Normal Left Ventricular Geometry Research Articles

The influence of sex on left ventricular remodeling in patients with aortic dissection.

Patients with aortic dissection have a high prevalence of left ventricular structural alterations, including left ventricular hypertrophy (LVH), but little is known about the impact of sex on this regard. This study compared clinical, cardiac, and prognostic characteristics between men and women with aortic dissection. We retrospectively assessed clinical and echocardiographic characteristics, and 1-year mortality in 367 aortic dissection patients (30% women; 66% with Stanford-A) who underwent echocardiography 60 days before or after the diagnosis of aortic dissection from three Brazilian centers. Men and women had similar clinical characteristics, except for higher age (59.4 ± 13.4 vs. 55.9 ± 11.6 years; P = 0.013) and use of antihypertensive classes (1.4 ± 1.3 vs. 1.1 ± 1.2; P = 0.024) and diuretics (32 vs. 19%; P = 0.004) in women compared with men. Women had a higher prevalence of LVH (78 vs. 65%; P = 0.010) and lower prevalence of normal left ventricular geometry (20 vs. 10%; P = 0.015) than men. Logistic regression analysis adjusted for confounding factors showed that women were less likely to have normal left ventricular geometry (odds ratio, 95% confidence interval = 0.42, 0.20-0.87; P = 0.019) and were more likely to have LVH (odds ratio, 95% confidence interval = 1.91, 1.11-3.27; P = 0.019). Conversely, multivariable Cox-regression analysis showed that women had a similar risk of death compared to men 1 year after aortic dissection diagnosis (hazard ratio, 95% confidence interval = 1.16, 0.77-1.75; P = 0.49). In aortic dissection patients, women were typically older, had higher use of antihypertensive medications, and exhibited a greater prevalence of LVH compared with men. However, 1-year mortality after aortic dissection diagnosis did not differ between men and women.

Remodelling and functional features of the left ventricle in miners

Introduction. Diseases of the circulatory system are the main cause of mortality in the employable population. Preserving occupational longevity involves the identification of early signs of myocardial damage by modern techniques, which will allow taking a fresh look at the prevention of cardiovascular pathology in people engaged in harmful working conditions. Materials and methods. The study included two hundred thirty six miners of average age of 47.1±0.36 years who underwent periodic medical examination at the Institute clinic. The work experience in hazardous occupation conditions was 22.7±0.6 years. The study was based on transthoracic echocardiography using tissue Dopplerography and speckle tracking technology. Results. Concentric remodelling of the left ventricle was detected in 25.9% of the miners. Arterial hypertension was revealed in 65.6% of the miners with concentric remodelling of the left ventricle versus 34.3% of the miners with its normal geometry (p=0.00002). There were no significant differences in the left ventricular contractile function indices in the groups. In both groups, diastolic dysfunction type 1 was predominantly detected, which was significantly more common in the miners with concentric remodelling of the left ventricle (62.3% and 42.0%, p=0.006). Pseudonormal type of diastolic dysfunction occurred in 8.2% of the group with concentric remodelling versus 5.14% with normal left ventricular geometry, p= 0.38. Limitations. The study was limited by the number of the examined persons undergoing periodic medical examination at the Research Institute for Complex Problems of Hygiene and Occupational Diseases. Conclusion. Remodelling of the left ventricular myocardium in miners did not correlate with a decrease in the longitudinal deformation of the left ventricle, which indicates the possible influence of harmful occupational factors on the development of its systolic dysfunction. Diastolic dysfunction of the left ventricle had a clear relationship with remodelling of the left ventricular myocardium. In this regard, it is recommended to conduct echocardiography during an in-depth periodic medical examination of miners with long-term work experience to identify a risk group for developing cardiovascular accidents.

LEFT VENTRICULAR GEOMETRIC PATTERNS AND TRIGLYCERIDE–GLUCOSE (TYG) INDEX

Objective: Background and aim of the study: the triglyceride–glucose (TyG) index, an indirect index of insulin resistance, has been found associated to the development of heart failure (HF). Left ventricular hypertrophy and concentric geometry are associated to the future risk of cardiovascular events, including heart failure Design and method: In 1070 patients undergoing an echocardiogram and laboratory examinations at an ESH Excellence Centre for workup for suspect arterial hypertension (age 56±14 years, 49% males, 75% hypertensives (HT), among them 79% treated) left ventricular mass (LVM) and geometry were assessed. Subjects were divided into 4 LV geometric patterns according to the presence of an increased LV mass index (LVM/h2.7> 47 for females and and > 50 for males) and/or an increased relative wall thickness (RWT> 0.42). Results: After echocardiography subjects were classified as follows: 795(74%) with normal LV geometry (NG), 88 (8%) with concentric remodelling (CR), 143(13%) with eccentric hypertrophy (E_LVH) and 44 (4%) with concentric hypertrophy (C_LVH). The TyG was greater in males, in obese and in diabetic patients, and was significantly correlated with age, BMI, eGFR, systolic and diastolic blood pressure, LVM, LVMI and relative wall thickness. TyG remained significantly greater in patients with C_LVH as compared to both patients with NG and to patients with E_LVH, even after adjusting for multiple possible confounders (TyG: 8.5±0.6, 8.9±0.5, 8.6±0.6 and 9.0±0.7 and in patients with NG, CR, EH and CH respectively, ANOVA p < 0.05). The results did not change after excluding diabetic patients Conclusions: Conclusion: the triglyceride–glucose (TyG) index, an indirect index of insulin resistance is significantly associated to concentric LVH, independently of several possible confounders. These findings can explain at least in part the association between TyG and the risk of cardiovascular events.

