Normal Left Ventricular Geometry Research Articles

Geometric patterns of the left ventricle in relation to left atrial size among hypertensive patients at a tertiary hospital in South-South Nigeria

Introduction: It is well established that left ventricular hypertrophy (LVH), determined by echocardiography, is a strong predictor of poor prognosis in cardiovascular disorders independent of the presence of traditional risk factors. The left ventricle undergoes morphological as well as functional alterations in its structure that impact adversely on the structure and overall function of the left atrium. The prevalence of left atrial (LA) enlargement in the hypertensive group was found to be 16% and 59% using LA linear diameter and LA maximum volume, respectively. Materials and Methods: The study was carried out on 200 adult hypertensive patients ≥18 years attending consultant cardiology outpatient clinics irrespective of blood pressure control, whether on antihypertensive medications or not. A transthoracic echocardiogram with ECG gating was performed according to established recommendations. Results: This study showed four different geometric patterns of left ventricular (LV) adaptation to chronic hypertension: concentric remodeling (CR) in 31.5%, concentric hypertrophy in 27.5%, eccentric hypertrophy in 12.5%, while 28.5% of the total population had normal LV geometry. LA size was discovered to be highest among patients with concentric patterns of hypertrophy compared to the eccentric geometric pattern. Findings suggest that LV pressure overload is more likely to impact on LA size than volume overload. This may be as a result of increased afterload in the left ventricle, leading to impairment of diastolic filling. Conclusion: Although CR of the LV is the most common type of geometric change among hypertensive patients, patients with dilated left atrium are more likely to have the concentric type of LVH than the eccentric type.

Influence of the statin therapy on cardiovascular remodeling in arterial hypertension, combined with subclinical hypothyroidism

There is a proven relation between hypothyroidism and appearance of the pronounced structural and functional changes of the heart and blood vessels as well as atherosclerosis and its related diseases progress. At the same time, there is a lack of information regarding the influence of statins on indices of the structure and function of the heart and blood vessels in patients with arterial hypertension (AH) combined with subclinical hypothyroidism (SH).Aim. To study the effect of the long-term statin therapy on the cardiac structure and function, as well as on vascular remodeling in patients with arterial hypertension combined with subclinical hypothyroidism.Material and methods. The study involved 31 patients with arterial hypertension grade 1–3, stage II, of high and very high additional cardiovascular risk, with a concomitant SH. All patients received a combination of two or three first-line antihypertensive drugs at average therapeutic daily doses and atorvastatin at a dose of 20–30 mg per day.Prior to treatment and after one year of follow-up, all patients underwent an echocardiographic examination and a carotid artery scan on My Lab Seven (Italy) device as well as a 24h-blood pressure monitoring on a bifunctional device “Cardiotechnics-04” (Inkart, St. Petersburg, RF) with the simultaneous registration of BP and ECG.Results. Under the influence of therapy, the target level of systolic blood pressure was reached in 74 % (23/31) of patients during the daytime observation period, in 65 % (20/31) of patients during the nighttime observation period; target diastolic blood pressure for the daytime observation period – in 87 % (27/31) of patients, for the nighttime observation period – in 71 % (22/31) patients. However, there was no significant change in the size of cavities of the left atrium and both ventricles, ejection fraction (before treatment 68.84 ± 5.43 %, after 67.13 ± 5.45 %), thickness of the interventricular septum and posterior wall, relative wall thickness (before treatment 0.41 ± 0.07, after 0.41 ± 0.07, P = 0.871), LV mass index (before treatment 122.29 ± 37.36 g/m2, after 118.00 ± 31.00 g/m2, P = 0.849), indices of diastolic function of the left ventricle (LV). The specific gravity of patients with eccentric LV hypertrophy after a year of treatment increased from 32 % to 39 % (P = 0.5668), with concentric hypertrophy decreased from 42 % to 39 % (P = 0.8107), with normal LV geometry – from 19 % to 16 % (P = 0.7570). The number of patients with AH with a concomitant SH with signs of a concentric LV remodeling remained unchanged – before treatment 6 %, after 6 %. The influence of the statin therapy on vascular remodeling in patients with AH with a concomitant SH was characterized by a tendency towards a decrease in the thickness of the intima-media complex of the right (0.769 ± 0.276 mm vs. 0.701 ± 0.222 mm, P = 0.512) and left (0.759 ± 0.185 mm vs. 0.745 ± 0.179 mm, P = 0.988) common carotid arteries.Conclusion. In patients with AH with a concomitant SH, the antihypertensive therapy during the year with the first-line drugs with addition of statins was associated with achievement of the target SBP level in the active period in 74 %, in the passive period – in 65 % of patients (according to the 24h-BPM data), but was not accompanied by a significant decrease in the cavity size, wall thicknesses, LV mass, improvement of LV diastolic filling, reduction in thickness of the intima-media complex.

Targeting persistent normal left ventricular geometry in the general population: a 25-year follow-up study.

