration of hypertension was 5 (0.08–44) years. The median value of LAVi was 20.9 (10.1–56.4) ml/m2, The median LVMi was 124.65 (52.9–281.8) g/m2. There was no significant association between duration of hypertension and LAVi, R2 = .009, P = .482, F = .370, CI (19.389, 24.456). There was no significant association between duration of hypertension and LVMi: R2 = .006, P = .446, F .58, CI (120.06, 138.72) Conclusion: Hypertension duration doesn’t significantly affect Left Atrial Volume Index and Left Ventricular Mass Index in Hypertensive patients at Regional Referral Hospital.

Predictors of Peripheral Artery Disease Progression. Is there Any Role for Vascular Age?

Predictors of Peripheral Artery Disease Progression. Is there Any Role for Vascular Age?

MO572BONE BIOPSY AND MINERAL METABOLISM, CARDIOVASCULAR DISEASE AND PATIENT SURVIVAL IN END-STAGE RENAL PATIENTS

Abstract Background and Aims Chronic kidney disease-mineral and bone disorder (CKD-MBD) is frequent in end-stage renal disease (ESRD) patients, increasing morbid-mortality. The aim of this study was to determine the prevalence and phenotype of bone disease before transplantation; and to correlate FGF23, klotho and sclerostin serum levels with bone histomorphometric parameters and CV disease. The secondary aim was to correlate bone biopsies data with other bone related parameters, as PTH, bone alkaline phosphatase, 25-hidroxivitamin D3, calcitonin, calcium, phosphorus, and magnesium. Method We performed a prospective cohort study of a sample of ESRD patients listed for renal transplant. All patients were submitted to renal transplant and were followed for 12 months. Patient and graft survival were recorded. At inclusion, demographic and clinical data were collected, laboratorial evaluation; bone biopsy and X-ray of the pelvis and hands (Adragão score) were performed. Continuous variables are presented as medians and categorical variables as frequencies. Associations between variables were performed using Wilcoxon rank sum test, Fisher and Kruskal Wallis test. Multivariate analysis was performed using logistic regression. STATA software was used and p < 0.05 was considered statistically significant. Results We included 84 patients. Median age 53.5 (IQ range: 40.5 – 61.5) years, 59 men (70.2%), 65 caucasian (77.4%). The median left ventricular mass index was 108.5 (92 – 129) g/m2, with 32 patients presenting left ventricular hypertrophy and 19 valve calcifications. Median Adragão score was 1 (0 – 2). We diagnosed adynamic bone disease in 15 patients; hyperparathyroid bone disease in 19 patients; osteomalacia in 1 patient and mixed renal osteodystrophy in 3 patients. At the end of 12 months, 4 patients died, 5 had graft failure (non-primary function) and 4 had a cardiovascular event. Sclerostin was found to be a risk factor for low bone volume; whereas low phosphorus, low FGF23 and high bAP risk factors for abnormal mineralization. High turnover was mainly present in patients with high bAP and phosphorus and low sclerostin levels. The presence of valve calcifications was associated with low volume and with low or high turnover disorder. FGF23 appears as an important independent factor for vascular calcifications [as well age (p=0.009), BMI (p=0.02), presence of diabetes (p=0.01)], and for cardiovascular events. Sclerostin emerged as a risk factor for vascular calcifications and lower levels of sclerostin were associated with patient survival at the end of 12 months. Conclusion From the bone-derived hormones, sclerostin and FGF23 seem to act as risk factors for vascular calcifications and worse outcomes.