Differential associations between abnormal cardiac left ventricular geometry types and cerebral white matter disease

ObjectivesReduced cardiac outflow due to left ventricular hypertrophy has been suggested as a potential risk factor for development of cerebral white matter disease. Our study aimed to examine the correlation between left ventricular geometry and white matter disease volume to establish a clearer understanding of their relationship, as it is currently not well-established. MethodsConsecutive patients from 2016 to 2021 who were ≥18 years and underwent echocardiography, cardiac MRI, and brain MRI within one year were included. Four categories of left ventricular geometry were defined based on left ventricular mass index and relative wall thickness on echocardiography. White matter disease volume was quantified using an automated algorithm applied to axial T2 FLAIR images and compared across left ventricular geometry categories. ResultsWe identified 112 patients of which 34.8 % had normal left ventricular geometry, 20.5 % had eccentric hypertrophy, 21.4 % had concentric remodeling, and 23.2 % had concentric hypertrophy. White matter disease volume was highest in patients with concentric hypertrophy and concentric remodeling, compared to eccentric hypertrophy and normal morphology with a trend-P value of 0.028. Patients with higher relative wall thickness had higher white matter disease volume (10.73 ± 10.29 cc vs 5.89 ± 6.46 cc, P = 0.003), compared to those with normal relative wall thickness. ConclusionOur results showed that abnormal left ventricular geometry is associated with higher white matter disease burden, particularly among those with abnormal relative wall thickness. Future studies are needed to explore causative relationships and potential therapeutic options that may mediate the adverse left ventricular remodeling and its effect in slowing white matter disease progression.

Coronary Artery Tortuosity and Spontaneous Coronary Artery Dissection: Association With Echocardiography and Global Longitudinal Strain, Fibromuscular Dysplasia, and Outcomes

The etiology and significance of coronary artery tortuosity (TCA) among patients with spontaneous coronary artery dissection (SCAD) are unknown. The aim of this prospective imaging cohort study was to report echocardiographic findings and evaluate whether TCA correlates with cardiac anatomy and function among patients with SCAD. Comorbidities including fibromuscular dysplasia (FMD) and outcomes were also assessed. TCA was determined on coronary angiography performed during the diagnosis of SCAD, and cardiac structure and function were evaluated using prospective comprehensive echocardiography. Among 116 patients with SCAD, the mean age at echocardiography was 50.8±8.8years, a median of 10.9months after SCAD. Sixty-two patients (53.4%) had FMD, 41 (35.3%) had histories of hypertension, and 17 (14.8%) were hypertensive during echocardiography. Most patients (n=78 [69%]) had normal left ventricular geometry with normal median ejection fraction (61%; interquartile range, 56% to 64%) and normal global longitudinal strain (-22.2%; interquartile range, -24.0% to -19.9%). Fifteen patients (13.4%) had diastolic dysfunction that was associated with hypertension at the time of echocardiography. Patients with TCA (n=96 [82.8%]) were older (mean age, 52.1±8.0 vs 44.7±9.9years; P<.001) with a higher prevalence of FMD (59.4% vs 25%, P=.007) but a similar prevalence of hypertension (35% vs 35%, P>.99) compared with patients without TCA. Across the age range (31.5 to 66.9years), each decade of age was associated with an approximately 0.89-unit increase in coronary tortuosity score (P<.0001). Echocardiographic parameters were not significantly different between the two groups. Median follow-up duration was 4.4years (95% CI, 3.8 to 5.2years). The Kaplan-Meier 3-year SCAD recurrence rate was 9.4% (95% CI, 3.7% to 14.8%). There were no deaths. The majority of patients with SCAD had normal or near normal echocardiographic results, including global longitudinal strain, with no differences according to TCA. However, patients with SCAD with TCA were older, with a higher prevalence of FMD.

Association of 20-Year Longitudinal Depressive Symptoms With Left Ventricular Geometry Outcomes in the Coronary Artery Risk Development in Young Adults Study: A Role for Androgens?