Findings regarding the extent of persistence over time of normal left ventricular (LV) geometry, a reference healthy echocardiographic phenotype, in the community are scanty. We sought to assess this issue in members of the general population enrolled in the Pressioni Arteriose Monitorate e Loro Associazioni study. The study included 433 participants who attended the second and third survey of the Pressioni Arteriose Monitorate e Loro Associazioni study performed after 10 and 25 years from the initial evaluation. Data collection included medical history, anthropometric parameters, office, home, ambulatory blood pressure, routine blood examinations and echocardiography. During 25-year follow-up 167 participants showed persistently normal LV mass (LVM) and LV geometry pattern, whereas 266 participants exhibited LV hypertrophy or LV concentric remodelling at any point during study. Compared with participants developing, maintaining or regressing from LV hypertrophy and LV concentric remodelling those with a persistently normal LVM index and geometry were younger (-8 years) and more frequently female (63 vs. 45%), exhibited baseline (and follow-up) lower office and out-of-office blood pressure, BMI, serum creatinine, fasting blood glucose total serum cholesterol and rate of antihypertensive treatment. In multivariate regression analysis age [odds ratio (OR): 0.93, confidence interval (CI): 0.91-0.96, P < 0.0001] BMI (OR: 0.90, CI: 0.83-0.97, P = 0.008), office SBP (OR: 0.97, CI: 0.95-0.99, P = 0.005) and fasting blood glucose (OR: 0.96, CI: 0.93-0.99, P = 0.007) were independently associated with persistent normal LVM index and geometry. The current long-term longitudinal study suggests that persistence of normal LV geometry is associated with normal/optimal SBP, BMI and blood glucose. Thus, a closer control of these risk factors in midlife may increase the likelihood of maintaining normal ventricular geometry and, in turn, reduce the burden of subclinical cardiac organ damage and related complications in advanced age.

Difference of Clinical Outcomes According to Left Ventricular Hypertrophy and Its Subtype in Korean Patients with Acute Myocardial Infarction

Background/Aims: Left ventricular hypertrophy (LVH) on clinical outcomes in patients with acute myocardial infarction (AMI) is not clear. This study was performed to investigate the effect of abnormal left ventricular geometry on clinical outcomes in Korean patients with AMI.Methods: A total of 852 consecutive patients with AMI were divided into two groups: normal left ventricular geometry (n = 470; 389 males) and LVH (n = 382; 214 males) groups. Major adverse cardiac events (MACEs) were defined as cardiac death, recurrent myocardial infarction, and rehospitalization.Results: During the clinical follow-up period of 21 ± 7.8 months, MACEs developed in 173 patients (20.0%), and the rate was higher in the LVH than normal left ventricular geometry groups (25.5% vs. 16.0%, respectively, &lt;i&gt;p&lt;/i&gt; = 0.001). According to Kaplan-Meier survival curves, the MACE-free survival rate was significantly lower in the LVH group than in the left ventricular geometry group (&lt;i&gt;p&lt;/i&gt; = 0.008). The rates of MACEs and all-cause mortality differed among the AMI with concentric remodeling, concentric hypertrophy, and eccentric hypertrophy subgroups (11.2% vs. 15.5% vs. 22.1%, respectively, &lt;i&gt;p&lt;/i&gt; = 0.046). Eccentric hypertrophy was a predictive factor of MACE according to Cox proportional hazards analysis (hazard ratio 1.804, confidence interval 1.034-3.148, &lt;i&gt;p&lt;/i&gt; = 0.038).Conclusions: LVH is a predictor of poor outcomes in patients with AMI, and eccentric hypertrophy is associated with a worse prognosis compared with concentric remodeling and concentric hypertrophy. Therefore, Korean patients with AMI and LVH, especially eccentric hypertrophy, require more careful observation and intensive treatment.

Structural and Functional Correlates of Gradient-Area Patterns in Severe Aortic Stenosis and Normal Ejection Fraction

ObjectivesThe authors sought to characterize the functional and structural myocardial phenotypes of patients with moderate-to-severe aortic stenosis (AS) and to determine whether severe paradoxical low-gradient AS (LG-AS) is specifically associated with left ventricular (LV) remodeling and fibrosis. BackgroundRecently, it was suggested that severe paradoxical LG-AS is a more advanced form of AS, with greater reduction of longitudinal deformation, adverse LV remodeling, and more interstitial fibrosis. MethodsThe study population includes 147 patients with moderate-to-severe AS and a normal LV ejection fraction, and 75 normal control subjects. They prospectively underwent 2-dimensional speckle-tracking echocardiography and cardiac magnetic resonance to evaluate myocardial deformation, LV remodeling, and age- and sex-adjusted extravascular volume fraction (ECV, %). Among AS patients, 18 had moderate AS, 74 had severe high-gradient AS (HG-AS), and 55 had severe paradoxical LG-AS. ResultsReduced longitudinal and circumferential deformation was observed in 21% and 6% of the AS patients, respectively. Multivariate analyses identified increased ECV (ß = 1.99; p = 0.001) and the absence of normal LV geometry (ß = −1.37; p = 0.007) and as independent predictors of reduced longitudinal deformation. Increased ECV was an independent predictor of reduced circumferential deformation (ß = 2.19; p = 0.001). Over a median follow-up of 29 months, reduced longitudinal deformation (hazard ratio: 0.82; p = 0.023) and higher transvalvular gradients (hazard ratio: 1.05; p < 0.001) increased the risk of death or need for aortic valve replacement. LV hypertrophy was more frequently observed among patients with severe HG-AS (65%) than among the other AS patients (14%; p < 0.001). On average, ECV was within normal limits and did not differ among gradient-area subgroups. When present, increased ECV was associated with reduced longitudinal deformation. ConclusionsThis study’s data show that patients with severe paradoxical LG-AS less frequently display reduced longitudinal deformation, LV hypertrophy, or myocardial fibrosis than patients with HG-AS. Also, interstitial fibrosis only occurs when reduced longitudinal deformation and severe HG-AS are present together. Finally, this study suggests that reduced longitudinal deformation and higher transvalvular gradients adversely affect patients’ outcomes.