Correlation between MMP-9 Level and Diastolic Dysfunction in Concentric Left Ventricular Hypertrophy Patients

Objective: To establish the relationship between plasma matrix metalloproteinase (MMP)-9 levels and diastolic functional abnormalities using the E/e’ measurement in concentric type Hypertensive Heart Disease (HHD) patients. Methods: A cross-sectional study was conducted from November 2014 to January 2015 in population with hypertension and concentric Left Ventricular Hypertrophy (LVH). Diastolic function was assessed with E/e’ measurement using echocardiography. The relationship between the two variables was analyzed using Spearman correlation. Results: Thirty-nine subjects (14 males, 35.9%) with the average relative wall thickness of 0.7(±0.15), average body weight of 63.45 (±12.97) kg, average height of 155.51 (±7.12) cm, average body mass index of 26.23 (±5.08) kg/m2, and mean age of 55 (±10) years were fit to be included in the analysis. The median systolic blood pressure was 140 (110-220) mmHg while the median diastolic blood pressure and median left ventricular mass index were 80 (70-110) mmHg and 119.24 (103.05-205.69) g/m2, respectively. The median MMP-9 was measured at 108 (4-460) ng/mL and the median E/e' was 10.99 (6.2-20.42). There was a significant positive correlation between MMP-9 and E/e' (r = 0.416, p = 0.004). Conclusion: There is a significant moderate positive correlation between the MMP-9 level and diastolic dysfunction in concentric LVH patients.

P1418BONE-DERIVED HORMONES, MINERAL METABOLISM, CARDIOVASCULAR DISEASE AND PATIENT OUTCOME IN END-STAGE RENAL PATIENTS

Abstract Background and Aims Chronic kidney disease-mineral and bone disorder (CKD-MBD) is frequent in end-stage renal disease ESRD (ESRD) patients, increasing morbid-mortality. The aim of this study was to analyse the associations between the new CKD-MBD players [alpha-klotho, fibroblast grow factor (FGF) 23, sclerostin] and the usual markers of the disease [parathyroid hormone (PTH), bone alkaline phosphatase (bAP), vitamin D (vitD), phosphorus (Pi), Calcium (Ca) and Magnesium (Mg)], as well echocardiographic findings [left ventricular mass index (LVMI) measured by Devereux formula, valvular calcifications], vascular calcifications and patients outcomes. Method We performed a prospective cohort study of a sample of ESRD patients listed for renal transplant. All patients were submitted to renal transplant and were followed for 12 months. Patient and graft survival were recorded. At inclusion, demographic and clinical data were collected, laboratorial evaluation, bone biopsy and X-ray of the pelvis and hands (Adragão score) were performed. Continuous variables are presented as medians and categorical variables as frequencies. Associations between variables were performed using Wilcoxon rank sum test and Spearman correlation test. STATA software was used and p < 0.05 was considered statistically significant. Results We included 85 patients. Mean age 50.1±12.7 years, 59 men (69.4%), 66 caucasian (77.6%). The median LVMI was 108.5 (92 – 129) g/m2, with 32 patients presenting LVH and 19 valvular calcifications. Median Adragão score was 1 (0 – 2). At the end of 12 months, 4 patients died and 5 had graft failure (non-primary function). Alpha-klotho correlated with bAP (p=0.0006) and marginally with PTH and absence of valvular calcifications (p=0.05). FGF23 correlated with Pi (p<0.001), Ca (p=0.004), PTH (p=0.003), Mg (p=0.002), and inversely with bAP (p=0.003). There was a marginal association with Adragão score (p=0.06). We didn’t found correlations between FGF23 and alpha-klotho or dialysis vintage or echocardiographic characteristics. Sclerostin correlated negatively with bAP (p=0.007) and PTH (p=0.04). The 3rd sclerostin tertile was associated with high scores of vascular calcifications (p=0.02). Lower levels of sclerostin were associated with patient survival at the end of 12 months (p=0.02). Conclusion From these 3 new bone-derived hormones, sclerostin, a bone formation inhibitor, seems to act as a risk factor for vascular calcifications and worse outcomes.