Depression is a risk factor for coronary heart disease and left ventricular hypertrophy (LVH) is a potent predictor of coronary heart disease events. Whether depression is associated with LVH has received limited investigation. This study assessed cross-sectional and 20-year longitudinal associations of depressive symptoms with LVH outcomes after accounting for important known confounders. From 5115 participants enrolled in 1985-1986 in the Coronary Artery Risk Development in Young Adults Study, 2533 had serial measures of depressive symptoms and subsequent echocardiography to measure normal LV geometry, concentric remodeling, and LVH. The primary exposure variable was trajectories of the Center for Epidemiologic Studies Depression (CES-D) scale score from 1990-1991 to 2010-2011. Multivariable polytomous logistic regression was used to assess associations of trajectories with a composite LV geometry outcome created using echocardiogram data measured in 2010-2011 and 2015-2016. Sex-specific conflicting results led to exploratory models that examined potential importance of testosterone and sex hormone-binding globulin. Overall CES-D and Somatic subscale trajectories had significant associations with LVH for female participants only. Odds ratios for the subthreshold (mean CES-D ≈ 14) and stable (mean CES-D ≈ 19) groups were 1.49 (95% confidence interval = 1.05-2.13) and 1.88 (95% confidence interval = 1.16-3.04), respectively. For female participants, sex hormone-binding globulin was inversely associated with LVH, and for male participants, bioavailable testosterone was positively associated with concentric geometry. Findings from cross-sectional and longitudinal regression models for female participants, but not male ones, and particularly for Somatic subscale trajectories suggested a plausible link among depression, androgens, and LVH. The role of androgens to the depression-LVH relation requires additional investigation in future studies.

Association of left ventricular structural remodeling types with fibronectin deficiency in patients with multivessel coronary artery disease

Aim. To evaluate the serum fibronectin level in patients with multivessel coronary artery disease, and to identify the relationship of fibronectin level with atrial fibrillation (AF) developed in the hospital after coronary artery bypass grafting (CABG) and types of left ventricular (LV) structural remodeling.Material and methods. This prospective observational study of 80 patients after elective CABG at the Cardiac Surgery Department № 1 of the N.V. Sklifosovsky Research Institute for Emergency Medicine from October 2020 to May 2022. The groups were divided depending on the development of AF after CABG surgery (19 patients with AF developed in the hospital after CABG (up to 10 days), 61 patients — control group). All patients underwent a general clinical examination and transthoracic echocardiography, with estimation of left ventricular remodeling type. Serum fibronectin level was determined by enzyme immunoassay using the Fibronectin agent (Technozym, Austria).Results. The median fibronectin values in the group with AF was 110,10 [86,86; 134,00] mcg/ml versus 120,90 [92,01; 161,50] µg/ml of the comparison group (p=0,19). The following LV patterns were observed: normal LV geometry (NLVG) — in 1 patient (5,26%), concentric LV remodeling (CLVR) — in 3 patients (15,79%), concentric LV hypertrophy (CLVH) — in 10 patients (52,63%), eccentric LV hypertrophy (ELVH) — in 5 patients (26,32%). In the group without AF, 25 patients (40,98%) were diagnosed with NLVG, 26 patients (42,62%) — CLVR, 6,56% (n=4) — CLVR, while ELVH was diagnosed in 6 patients (9,84%). Differences in geometry types between groups were significant (p&lt;0,0001). Multivariate analysis adjusted for gender, age, cardiopulmonary bypass time, the predictive value remained for CLVH — odds ratio 15,83 (95% confidence interval, 4,082-1,442,00; p=0,0001) and ELVH — odds ratio 5,17 (95% confidence interval, 1,365-19,573; p=0,015). A further study showed that fibronectin &lt;116,496 µg/ml with a sensitivity of 78% and specificity of 53% is associated with CLVH (p=0,006) in patients of both groups.Conclusion. Fibronectin &lt;116,496 µg/ml is associated with CLVH in patients with multivessel coronary artery disease (sensitivity 78%, specificity 53%; p=0,006).

Predictors of Atrial Fibrillation Developing in Hospital Stage After Coronary Artery Bypass Surgery