Five-year dynamics of carotid artery remodeling in hypertensive patients working on a fly-in/fly-out basis in the Arctic

Aim. To analyze the 5-year dynamics of atherosclerotic remodeling of common carotid arteries (CCA) in persons with hypertension (HTN) working on a fly-in/fly-out basis in the Arctic. To determine sex characteristics, factors associated with atherosclerotic plaque (ASP) imaging, and outcome endpoints. Material and methods. In the period 2012-2017, 372 (men, 273; women, 99) employees with grade 1-2 HTN working on a fly-in/fly-out basis in the Arctic were observed. Depending on the ultrasound data, the subjects were divided into 2 groups: with an initially normal CCA wall (men, 137; women, 65) and with subclinical carotid atherosclerosis (SCA) in the form of intima-media thickness (IMT) increase &gt;0,9 mm (men, 136; women, 34) without differentiable ASPs. The dynamics of CCA wall remodeling was analyzed depending on sex, the level of mean 24-hour blood pressure (BP) and echocardiography data on the left ventricular (LV). Factors associated with the identification of ASPs and endpoints were determined. Results. Men with HTN were significantly more likely to have SCA than women. The frequency of ASP imaging directly depended on the initial CCA characteristics and was higher in both sexes with IMT increase. The level of mean 24-hour BP insignificantly influenced the atherosclerosis severity. According to the 5-year follow-up, the structure of CCA wall changed significantly more often in men than in women. In individuals with concentric LV hypertrophy, regardless of the initial CCA state, the highest prevalence of ASP was recorded. The progression of the atherosclerotic process was more intense in individuals with concentric remodeling and normal LV geometry in combination with IMT increase. In individuals with initial atherosclerosis of CCA, acute myocardial infarction and acute cerebrovascular accident developed significantly more often than in patients with initially normal CCA walls. Conclusion. Under the fly-in/fly-out conditions in the Arctic, in hypertensive men significantly more often than in women, SCA was detected and was characterized by more intense progression during 5-year follow-up. In men, it was significantly more often accompanied by cardiovascular complications. It is important to identify signs of SCA for early initiation of therapy in order to prevent fatal cardiovascular events in Arctic workers.

Features of cardiac remodeling depending on the mode of training session

Different types of physiological adaptation of the heart in athletes are formed depending on the specifics of sports activities. In cyclic, mostly aerobic training athletes (long-distance running, skiing, swimming), left ventricular (LV) dilation with a proportional increase in its wall thickness are mainly developed. Athletes participating in sports with mostly static or isometric component (weightlifters, wrestlers, throwers) develop concentric hypertrophy with increased LV wall thickness without changes in the cavity size. However, changes in the heart geometry in athletes are not limited to eccentric or concentric LV hypertrophy.The aim of this work was to study the features of athletes’ heart remodeling depending on the mode of training session (endurance, speed, strength).Material and methods. After the signing of the informed consent, 104 athletes (84 men and 20 women) were involved in the study: 63 – athletes who mainly trained endurance performance, 31 – strength athletes, 10 – speed athletes. The mean age of the athletes was 21.75 ± 3.32 years. Among them, there were Masters of Sports of International Class (MSIC) – 2 athletes, Masters of Sports (MS) – 25, Candidates Master of Sports (CMS) – 48, First-Class athletes – 29. All the athletes underwent M – and B-mode echocardiographic examination, Doppler interrogation of transvalvular flows and tissue Doppler imaging.Results. In the endurance athletes, unlike the strength athletes, the diameter of the left atrium (P = 0.019) and the right ventricle (P = 0.004) as well as left ventricular myocardial mass index (LVMMI) (P = 0.004) prevailed, all other indicators showed no differences. In the endurance athletes, unlike the speed athletes, interventricular septal thickness (IVST) (P = 0.015), LVMMI (P = 0.003), left ventricle ejection fraction (LV EF) (P = 0.035) and pressure gradient in the aorta (P = 0.024) prevailed. In the strength athletes, unlike the speed athletes, left ventricular end-diastolic diameter was 10.8 % (P = 0.004) larger. The largest left atrial diameter was detected in the endurance athletes, the smallest one – in the strength athletes (P = 0.019).Conclusions. Despite long-term exercise, normal left ventricular geometry remained in 90 % (9/10) of the speed athletes, in 74.2 % (23/31) of the strength athletes, in 46.0 % (29/63) of the endurance athletes (P = 0.012). Left ventricular hypertrophy most commonly occurred in the endurance athletes, unlike the strength athletes (47.6 % vs. 25.8 %, P = 0.044). Eccentric hypertrophy significantly prevailed over concentric type in the structure of hypertrophy in both the endurance athletes (34.9 % vs. 12.7 %, P = 0.045, respectively) and strength athletes (22.6 % vs. 3.2 %, P = 0.023, respectively).