Adiposity, Sex, and Cardiovascular Disease Risk in Children With CKD: A Longitudinal Study of Youth Enrolled in the Chronic Kidney Disease in Children (CKiD) Study

Traditional and nontraditional cardiovascular disease risk factors are highly prevalent in children with chronic kidney disease (CKD). We examined the longitudinal association of adiposity with cardiac damage among children with CKD and explored whether this association was modified by sex. Prospective cohort study. Children with mild-to-moderate CKD enrolled in the Chronic Kidney Disease in Children (CKiD) Study at 49 pediatric nephrology centers across North America. Age- and sex-specific body mass index (BMI) z score. Age- and sex-specific left ventricular mass index (LVMI) z score and left ventricular hypertrophy (LVH). Longitudinal analyses using mixed-effects models to estimate sex-specific associations of BMI z scores with LVMI z score and with LVH, accounting for repeated measurements over time. Among 725 children with 2,829 person-years of follow-up, median age was 11.0 years and median estimated glomerular filtration rate was 52.6mL/min/1.73m2. Nearly one-third of both boys and girls were overweight or obese, median LVMI z score was 0.18 (IQR:-0.67, 1.08), and 11% had LVH. Greater BMI z scores were independently associated with greater LVMI z scores and greater odds of LVH. For each 1-unit higher BMI z score, LVMI z score was 0.24 (95% CI, 0.17-0.31) higher in boys and 0.38 (95% CI, 0.29-0.47) higher in girls (Pinteraction= 0.01). For each 1-unit higher BMI z score, the odds of LVH was 1.5-fold (95% CI, 1.1-2.1) higher in boys and 3.1-fold (95% CI, 1.8-4.4) higher in girls (Pinteraction= 0.005). Not all children had repeated measurements. LVH is a surrogate and not a hard cardiac outcome. The observational design limits causal inference. In children, adiposity is independently associated with the markers of cardiac damage, LVMI z score and LVH. This association is stronger among girls than boys. Pediatric overweight and obesity may therefore have a substantial impact on cardiovascular risk among children with CKD.

ADHERENCE TO ANTIHYPERTENSIVE MEDICATION AND LEFT VENTRICULAR HYPERTROPHY IN RESISTANT ARTERIAL HYPERTENSION

Objective: According to current registry data, 37% of hypertensive patients reach target blood pressure level. The failure to achieve target blood pressure level cause cardiovascular complications and mortality. Poorly treated arterial hypertension is long-term asymptomatic condition leading to hypertension-mediated organ damage (HMOD), that can be detected by imaging methods and laboratory tests. The aim of our study was to find out the difference in left ventricular (LV) mass values in nonadherent and adherent hypertensive patients. Design and method: We determined adherence to therapy by measuring serum levels of antihypertensive drugs in 329 subjects with resistant arterial hypertension. The full adherence was defined by presence of antihypertensive agents in serum. Non-adherent patients had at least one antihypertensive agent absent. All subjects had transthoracical echocardiographic examination. LV mass (LVM) was calculated by the cubic method and indexed to body surface area to obtain LV mass index (LVMI). The relation of adherence to LVM and LVMI was analysed with Mann-Whitney test and Spearman correlation test. Supported by IGA_LF_2018_045. Results: 240 subjects (73%) were assessed as adherent, the remaining 89 (27%) as non-adherent. Median LVM in adherent patients was 228 g, in non-adherent 245 g (P = 0.105). Median LVMI in adherent patients was significantly lower (106 g/m2) compared to non-adherent patients (120 g/m2) (P = 0.019). LVMI showed weak but statistically significant negative correlation with adherence, correlation coefficient r = −0.123 (P = 0.025). The correlation of LVM with adherence had r = −0.079 (P = 0.134). Conclusions: Non-adherent patients with resistant arterial hypertension have higher prevalence of left ventricular hypertrophy in comparison to adherent patients. Early detection of nonadherence can define a group of patients at high risk for developing hypertension modified organ damage (HMOD).