Aim To identify independent predictors associated with in-hospital atrial fibrillation (AF) following coronary artery bypass grafting (CABG).Material and methods The study included 80 patients (88.75 % men) who had elective CABG surgery at the Sklifosovsky Research Institute of Emergency Medicine. Based on the development of AF during the hospital stage of treatment (up to 10 days after CABG surgery), patients were divided into two groups. The group with AF consisted of 19 patients, and the group without AF consisted of 61 patients. All patients underwent electrocardiography (ECG), transthoracic echocardiography (EchoCG) with calculation of the left ventricular (LV) geometry type, and assessment of operational indexes. During surgery, biopsy of a part of the right atrial (RA) appendage was taken from 61 patients to verify the severity of myocardial fibrosis on a four-score scale where 0 is no interstitial fibrosis, 1 is slight fibrosis, 2 is moderate fibrosis, and 3 is severe fibrosis.Results All included patients had a low risk of developing postoperative complications according to the EuroSCORE II scale. According to EchoCG data, patients with AF had significantly higher ratios of left ventricular myocardial mass to body surface area (LVMM / BSA) (p = 0.0006) and of left atrial volume to body surface area (LA volume / BSA), p = 0.008). The distribution of patients by type of LV geometry was as follows: in the group with AF, 52.63 % (n=10) of patients were diagnosed with concentric LV hypertrophy (LVH) whereas in the group without AF, the majority of patients (83.60 %, n=51) had normal LV geometry and concentric LV remodeling (LVR) (p&lt;0.0001). According to the results of histological study, patients of the AF group more frequently had moderate and severe interstitial fibrosis in the AF appendage (p = 0.003). After multivariate regression and ROC analysis, the predictive value remained for concentric LVH (p=0.002), LVMM / BSA ratio ≥97 g / m2 (p=0.006), LA volume / BSA ratio ≥ 34.4 ml / m2 (p=0.04), and for RA appendage interstitial fibrosis score ≥2 (p=0.004). Based on the identified predictors, a regression model was developed to predict the development of AF at the hospital stage after CABG (p&lt;0.0001). The sensitivity and specificity of the model were 86.67 % and 78.26 %, respectively.Conclusion In patients at low perioperative risk, the LVMM / BSA ratio ≥97 g / m2, the LA volume ratio / BSA ≥34.4 ml / m2, a RA appendage interstitial fibrosis score ≥2, and the presence of LVH were independent predictors of the development of AF at the hospital stage after CABG operation.Conclusion In patients at low perioperative risk, a LVMM / BSA ratio ≥97 g / m2, a LA volume / BSA ratio ≥34.4 ml / m2, a RA appendage interstitial fibrosis score ≥2, and the presence of LVH were independent predictors of the development of AF at the hospital stage after CABG.

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

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

Comparison of echocardiographic methods for calculating left ventricular mass in elite rugby football league athletes and the impact on chamber geometry.

Recommendations for the echocardiographic assessment of left ventricular (LV) mass in the athlete suggest the use of the linear method using a two-tiered classification system (2TC). The aims of this study were to compare the linear method and the area-length (A-L) method for LV mass in elite rugby football league (RFL) athletes and to establish how any differences impact the classification of LV geometry using 2TC and four-tier (4TC) classification systems. Two hundred and twenty (220) male RFL athletes aged 25 ± 5 (14-34 years) were recruited. All athletes underwent echocardiography and LV mass was calculated by the American Society of Echocardiography (ASE) corrected Linear equation (2D) and the A-L method. Left ventricular mass Index (LVMi) was used with relative wall thickness to determine geometry in the 2TC and with concentricity and LV end diastolic volume index for the 4TC. Method specific recommended cut-offs were utilised. Higher values of absolute (197 ± 34 vs. 181 ± 34 g; p < 0.0001) and indexed (92 ± 13 vs. 85 ± 13 g/m2; p < 0.0001) measures of LV mass were obtained from A-L compared to the linear method. Normal LV geometry was demonstrated in 98.2% and 80% of athletes whilst eccentric hypertrophy in 1.4% and 19.5% for linear and A-L respectively. Both methods provided 0.5% as having concentric remodelling and 0% as having concentric hypertrophy. Allocation to the 4TC resulted in 97% and 80% with normal geometry, 0% and 8.6% with eccentric dilated hypertrophy, 0% and 7.7% with eccentric non-dilated hypertrophy, 1.4% and 0.5% with concentric remodelling and 1.4% and 3% with concentric non-dilated hypertrophy for linear and A-L methods respectively. No participants had concentric dilated hypertrophy from either methods. The linear and A-L method for calculation of LV mass in RFL athletes are not interchangeable with significantly higher values obtained using A-L method impacting on geometry classification. More athletes present with eccentric hypertrophy using 2TC and eccentric dilated/non-dilated using 4TC. Further studies should be aimed at establishing the association of A-L methods of LV mass and application of the 4TC to the multi-factorial demographics of the athlete.

99mTc-HFAPi imaging identifies early myocardial fibrosis in the hypertensive heart.