Specifics of Left Ventricular Remodeling and Daily Blood Pressure Profiles in Young and Middle-Aged Servicemembers Dealing with Arterial Hypertension

Objective: Investigating structural and geometrical parameters, specifics of LV remodeling, as well as dailyBP profiles in young and middle-aged service members dealing with hypertension Stage 1 and Stage 2. Agroup of 86 male subjects has been researched, including 52 young (26-44 y/o) and 34 middle-aged (45-55 y/o) subjects with AH. The cardiac function has been evaluated through echo cardiography, and dailyBP monitoring has been carried out. The results of the study have shown that young and middle-agedservicemen with AH have a normal LV geometry (59.6% of young subjects (31), 55.9% of middle-agedsubjects (19)), and concentric LV remodeling has been observed in 40.4% of young subjects (21) and in22.1% of middle-aged (15) subjects with AH. According to data obtained during 24-hr BPM,as comparedto the normal LV geometry group, in the concentric LV remodeling groups the occurrence of the dipper AHprofile has decreased both in young (28.5% vs. 39%) and middle-aged (40% vs. 47.7%) subjects.

RELATION BETWEEN LEFT VENTRICULAR HYPERTROPHY AND SILENT ISCHEMIA DETECTED BY 24-HOUR HOLTER MONITOR IN HYPERTENSIVE AND TYPE 2 DIABETIC PATIENTS

Background: Hypertension is a prevalent and well-recognized cardiovascular risk factor that predisposes to the development of left ventricular hypertrophy (LVH), coronary heart disease and systolic and diastolic dysfunction. The presence of high left ventricular (LV) mass or a high left ventricular mass index (LVMI) is reportedly an independent predictor of increased cardiovascular morbidity and mortality both in the general populations and in hypertensive populations. Ambulatory ECG (Holter) monitoring is a very effective way of measuring ischemic events over 24 hrs. period, it has advantages over exercise testing. Objective: To assess presence of silent ischemia in type 2 diabetic and hypertensive patients with LVH in comparison to type 2 diabetic and hypertensive patients with normal LV geometry. Patients and methods: This study was a pilot one that was carried out on 60 type 2 diabetic and hypertensive patients (28 males and 32 females aged 53.5 ± 10.4). Thirty cases had LVH and the other 30 had normal geometry. This study was conducted from October 2018 to February 2020. All patients were subjected to complete history taking including comorbidities, risk factors and full clinical examination. Patients with baseline ST segment depression > 2 mm in 2 consecutive leads, mitral stenosis, aortic stenosis, congenital heart disease, atrial fibrillation, prior myocardial infarction (MI) or coronary artery bypass graft surgery (CABG), pericardial diseases, advanced renal or hepatic disease were excluded. Echocardiography was done and LV assessment alongside with measuring LVMI. Also, all patients were investigated by 24 hours continuous holter monitoring, and all of them underwent further investigation to assess the presence of CAD either by coronary angiography or multislice CT coronary angiogram. Results: There was a statistically significant relationship between the presence of LVH and positive Holter findings for silent ischemia. Out of 30 patients with normal geometry, 25 patients (83.3%) were negative and 5 patients (16.7%) were positive for silent ischemia. Out of the other 30 patients with abnormal geometry (LVH), 9 patients (30%) were negative and 21 patients (70%) were positive for silent ischemia. In 10 patients with mild LVH, 4 patients (40%) were negative and 6 patients (60%) were positive for silent ischemia. Out of 14 patients with moderate LVH, 4 patients (28.6%) were negative and 10 patients (71.4%) were positive for silent ischemia. As regards the last 6 patients with severe LVH, 1 patient (16.7%) was negative and 5 patients (83.3%) were positive for silent ischemia. Conclusion: The prevalence of silent ischemia markedly increased amongst diabetic and hypertensive patients with LVH in comparison to those with normal left ventricular geometry. The incidence of silent ischemia increased with increased LVMI. Ambulatory ECG monitoring may have a use in the identification of those at greatest risk of cardiovascular complications and sudden death.