Abstract P232: Hemodynamic Phenotype and Target Organ Damage in Adolescents With Spurious Hypertension

Objective: Spurious hypertension (sHTN) is characterized by elevated systolic blood pressure (BP) in peripheral arteries measured by office BP and ambulatory BP monitoring (ABPM), but normal central BP. The prevalence of sHTN and its clinical significance remains unknown. The aim of the study was to assess hemodynamics and target organ damage (TOD) in adolescents with sHTN in comparison with other forms of hypertension (HTN). Patients and Methods: We analyzed 265 children (54 girls; 15.1 ±2.5 years) referred with arterial HTN, in whom secondary HTN was excluded. We assessed BP levels - office BP, ABPM, central systolic BP (cSBP), hemodynamics - cardiac output (CO), stroke volume (SV) and target organ damage (TOD) - left ventricular mass index (LVMi), carotid intima-media thickness (cIMT), pulse wave velocity (PWV). Anova with TukeyHSD post hoc test was used for analysis. Results: 115 subjects had white coat hypertension (WCH; office BP>95 th perc+ABPM<95 th perc), 25 had ambulatory prehypertension (preHTN; office BP<95 th perc+ABPM<95 th perc+ABPM load >25%), 43 had sHTN (office BP+ABPM >95th perc+cSBP<95 th perc), 82 had true hypertension (tHTN; office BP+ABPM+cSBP >95th perc. There were no significant differences between groups in age, weight and BMI. Only pts with tHTN presented features typical of hyperkinetic circulation and pts with preHTN presented intermediate hemodynamic phenotype between WCH and sHTN and those with tHTN (p<0.001). Median LVMi ratio to upper limit of normal (g/m 2.7 /95 th percentile by Khoury et. 2009) was similar in both WCH and sHTN (0.82 and 0.80, respectively), and significantly lower than in tHTN (0.89, p=0.04). The proportion of patients with LVH (LVMi>=95 th perc) was 12% in WCH, 4% in preHTN, 9% in sHTN, 22% in tHTN (p=0.05). cIMT Z-scores were also significantly lower in both WCH (0.92) and sHTN (0.90) groups compared to tHTN (1.22, p=0.01). Similar results were obtained for PWV Z-scores (WCH=1.8, sHTN=1.29, tHTN=2.28, p=0.01). Patients with preHT were not significantly different from tHTN patients in all parameters. Conclusions: Adolescents with sHTN have similar hemodynamic phenotype and TOD as patients with WCH. However, because of lack of data on the evolution of sHTN, close monitoring and follow-up is warranted.

Cardiac outcome in classic infantile Pompe disease after 13 years of treatment with recombinant human acid alpha-glucosidase

BackgroundCardiac failure is the main cause of death in untreated classic infantile Pompe disease, an inheritable metabolic myopathy characterized by progressive hypertrophic cardiomyopathy. Since the introduction of enzyme replacement therapy (ERT), survival has increased significantly due to reduced cardiac hypertrophy and improved cardiac function. However, little is known about ERT's long-term effects on the heart. MethodsFourteen patients were included in this prospective study. Cardiac dimensions, function, conduction and rhythm disturbances were evaluated at baseline and at regular intervals thereafter. ResultsTreatment duration ranged from 1.1 to 13.9 years (median 4.8 years). At baseline, all patients had increased left ventricular mass index (LVMI) (median LVMI 226 g/m2, range 98 to 599 g/m2, Z-score median 7, range 2.4–12.4). During the first four weeks, LVMI continued to increase in six patients. Normalization of LVMI was observed in 13 patients (median 30 weeks; range 3 to 660 weeks). After clinical deterioration, LVMI increased again slightly in one patient. At baseline, PR interval was shortened in all patients; it normalized in only three. A delta-wave pattern on ECG was seen in six patients and resulted in documented periods of supraventricular tachycardias (SVTs) in three patients, two of whom required medication and/or ablation. One patient had severe bradycardia (35 beats/min). ConclusionThis study shows that ERT significantly reduced LVMI, and sustained this effect over a period of 13.9 years. The risk for rhythm disturbances remains. Regular cardiac evaluations should be continued, also after initially good response to ERT.