This study aimed to explore whether 99mTc-radiolabeled fibroblast activation protein inhibitor (99mTc-HFAPi) imaging can detect early myocardial fibrosis in the hypertensive heart. In the experimental model, spontaneously hypertensive rats (SHRs) and age-matched Wistar Kyoto rats (WKYs) were randomly divided into three groups (8, 16, and 28 weeks). The animals underwent 99mTc-HFAPi imaging and echocardiography. Autoradiography and histological analyses were performed in the left ventricle. The mRNA and protein expression level of the fibroblast activation protein (FAP) and collagen I were measured using quantitative PCR and western blot. In the clinical investigation, a total of 106 patients with essential hypertension and 20 gender-matched healthy controls underwent 99mTc-HFAPi imaging and echocardiography. In-vivo and in-vitro autographic images demonstrated diffusely enhanced 99mTc-HFAPi uptake in the SHR heart starting at week 8, before irreversible collagen deposition. The mRNA and protein levels of FAP in SHRs began to increase from week 8, whereas changes in collagen I levels were not detected until week 28. In the clinical investigation, even in hypertensive patients with normal diastolic indicators, normal left ventricular geometry, and normal global longitudinal strain (GLS), the prevalence of increased 99mTc-HFAPi uptake reached 34, 41, and 20%, respectively, indicating that early fibrogenesis precedes structural and functional myocardial abnormalities. In hypertension, 99mTc-HFAPi imaging can detect early fibrotic process before myocardial functional and structural changes.

Modern opportunities for assessing the left ventricle remodeling

Aim: To compare the results of distributing left ventricular (LV) remodeling patterns according to two classifications and identify their advantages and disadvantages. Materials and methods. The study involved 2019 patients, aged from 18 to 94 years with a mean of 57.6 ± 16.4 years, 51 % males, apparently healthy and with cardiovascular and respiratory system pathology. Echocardiography was performed using an Esaote MyLab Seven device (Italy) according to generally accepted standards. The distribution of patients according to four classic LV remodeling patterns and according to the classification proposed by W. Gaasch and M. Zile was studied. Statistical analysis was performed using Statistica for Windows 13.0 (StatSoft Inc., USA; license No. JPZ804I382130ARCN10-J). Qualitative variables were given as absolute and relative frequency (n (%)). Results. The distribution of patients according to 4 classic LV remodeling patterns was as follows: 53.0 % had normal LV geometry; 10.2 % – concentric remodeling; 15.6 % – concentric hypertrophy; 21.2 % – eccentric hypertrophy. At the same time, in the group of normal LV geometry, 25.2 % of people had LV dilatation. When distributing the patients by remodeling patterns according to the W. Gaasch and M. Zile classification, the following data were obtained: 26.9 % of people had normal LV geometry, concentric remodeling – 10.2 %, concentric hypertrophy – 12.4 %, mixed hypertrophy – 3.1 %, physiological and dilated hypertrophy – 11.8 %, eccentric hypertrophy – 5.5 %, eccentric remodeling – 11.4 %. In addition, 3 more groups of patients were formed, who did not have a terminological definition based on the W. Gaasch and M. Zile classification and, in total, accounted for 18.6 % of the examined. Conclusions. The missing options of dilated left ventricle should be recognized as a limitation of the classic classifications of left ventricular remodeling patterns. The imposition of additional criteria covering the cavity dilatation in determining the left ventricular remodeling patterns improves the assessment of the patient’s prognosis and contributes to a more individual selection of pathogenetic therapy.

Concentric and Eccentric Remodelling of the Left Ventricle and Its Association to Function in the Male Athletes Heart: An Exploratory Study.

To compare (1) conventional left ventricular (LV) functional parameters, (2) LV peak strain and strain rate and (3) LV temporal strain and strain rate curves in age, ethnicity and sport-matched athletes with concentric, eccentric and normal LV geometry. Forty-five male athletes were categorised according to LV geometry including concentric remodelling/hypertrophy (CON), eccentric hypertrophy (ECC) or normal (NORM). Athletes were evaluated using conventional echocardiography and myocardial speck tracking, allowing the assessment of myocardial strain and strain rate; as well as twist mechanics. Concentric remodelling was associated with an increased ejection fraction (EF) compared to normal geometry athletes (64% (48-78%) and 56% (50-65%), respectively; p < 0.04). No differences in peak myocardial strain or strain rate were present between LV geometry groups including global longitudinal strain (GLS; CON -16.9% (-14.9-20.6%); ECC -17.9% (-13.0-22.1%); NORM -16.9% (-12.8-19.4%)), global circumferential strain (GCS; CON -18.1% (-13.5-24.5%); ECC -18.7% (-15.6-22.4%); NORM -18.0% (-13.5-19.7%)), global radial strain (GRS; CON 42.2% (30.3-70.5%); ECC 50.0% (39.2-60.0%); NORM 40.6 (29.9-57.0%)) and twist (CON 14.9° (3.7-25.3°); ECC 12.5° (6.3-20.8°); NORM 13.2° (8.8-24.2°)). Concentric and eccentric remodelling was associated with alterations in temporal myocardial strain and strain rate as compared to normal geometry athletes. Physiological concentric and eccentric remodelling in the athletes heart is generally associated with normal LV function; with concentric remodelling associated with an increased EF. Physiological concentric and eccentric remodelling in the athletes heart has no effect on peak myocardial strain but superior deformation and untwisting is unmasked when assessing the temporal distribution.