Abstract 382: Four-tiered Classification of Left Ventricular Hypertrophy Based on Ventricular Concentricity and Dilatation Identifies Ischemic Stroke in the General Population

Background: Left ventricular hypertrophy (LVH) is traditionally classified as concentric or eccentric based on LV relative wall thickness. We evaluated the prediction of ischemic stroke in a new 4-group LVH classification based on LV concentricity (mass/end-diastolic volume 0.67 ) and indexed LV end-diastolic volume (EDV) in the general Chinese population. Methods: The cross-sectional study consisted of 11,037 general Chinese population (mean age 54 years; 54% women) from Northeast China Rural Cardiovascular Health (NCRCH) study who underwent echocardiography measurement. A 4-tiered classification of LVH was proposed where eccentric LVH is subdivided into “indeterminate hypertrophy (n=484)” and “dilated hypertrophy (n=386)” and concentric LVH into “thick hypertrophy (n=246)” and “both thick and dilated hypertrophy (n=138)” based on the presence of increased LV end-diastolic volume. Results: Compared with normal LV geometry (2.6%), indeterminate (7.4%) and thick hypertrophy (10.2%) showed a higher prevalence of ischemic stroke (p&lt;0.05). Ischemic stroke was significantly greater in participants with indeterminate (adjusted odd ratio [OR]:1.635, 95% confidence interval [CI]: 1.115–2.398) and thick (2.143 [1.329–3.456]) hypertrophy but not significantly in those with dilated (1.251 [0.803–1.950]) and both thick and dilated hypertrophy (0.926 [0.435–1.971]) compared with normal geometry in multivariable analysis. Additionally, the continuous parameters of LV concentricity 0.67 (OR, 1.067; 95% CI, 1.024–1.113 per 1 SD increment) was independently associated with the presence of ischemic stroke in multivariable analysis adjusted for age, sex, race, physical activity, current smoking and drinking status, BMI, TC, hypertension and diabetes, while LVEDV/BSA was not (OR, 0.957; 95% CI, 0.859–1.065 per 1 SD increment). Conclusions: In a large-scale Asian population, we identified that thick hypertrophy carried the greatest odd for ischemic stroke, independently of traditional risk factors, followed by indeterminate hypertrophy. The new 4-tiered categorization of LVH can permit a better understanding of which subjects are at high enough risk for ischemic stroke to warrant early targeted therapy.

Abnormal left ventricular global strain during exercise-test in young healthy smokers

Background. It is unknown how much precociously the cigarette smoking (CS) may compromise the integrity of the cardiovascular (CV) system. Myocardial function can be routinely assessed by conventional echocardiography, but abnormalities are only detected when somewhat a remodelling has already occurred. These limitations could be overcome by strain imaging. Methods. We evaluated whether young smokers with normal left ventricular (LV) geometry, wall motion and ejection fraction may present abnormalities in myocardial deformation, both at rest and during physical effort. We selected 50 young smokers with no additional CV risk factors, and 60 non-smokers to undergo a standardized exercise-test. Consistently, we evaluated the CV adaptation to exercise by both conventional echocardiography and speckle-tracking analysis (2D-STE). Results. We found no difference between smokers and controls regarding baseline characteristics; as expected, smokers presented with lower HDL-cholesterol (p < 0.005), and higher fibrinogen, C-reactive protein (CRP), and interleukin-6 (p < 0.001). Conventional echocardiography parameters were not different between groups, while we detected a different behaviour of global longitudinal strain (GLS), global circumferential strain (GCS) and twist by 2D-STE during exercise-test. Indeed, GLS, GCS and twist behaved differently during exercise test in smokers with respect to controls. We found an association between CS, inflammation and LV mechanics changes uncovered by physical effort, and regression analysis confirmed that the intensity of the exposure to cigarette smoking, together with the inflammatory status (CRP, fibrinogen and Il-6) plasma levels, drive this impairment. Conclusions. We confirm strain imaging (2D-STE) as a very useful tool to identify early changes in cardiac mechanics, as adaptation to exercise; our findings may reflect a very precocious functional abnormality in active smokers, likely long before structural damage occurs.

NLR-A Simple Indicator of Inflammation for the Diagnosis of Left Ventricular Hypertrophy in Patients with Hypertension.

This study included 386 patients with hypertension. Mann-Whitney U test and multivariate binary logistic regression analysis were used to investigate the relationship between NLR, CRP, BNP, and LVH in patients with hypertension, as well as compare the levels of NLR, CRP, and BNP in the four configurations. Receiver operator characteristic (ROC) curve was used to compare the diagnostic efficacy of NLR, CRP, and BNP on LVH. The NLR and CRP and BNP levels of the LVH group were significantly higher than those of the non-LVH group. In the multivariate logistic regression analysis, NLR as well as age, BMI, and SBP were associated with LVH. In addition, in patients with eccentric and concentric hypertrophy, the NLR and CRP and BNP levels were higher than those of the normal left ventricular geometry and concentric remodeling groups. The cutoff values of NLR, CRP, and BNP obtained by ROC curve were 2.185, 2.205, and 283.45, respectively, for the prediction of LVH. NLR is independently associated with LVH in patients with hypertension, and this is consistent with the diagnostic efficacy of CRP and BNP, which may be a simple and convenient indicator for judging LVH.