Left ventricular mass, geometric patterns, and diastolic myocardial performance in children with chronic kidney disease

Background: Excessive left ventricular mass (LVM) and diastolic dysfunction are associated with higher morbidity and mortality among patients with chronic kidney disease (CKD). Objective: The objective of the following study is to determine the prevalence of increased LVM index (LVMI), pattern of abnormal LV geometry, and diastolic dysfunction in Nigerian CKD children and to establish a relationship of these with estimated glomerular filtration rate (eGFR). Subjects and Methods: Cross-sectional comparative study of LV structure and diastolic function of 21 children with CKD age- and sex-matched and controls asymptomatic for cardiac disease. Results: The median LVMI was 62.19 (34.7) g/m2 in CKD patients compared with 52.89 (30.2) g/m2 in controls (P = 0.04). Excessive LVMI was present in 3 (14.3%) individuals compared with none (0%) of the controls P < 0.001. The prediction equation for LVMI using eGFR is: LVMI = 123.11+ (−0.48) × eGFR ml/m2/min. Abnormal LV geometry was present in 19.05% of the CKD patients and none of the controls (P = 0.04). CKD stages differed significantly with respect to the presence of abnormality with LV geometry (P = 0.04). LV diastolic dysfunction was present in 4 (19.1%) individuals (2 each had impaired relaxation and restrictive patterns) compared with 1 (4.8%) control (restrictive pattern)-P < 0.001. Children with CKD who had abnormal LV geometry had 48 times increase in the odds of having LV diastolic dysfunction when compared with those having normal LV geometry (confidence interval = 2.31–997.18, P = 0.012). Conclusion: Excessive LVM, LV hypertrophy and diastolic dysfunction are significantly more common in children with CKD compared with controls.

OS 27-06 INDEPENDENT PROGNOSTIC VALUE OF LEFT VENTRICULAR MASS, DIASTOLIC FUNCTION, AND FASTING PLASMA GLUCOSE

Objective: To explore the independent prognostic value of left ventricular (LV) mass, diastolic function, and fasting plasma glucose (FPG) for the prediction of incident cardiac events in a random population sample. Design and Method: 415 women and 999 men aged 56–79 years, included between 2002-2006, underwent echocardiography based on groups defined by FPG, i.e. normal (NFG): FPG ≤ 6.0 mmol/L; impaired (IFG): FPG 6.1–6.9 mmol/L; and diabetes mellitus (DM): FPG ≥ 7.0 mmol/L, self-reported DM, and/or on anti-diabetic drugs. Additive prognostic value of FPG category and echocardiography (LV mass index (LVMI), LV hypertrophy (LVH), averaged E/e, and diastolic function graded as normal, grade 1, or grade 2 + 3 diastolic dysfunction) to a prediction model with traditional cardiovascular (CV) risk factors was assessed using Cox proportional hazards regression. Cardiac events were defined as myocardial infarction, coronary revascularization, or heart failure. Results: 37 % were classified as NFG, 26 % as IFG, and 37 % as DM. Median LVMI and E/e were 86 [74–102] g/m2 and 8 [6–10], respectively. Over a median follow-up time of 7.8 [7.2–8.7] years, 181 events occurred. The simple prediction model included age, gender, systolic blood pressure, heart rate, previous CV disease, and use of CV medication. Addition of averaged E/e (likelihood-ratio c2 11.69, p Conclusions: LVMI and E/e, but not FPG category provided additional adverse prognostic value on top of traditional CV risk factors. The combination of both glucometabolic and echocardiographic abnormalities was associated with a progressively greater risk of cardiac events.

Elevated Plasma Cardiac Troponin T Levels Caused by Skeletal Muscle Damage in Pompe Disease.