Effect of insulin resistance on left ventricular remodelling in essential hypertensives: a cross-sectional study.

In clinical practice, left ventricular hypertrophy (LVH) is defined by physical findings and electrocardiographic criteria, which are useful but imperfect tools, echocardiographic criteria and cardiac magnetic resonance imaging. In echocardiography, LVH is defined not by left ventricular wall thicknesses but by left ventricular mass. The latter is calculated according to Devereux's formula, and is increased by insulin resistance/hyperinsulinaemia. It is however unclear whether insulin resistance, hyperinsulinaemia, or both, is actually causative and what their collective or individual influence is on the components of Devereux's formula and parameters of left ventricular diastolic function. This study evaluated the associations of the homeostatic model assessment for insulin resistance (HOMAIR) and fasting plasma insulin levels with components of Devereux's formula and parameters of left ventricular diastolic function. Relevant clinical data were collected from 220 hypertensive patients recruited between January and December 2019. The associations of components of Devereux's formula and parameters of diastolic function with insulin resistance were tested using binary ordinal, conditional and classical logistic regression models. Thirty-two (14.5%) patients (43.9 ± 9.1 years), 99 (45%) patients (52.4 ± 8.7 years) and 89 (40.5%) patients (53.1 ± 9.8 years) had normal left ventricular geometry, concentric left ventricular remodelling and concentric left ventricular hypertrophy, respectively. In multivariable adjusted analysis, 46.8% of variation in interventricular septum diameter (R² = 0.468; overall p = 0.001) and 30.9% of E-wave deceleration time (R² = 0.309; overall p = 0.003) were explained by insulin level and HOMAIR, 30.1% of variation in left ventricular end-diastolic diameter (R² = 0.301; p = 0.013) by HOMAIR alone, and 46.3% of posterior wall thickness (R² = 0.463; p = 0.002) and 29.4% of relative wall thickness (R² = 0.294; p = 0.007) by insulin level alone. Insulin resistance and hyperinsulinaemia did not have the same influence on the components of Devereux's formula. Insulin resistance appeared to act on left ventricular end-diastolic diameter, while hyperinsulinaemia affected the posterior wall thickness. Both abnormalities acted on the interventricular septum and contributed to diastolic dysfunction via the E-wave deceleration time.

Familial cardiolaminopathy due to a previously undescribed LMNA gene mutation

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiolaminopathies are rare genetic alterations, which present diverse mechanical and electrical alterations. OBJECTIVE To present a family carrying an LMNA gene mutation that although not described manifest clinical and electrocardiographic characteristics of the disease. Methods We present the case of two sisters and one brother, aged 65, 57 and 51 years, respectively. At the beginning of their fourth decade, all of them debuted with atrial flutter associated with second and third degree atrioventricular block. Two of them (one or the sisters and the brother) underwent ablation of isthmus-dependent atrial flutter. However, in both, the flutter recurred and no new interventional treatment was further offered. The male subject received a pacemaker implant for treatment of AV block; some years later, he presented a cerebrovascular event and subsequently a recurrence, both while in oral anticoagulation and, actually remains with moderate motor deficit and dysarthria. The youngest woman suffered an embolic cerebrovascular event when she was 50 y/o; she remained asymptomatic in relation to the rhythm disorder and refused a pacemaker. The oldest sister who is asymptomatic, received a pacemaker when she was 45 y/o and now is anticoagulated. By echocardiography, all siblings presented left ejection fraction in between 40 and 50% with decreased strain values and normal left ventricular geometry. Results Recently in our country it is possible to carry out a genetic test, for which the three were subjected to it. In this family, the genetic testing was done using a comercial kit for 172 genes. The result was a Frameshift Indels (non misense) mutation NM_170707.3 c.1526del p.(Pro509LeufsTer39) Exon:9/12, in all three. The caveat is that this LMNA gene mutation has not been previously described. In light of these results, the youngest woman with total AV block and sequelae of cerebrovascular disease and mild left ventricular dysfunction, received an implantable cardiac defibrillator (ICD) implant for primary prevention of sudden death and her siblings are undergoing an upgrade to ICD. Conclusion The mutation found in this family is unique and for the first time reported in the LMNA gene in the world. Genetic diagnosis is limited in our country, which makes it difficult to determine this type of pathology. However, given the clinical presentation of an electrical disorder in all the siblings of a family, in this particular case, it was mandatory to perform this test. These results allow us to better understand the prognosis and intervene appropriately to prevent sudden death, even though there is no treatment to avoid the progression of the disease.