P302 Forgotten and neglected: LV hypertrophy and LV remodeling as important predictors in patients with mitral valve prolapse

Abstract Current ESC guidelines recommends left ventricular (LV) end-systolic diameter (ESD), LV ejection fraction (LV EF), systolic pulmonary arterial pressure (SPAP) as key parameters in a multifactorial treatment algorithm for chronic severe primary MR. However, LV hypertrophy (LVH) and LV remodelling during the process of adaptation to chronic MR can influence further clinical course. Aim of this study was to test whether LVH and distinctive LV geometry are coupled with increased risk for heart failure (HF) development and occurrence of major adverse cardiac event (MACE) among patients with MVP and can they improve power of statistical models for HF and MACE prediction based on parameters supported by the current guidelines. Methods 376 pts diagnosed with mitral valve prolapse (MVP) between 1. January 2014. and 31. December 2017 and with complete medical chart and follow-up data from central echo laboratory in the tertiary health center were enrolled in the study. Four types of LV geometry were identified: Type 1 (normal LV mass with normal geometry), Type 2 (normal LV mass with concentric remodeling), Type 3 (eccentric hypertrophy) and Type 4 (concentric hypertrophy). The primary outcome was HF and secondary outcome was MACE (HF development, myocardial infarction, myocardial revascularisation (both PCI and/or ACBG) and cardiac death). Results The distribution of patients was as follow: 51.2% (Group 1) vs 3.3% (Group 2) vs 41.4 % (Group 3) vs 4.1% (Group 4). In multivariable model the highest OR for HF development after adjustment for age, ESD and LVH, had concentric LVH (OR= 5.361, p= 0.004, 95% CI 1.696-16.648), then EF &amp;lt; 60% (OR= 3.025, p = 0.004, 95% CI 1.427-6.411) and the lowest OR had SPAP &amp;gt; 40 mmHg (OR = 2.274, p = 0.039, 95% 1.43-4.958). Adding LVH significantly increased model’s power to predict HF above traditional parameters (Chi-square from 19.386 to 23.640, p &amp;lt; 0.001; Nagelkerke R square from 0.090 to 0.110), whereas addition of LV geometry increased it even more (Chi-square from 23.640 to 28.729, p &amp;lt; 0.001; Negelkerke R square from 0.110 to 0.132). Independent MACE predictors in multivariable model were: EF &amp;lt; 60% (OR 3.645, p &amp;lt; 0.001, 95% CI 1.808- 7.50), new onset atrial fibrillation during the follow-up (OR =3.327, p = 0.012, 95% CI 0.305-8.484), concentric LVH (OR= 4.241, p = 0.015, 95% CI 1.327-13.550) and normal LV geometry without LVH (OR= 0.514, p = 0.002, 95% CI 0.288-0.918), even after adjustment for MV surgery. Adding LVH significantly improved model’s power (Chi-square from 29.026 to 35.112, p &amp;lt; 0.001; Nagelkerke R square 0.121 to 0.146) to predict MACE and addition of type of LV geometry provided additional strength (Chi-square from 35.112 to 39.707, p &amp;lt; 0.001; Nagelkerke R square from 0.146 to 0.164). Conclusion LVH and especially concentric LVH are independent predictors of heart failure development and MACE in mitral valve prolapse and significantly improves predictive powers of the models based on traditional parameters.

Relationship between ECG QRS voltage and left ventricular functions in patients with heart failure attending federal Medical Centre Nguru, Northeastern Nigeria