Elevated plasma cardiac troponin T (cTnT) levels in patients with neuromuscular disorders may erroneously lead to the diagnosis of acute myocardial infarction or myocardial injury. In 122 patients with Pompe disease, the relationship between cTnT, cardiac troponin I, creatine kinase (CK), CK-myocardial band levels, and skeletal muscle damage was assessed. ECG and echocardiography were used to evaluate possible cardiac disease. Patients were divided into classic infantile, childhood-onset, and adult-onset patients. cTnT levels were elevated in 82% of patients (median 27 ng/L, normal values <14 ng/L). Cardiac troponin I levels were normal in all patients, whereas CK-myocardial band levels were increased in 59% of patients. cTnT levels correlated with CK levels in all 3 subgroups (P<0.001). None of the abnormal ECGs recorded in 21 patients were indicative of acute myocardial infarction, and there were no differences in cTnT levels between patients with and without (n=90) abnormalities on ECG (median 28 ng/L in both groups). The median left ventricular mass index measured with echocardiography was normal in all the 3 subgroups. cTnT mRNA expression in skeletal muscle was not detectable in controls but was strongly induced in patients with Pompe disease. cTnT protein was identified by mass spectrometry in patient-derived skeletal muscle tissue. Elevated plasma cTnT levels in patients with Pompe disease are associated with skeletal muscle damage, rather than acute myocardial injury. Increased cTnT levels in Pompe disease and likely other neuromuscular disorders should be interpreted with caution to avoid unnecessary cardiac interventions.

Hypertension in children after renal transplantation.

Hypertension (HT) is a common and serious complication following renal transplantation in children, and an important risk factor for cardiovascular morbidity and mortality. This study evaluated the clinical characteristics of HT in children after renal transplantation. Twenty-four children who were followed up at least 6 months after renal transplantation were enrolled in the study. From the clinical records, demographic and laboratory data, casual blood pressure (BP) measurement, ambulatory BP monitoring (ABPM), medication, and left ventricular mass index (LVMI) at echocardiogram were documented. Mean age at time of transplantation was 12.6 ± 3.0 years and mean follow-up period was 19.6 ± 15.8 months. HT was detected in 21 children (87.5%) after renal transplantation. Twelve patients (50%) had HT both before and after transplantation and nine (38%) had HT only after transplantation. HT developed in 67% within the first week and in 95% within the first month. All hypertensive children had night-time HT and no child had isolated daytime HT. The efficacy of HT control was 42%. Median LVMI in patients with HT after renal transplantation was 42.3 g/m(2.7). Severe HT, an important complication, was frequently seen in the early period after renal transplantation. Predominance of nocturnal HT and the lack of isolated daytime HT after transplantation underline the importance of ABPM. ABPM should be performed regularly in the first year after transplantation, not only for diagnosis but also for evaluation of HT control.

Abstract 20128: Effect of Renin-angiotensin Blockers on Left Ventricular Remodelling in Severe Aortic Stenosis

Background: The use of renin-angiotensin blockers (RAB: angiotensin converting enzyme inhibitors, ACEI and angiotensin receptor blockers, ARB) in severe aortic valve stenosis (AS) remains controversial. We aim to explore the relation on their use with degree of left ventricular (LV) remodelling in patients with normal flow (NF) and low-flow (LF) severe AS despite preserved LV ejection fraction (LVEF). Methods: We studied 423 consecutive patients with aortic valve area (AVA) 50%. Subjects with concomitant valvular pathologies, congenital heart disease or prosthetic valves were excluded. NF was categorized as LV stroke volume index (SVi) &gt; 35ml/m2. Increased left ventricular mass index (LVMI) was ≥96g/m2 and 116g/m2 in females and males respectively while abnormal relative wall thickness (RWT) was ≥0.45. Results: The median age was 74 yrs (IQR: 65-82). Prevalence of male subjects 52%, diabetes mellitus 61%, dyslipidemia 48% and hypertension 43%. A quarter of the patients were on RAB, with a mean duration of 6.7 months(IQR:1.0-72.3). Median LVMI for patients on RAB was 94.5 g/m2 (IQR: 87.3-144), whilst those without was 120.3 g/m2 (IQR: 102-159) (p=0.005). RAB use in patients with LF AS was significantly associated with normal LVMI, adjusted for hypertension (OR 2.00, p=0.002). The use of RAB had a duration dependent association with normal LVMI. Patients on RAB for a year were twice more likely to have normal LVMI (OR 2.24, p=0.048). This effect is greater in patients with 2 years of therapy (OR 3.417, p=0.002). In contrast, the use of RAB was not associated with normal LVMI in the NF group (p=0.428). There was no significant difference between use of either ACEI or ARB on LVMI (p=0.855). Patients on RAB had less risk of having concentric hypertrophy (OR= 0.373, p=0.009) and eccentric hypertrophy (0.392, p=0.025) as compared to those without. Conclusion: Use of RAB in LF severe AS may be associated with beneficial remodeling of the LV especially if prescribed for more than a year. Further studies are warranted to determine the deferential effects of RAB on clinical outcomes in LF versus NF AS.