Структура кардиоваскулярных нарушений у детей с хронической болезнью почек

Objective. To study the structure of cardiovascular pathology in children with chronic kidney disease (CKD). Patients and methods. 74 children were examined, including 40 patients on dialysis and 34 patients at the predialysis stage of CKD. The following parameters were determined: the thickness of the interventricular septum and the posterior wall of the left ventricle (LV), the final systolic and final diastolic LV size, shock volume, ejection fraction. The myocardial mass index (LVMI) and the relative wall thickness (RWT) of the LV were calculated according to the following formulas. Results. According to echocardiography data in children receiving dialysis, LV myocardial hypertrophy was observed in the majority of children – 17 (42.5%, p &lt; 0.001), of which in 35.3% of cases (6 children) concentric remodeling was detected (RWT ≥0.45, LVH within 90 g/m2), in 41.2% of cases (in 7 patients), concentric hypertrophy was determined (RWT ≥0.45, LVMI 111.7 ± 11.4 g/m2), eccentric hypertrophy was detected in 23.5% of patients (in 4 – RWT ≤0.45, IMLJ 115.6 ± 11.9 g/m2); systolic dysfunction was found in 10 (25%) children with stage 5d CKD, in 8 (20%) – diastolic dysfunction, in 5 (12.5%) – the valvular damage. In 19 (55.9%) children with the predialysis stage, there is a normal LV geometry (RWT &lt;45 with normal LV), in 15 (44.1%) – concentric remodeling (RWT &gt;45 with normal LVMI). Conclusion. CKD in children, as in adults, is associated with the highest risk of accelerated development of cardiovascular pathology. Cardiovascular pathology in CKD is manifested mainly by LV myocardial hypertrophy. LV hypertrophy, being an important risk factor for arrhythmias and heart failure, is especially characteristic of patients with dialysis for,m of CKD. Key words: cardiovascular disorders, chronic kidney disease

Стресс-эхокардиография в диагностике кардиальной дисфункции в раннем постинфарктном периоде

The purpose — to assess the importance of stress echocardiography in identifying the nature and severity of cardiac dysfunction in patients with myocardial infarction. Material and methods.86 patients were examined at the outpatient stage of rehabilitation 6 weeks after myocardial infarction with primary coronary angioplasty with stenting. Results.Echocardiography revealed left ventricular hypertrophy (LVH) in 34 patients with myocardial infarction with concomitant arterial hypertension. Patients with LVH are characterized by more pronounced structural and functional LV remodeling, which is expressed in a lower LVEF and increased LVEDD, LVESVand LVEDV(p&lt;0.05). There were no differences in stroke volume between patients with and without LVH. The performed diastolic stress test in patients with LVH is characterized by significantly lower average early diastolic mitral annular velocity e` (7.6 vs. 9.3 cm/s, p&lt;0.01) without differences in the peak early transmitral Doppler flow velocity E (69.8 vs 78.0, p&gt;0.05) compared with patients without LVH. The revealed differences between patients with and without LVH are due to a higher post-exercise velocity e` in patients with normal LV geometry and a decrease in eccentric LVH subgroup. Conclusions.1) Patients with LVH in the early postinfarction period (6 weeks) have more pronounced LV systolic dysfunction, expressed in a decrease in LVEF and an increase in LVEDD, LVESV, LVEDV compared to patients without LVH.2) Left ventricular hypertrophy, in conditions of myocardial infarction, is associated with latent diastolic dysfunction, which is manifested by a lower average early diastolic mitral annular velocity e` after the stress-test.

Prevalence and Characterisation of Severe Left Ventricular Hypertrophy Diagnosed by Echocardiography in Hypertensive Patients

Arterial hypertension (AHT) is the leading preventable cause of death worldwide. Left ventricular hypertrophy (LVH) is one of the most important prognostic markers in hypertension and a predictor for mortality. The goals of this study were to examine the prevalence of LVH detected by echocardiography in patients with AHT and to describe patients with severe LVH. This is a retrospective monocentric study including patients treated at a tertiary hypertension clinic. Echocardiographic data were taken from written reports from our hospital's echocardiography laboratories. We compared patients with severe LVH (septum thickness ≥ 15 mm) with patients with normal left ventricular (LV) geometry and with patients with concentric or eccentric hypertrophy regarding age, gender, comorbidities, medication, duration of hypertension, blood pressure (BP) and ECG changes at time of echocardiography. Twenty-nine patients (7.3%) out of four hundred patients showed severe LVH and one hundred and eighty-nine (47.3%) a normal geometry. In comparison to patients with normal geometry, patients with severe LVH were more likely to be male, older, and with more uncontrolled BP, especially regarding asleep values, multi-drug antihypertensive treatment and comorbidities. In comparison to patients with concentric or eccentric hypertrophy, patients with severe LVH had a significantly higher diastolic BP in the 24 h mean, awake and asleep values. A positive Sokolow-Lyon index did not predict LVH. However, patients with severe LVH were more likely to have T-wave-inversions V4-V6 in at least one lead. More than half of the patients with AHT have an abnormal geometry in our study (52.5%) and 7.3% a severe LVH. Patients with severe LVH have more often an uncontrolled AHT than patients with a normal LV geometry, despite more antihypertensive treatment. The Sokolow-Lyon index seems to be insufficient to detect LVH.