Introduction: Heart failure (HF) is a clinical syndrome characterized by typical symptoms (e.g., breathlessness, ankle swelling, and fatigue) that may be accompanied by signs (e.g. elevated jugular venous pressure, pulmonary crackles, and peripheral edema) caused by a structural and/or functional cardiac abnormality, resulting in a reduced cardiac output and/or elevated intracardiac pressures at rest or during stress. Electrocardiogram (ECG) is a widely available tool; it is relatively inexpensive and simple to perform; and it yields an instant result. A normal ECG makes systolic dysfunction unlikely and is rare in patients with suspected heart failure. Low ECG voltage has been reported as a marker of the severity of HF and is a risk factor for adverse outcomes in patients with systolic HF at 1 year. However, the relationship between ECG QRS voltage and left ventricular function in patients with heart failure has not been evaluated. Therefore, the objective of this study is to determine the relationship between electrocardiographic QRS voltage and left ventricular function. Methodology: This was a prospective cross-sectional study conducted among inpatients with HF in the medical ward of the hospital. Results: Three hundred and sixty patients were recruited for the study, of which 19 had incomplete data and were excluded in the analysis. The remaining 341 subjects were analyzed comprising 215 female and 126 male with a mean age of 47.54 ± 18.85 years. Majority of patients with normal or high QRS voltage had HF with preserved ejection fraction (HFpEF), while those with low QRS voltage had HF with reduced ejection fraction (HFrEF). On the other hand, patients with high QRS voltage had impaired relaxation pattern of diastolic dysfunction, while those with low QRS voltage had a restrictive pattern of diastolic dysfunction. There was a positive and significant correlation between the QRS voltage and ejection fraction, fractional shortening, isovolumic left ventricular relaxation time, and left ventricular deceleration time, while a negative but not significant correlation was observed between electrocardiographic QRS voltage and transmitral E/A ratio. Majority of patients with normal QRS voltage had normal left ventricular geometry, while those with high QRS voltage predominantly had concentric left ventricular hypertrophy and those with low QRS voltage had eccentric left ventricular hypertrophy. Patients with concentric left ventricular hypertrophy had predominantly HFpEF and impaired relaxation pattern of diastolic dysfunction, while those with eccentric left ventricular hypertrophy had HFrEF and restrictive pattern of diastolic dysfunction. Conclusion: HF patients with high QRS voltage had preserved left ventricular systolic function, impaired relaxation pattern of left ventricular diastolic dysfunction, and concentric left ventricular hypertrophy. While those with low QRS voltage predominantly had reduced left ventricular systolic function, restrictive pattern of left ventricular diastolic dysfunction, and eccentric left ventricular hypertrophy.

1033 Prominent longitudinal strain involvement of left ventricular basal segments in native hypertensive patients without clear-cut hypertrophy

Abstract Background Left ventricular (LV) global longitudinal strain (GLS) is able to detect an early subclinical dysfunction and it has been demonstrated to be a prognosticator in arterial hypertension. Information of regional longitudinal strain (LS) pattern has not been investigated in this clinical setting. Purpose We analyzed regional LV patterns of LS and base-to-apex behaviour of LS in newly diagnosed and never-treated hypertensive patients (HTN) without clear-cut LV hypertrophy (LVH). Methods 166 HTN (M/F = 107/59; age 43.9 ± 14.3 years, blood pressure [BP] = 146.5± 10.7/90.1 ± 7.5 mmHg) and a control group of 94 healthy subjects (M/F = 58/36; age 41.2 ± 15.0 years) underwent standard echo-Doppler exam, including speckle tracking quantification of regional LS and GLS (considered in absolute values). The average LS of six basal (BLS), six middle (MLS), and six apical (ALS) segments and relative regional strain ratio - RRSR = [ALS/(BLS + MLS)] - were also computed. Exclusion criteria were LVH (LV mass index ≥45 g/m^2.7 in females and ≥49 g/m^2.7 in males), diabetes mellitus, coronary artery disease, overt heart failure, hemodynamically significant valve heart disease, primary cardiomyopathies, atrial fibrillation and inadequate echo imaging. Results The two groups were comparable for sex, age, heart rate and LV ejection fraction (EF). Body mass index (BMI), systolic (SBP), diastolic (DBP) and mean BP (MBP) (all p &amp;lt; 0.0001), LV mass index (p = 0.03), relative wall thickness (RWT) (p &amp;lt; 0.02) and E/e’ ratio (p &amp;lt; 0.01) were higher, and GLS lower (21.6 ± 2.0 vs. 22.2 ± 2.1%, p &amp;lt; 0.02) in HTN. By analyzing regional LS, BLS (18.2 ± 2.1% vs. 19.2 ± 2.1%, p &amp;lt; 0.0001) and MLS (20.7 ± 2.0 vs. 21.4 ± 2.1%, p = 0.007) resulted significantly lower in HTN, without significant difference in ALS (26.0 ± 3.6 vs. 25.9 ± 3.8%, p = 0.98). Accordingly, RRSR was higher in HTN (0.67 ± 0.09 vs. 0.64 ± 0.09, p &amp;lt; 0.01). Even after excluding patients with LV concentric remodeling (RWT &amp;gt; 0.42) (n = 34), BLS (p &amp;lt; 0.0001) and MLS (p &amp;lt; 0.002) were again lower and RRSR (p &amp;lt; 0.01) higher in HTN than in controls. In the pooled population, BLS negatively correlated with SBP (r=-0.22), DBP (r=-0.25) and MBP (r=-0.26) (Figure) (all p &amp;lt; 0.0001). By a multiple linear regression analysis, after adjusting for age, sex, BMI and RWT, the association between BLS and MBP remained significant (β coefficient=-0.23, p &amp;lt; 0.0001), with an additional significant impact of male sex (β=-0.33, p &amp;lt; 0.0001) (cumulative R²=0.18, SEE = 1.9%, p &amp;lt; 0.0001). Conclusions Besides normal LV EF, GLS is lower in HTN. LS dysfunction involves basal and, with a lower extent, middle myocardial segments, with a compensation of apical segments. RRSR appears to be significantly higher in HTN. These results are even confirmed in hypertensive patients with normal LV geometry. The association of BLS and BP appears to be independent on several confounders. Regional LS pattern might be useful to detect very early LV systolic abnormalities in arterial hypertension. Abstract 1033 Figure. Relation between MBP and BLS