Interdialytic weight gain in oligoanuric children and adolescents on chronic hemodialysis.

Little is known about the clinical impact of interdialytic weight gain (IDWG) on oligoanuric children undergoing chronic hemodialysis (HD). We retrospectively assessed IDWG, left ventricular mass index (LVMI) and its changes (ΔLVMI), pre-HD systolic and diastolic blood pressure (DBP), residual urine output, Kt/V, the frequency of intradialytic symptoms, normalized protein catabolic rate, and the 3-month change in the dry weight of 16 hemodialyzed oligoanuric patients with a median age of 14.8 years (range 5.0-17.9). There was a significant correlation between IDWG and median LVMI (r 0.55, p = 0.026), which was 27.3 g/m(2.7) (22.5-37.6) in the patients with a median IDWG of <4 %, and 44.3 g/m(2.7) (28.2-68.7) in those with a median IDWG of >4 % (p = 0.003). None of the four patients with an IDWG of <4 % showed left ventricular hypertrophy, compared with 10 of the 12 patients (83.3 %) with an IDWG of >4 % (p = 0.003); the former also had a better median ΔLVMI (-33.5 % vs -13.0 %; p = 0.02) and a lower median DBP sds (0.24 vs 1.72, p = 0.04). There is a significant correlation between IDWG and LVMI in pediatric oligoanuric patients on chronic HD: those with an IDWG of >4 % are at a higher risk of left ventricular hypertrophy.

Prognostic significance of left ventricular hypertrophy observed at dialysis initiation depends on the pre-dialysis use of erythropoiesis-stimulating agents

Recent experimental studies suggest that erythropoietin promotes beneficial myocardial remodeling during left ventricular hypertrophy (LVH); however, such compensatory capacity may be limited due to insufficient erythropoietin production in chronic kidney disease patients. Thus, this study aimed to explore the effect of pre-dialysis erythropoiesis-stimulating agent (ESA) use on the prognostic significance of LVH in dialyzed patients. This retrospective study included 404 consecutive patients who started dialysis between 2001 and 2009. The interaction of ESA with the association between left ventricular mass index (LVMI) observed at dialysis initiation and all-cause and cardiovascular mortality was analyzed at the end of 2010 using the Cox model. During a median follow-up of 36.5 months, 164 patients died, 31 of them from heart failure. The frequency of pre-dialysis ESA use was 58.7 % and median LVMI was 160.3 g/m(2). Of interest, patients with the lowest tertile of LVMI had worse survival compared with those with each subsequent tertile. LVMI was inversely associated with all-cause mortality [hazard ratio (HR) 0.991, 95 % confidence interval (CI) 0.988-0.995, P = 0.000] after extensive adjustment including ejection fraction, whereas the prognostic value of LVMI for cardiovascular mortality was dependent on pre-dialysis ESA use [adjusted HR 1.010, 95 % CI 0.999-1.020, P = 0.065 for pre-dialysis ESA(+) and 0.978, 95 % CI 0.967-0.989, P = 0.000 for pre-dialysis ESA(-), respectively]. Our results suggest that reverse epidemiology may exist between LVH and mortality and that pre-dialysis ESA use may modify the prognostic significance of LVH observed at dialysis initiation for cardiovascular mortality in dialyzed patients.