1098 CHARACTERIZATION OF DIFFERENT TYPES OF LV REMODELING USING QUANTITATIVE INTRACARDIAC FLUID-DYNAMICS

Abstract Background Hyperdoppler is a novel advanced echocardiographic technique for the quantitative assessment of intracardiac fluid-dynamics. Recently, its use has been proven useful to complement traditional echocardiographic evaluation of cardiac function in Heart Failure. However, no specific data are available on its application to differentiate between different types of LV remodeling. Thus, our aim was to investigate whether quantitative changes in fluid dynamics might be able to characterize patients with different ventricular geometry. Methods We enrolled 100 consecutive patients with one of the following: LV concentric hypertrophy (CH), eccentric hypertrophy (EH), concentric remodeling, normal LV geometry (CTRL). They underwent a complete echocardiographic examination with intracardiac fluid-dynamic analysis by Color Vector Flow Mapping (Hyperdoppler, Esaote, Genova, Italy). The following parameters were obtained: vortex area (VA); vortex length (VL); vortex depth (VD). Bland Altman Plot has been used to assess intra and inter-observer variability. Results Mean Vortex Depth was significantly higher in CR (p=0.011), CH (p=0.001) and EH (p=0.025) compared to CTRL (p=0.013, p=0.001 and p=0.022, respectively). In addition, CH had significantly higher Vortex Length (p= 0.008) and larger VA (p=0.012) compared to CTRL. No significative differences in vortices parameters have been observed between CH and EH. Conclusion(s) Quantitative fluid-dynamic assessment was feasible and reliable in the whole population and is a promising tool to complement standard echocardiography for the early characterization of different types of LV remodeling.

171 SEX AND PHYSICAL EXERCISE: ONE SIZE DOES NOT FIT ALL

Abstract Differences in regulation and adaptations in response to exercise between men and women Numerous cardiovascular adjustments occur during exercise so that cardiac output (CO) rises linearly as a function of VO2 to meet the increased demands of muscular work. There are several genetic, anatomical and hormone sex-related differences that impact the hemodynamic and structural cardiovascular response to exercise. From a hemodynamic point of view, women have lower CO. Females have lower Stroke Volume (SV) and smaller increase in SV in response to exercise, mainly due to their smaller cardiac size/mass, so the main mechanism to enhance CO in women is the increase of HR. Maximum HR has been shown to be similar between females and males and depends mainly on the age rather than on gender. Furthermore, women have lower maximal oxygen uptake (VO2max) values, mainly due to their lower CO, together with differences in peak Da-vO2. Blood volume, hemoglobin, and hematocrit values are 15– 20% lower in women, and sex-based differences exist in pulmonary structure and respiratory function, resulting in a lower oxygen supply for the same quantity of blood flow than men. Moreover, females have lower systolic and diastolic peak blood pressures as compared to males, as they experience a greater drop in systemic vascular resistance during exercise and have lower CO. This could be the reason of the higher occurrence of post-exercise hypotension in women. From a structural point of view, regular physical training induces cardiac remodeling and structural adaptations to improve SV reserve. Trained women exhibited smaller left ventricular wall thickness, cavity size and mass compared to age and fitness-matched men. Women were reported to maintain a normal left ventricular geometry, with a relatively larger increase of cavity dimensions compared with men, evidently influenced by the type of sport praticated. These sex-related differences in cardiac adaptations may be partially explained by the higher concentrations of endogenous anabolic hormones in males and higher hypertrophic potential of male cardiac tissue compared to women. Heart size accounts for many of the sex-based differences in cardiac functional and structural responses, however, it may not entirely account for sex-related cardiovascular differences as they tend to shrink when parameters are normalized for body surface area and lean body mass, suggesting that other factors, such as different body composition, may play a role and indexed parameters should be analyzed rather than absolute values. The more and more large participation of women in a broad variety of sport, together with the increasing awareness about the existence of relevant sex-related differences in response to training, confirm the need to include sex as a biological variable to consider for optimal tailored exercise intervention. Identifying and understanding sex-specific differences is crucial, both from a clinical point of view, as they could impact exercise rehabilitation and prevention strategies, and from a sport and physiological point of view, both in terms of improving performances and reducing injuries.