Impact of preprocedural left ventricle hypertrophy and geometrical patterns on mortality following TAVR

In contrast to surgical aortic valve replacement, left ventricle (LV) hypertrophy (LVH) had not been clearly associated with mortality following transcatheter aortic valve replacement (TAVR). We performed a retrospective analysis of patients enrolled in the Israeli multicenter TAVR registry for whom preprocedural LV mass index (LVMI) data were available. Patients were divided into categories according to LVMI: normal LVMI and mild, moderate, and severe LVH. Mild LVH was regarded as the reference group. Additionally, LV geometry patterns were examined (concentric and eccentric LVH, and concentric remodeling). The cohort consisted of 1,559 patients, 46.5% male, with a mean age of 82.2 (±6.8) years and mean LVMI of 121 (±29) g/m2. Rates of normal LVMI and mild, moderate, and severe LVH were 31% (n = 485), 21% (n = 322), 18% (n = 279), and 30% (n = 475), respectively. Three-year mortality rates for normal LVMI and mild, moderate, and severe LVH were 19.8%, 18.3%, 23.7%, and 24.4%, respectively. Compared to mild LVH, moderate LVH and severe LVH were independently associated with an increased risk for all-cause mortality (hazard ratio [HR] 1.58, 95% CI 1.15-2.18, P = .005; HR 1.46, 95% CI 1.1-1.95, P = .009; respectively). Concentric LVH was independently associated with a decreased risk for mortality compared to normal LV geometry (HR 0.75, 95% CI 0.63-0.89, P = .001). Compared to concentric LVH, eccentric LVH was independently associated with a 33% increased risk for mortality (HR 1.33, 95% CI 1.11-1.60, P = .002). Mild concentric LVH confers a protective effect among patients with severe aortic stenosis undergoing TAVR. However, hypertrophy becomes maladaptive, and an increased baseline LVMI, eccentric pattern particularly, may be associated with all-cause mortality in this population.

5-YEAR DYNAMICS OF FEATURES OF LEFT VENTRICULAR GEOMETRY IN PATIENTS WITH ISCHEMIC HEART DISEASE, DEPENDING ON TREATMENT TACTICS

Introduction. For a patient with coronary heart disease, recovery from myocardial revascularization is a complex process. Cardiac remodeling involves, after myocardial infarction, hypertrophy and dilation, resulting in impaired systolic-diastolic cardiac function, which is an additional risk factor for events. Prospective studies have shown a relationship between left ventricular size and the risk of cardiovascular events. Given this, there was a need to conduct our research. Purpose: To determine the prevalence of types of left ventricular geometry in patients with coronary heart disease, post-infarction cardiosclerosis, depending on therapeutic tactics: revascularization or conservative therapy for 60 months. Material and Methods: We examined 101 patients aged 58.6±4.2 years after myocardial revascularization (n = 71) and with conservative treatment only (n = 30), in whom the dynamics of echocardiographic parameters of the heart were evaluated for 5 years. The values ​​of remodeling myocardial mass index of the left ventricle and the relative thickness of the left ventricle were determined. Results and Discussion. At baseline, patients with concentric left ventricular hypertrophy (50.0%) and concentric remodeling (24.1%) predominated in the main group. Normal geometry in 14.8% and eccentric left ventricular hypertrophy were observed in 11.1%. In the comparison group, eccentric hypertrophy and concentric left ventricular remodeling were most commonly observed, 29.6% each, slightly less than 25.9% concentric hypertrophy, and the least was normal geometry (14.8%). After 60 months, patients with both groups did not experience normal left ventricular geometry and concentric remodeling. The concentric type (80.0%) was predominant in the main group, and the eccentric type (55.6%) in the comparison group. Conclusions. In patients with ischemic heart disease, postinfarction cardiosclerosis progresses in 5 year follow-up myocardial hypertrophy regardless of treatment. After revascularization, concentric left ventricular hypertrophy develops more often, whereas under conservative treatment, left ventricular eccentric hypertrophy is combined with systolic dysfunction and left atrial dilatation. After revascularization, an increase in the index was associated with an increase not only in body weight but also in changes in lipid profile and diastolic hypertension.

P3457Oxidative stress and left ventricular remodeling in postmenopausal women

Abstract Purpose To asses the level of oxidative stress in postmenopausal women in dependence of LV structural and functional changes and its filling parameters. Methods 203 postmenopausal women were included in the investigation: 142 women with surgical menopause (average age 44,3±5,4 years, menopause duration 3,8±2,4 years); and 61 women with natural menopause (average age 46,2±4,7 years, menopause duration 4,3±2,1 years). All patients underwent general clinical examination, menopausal index evaluation, ambulatory blood pressure (BP) monitoring (Cardiotens-01, Meditech, Hungary), echocardiographic examination with systolic and diastolic left ventricular (LV) function assessment. We also measured erythrocyte thiobarbituric acid reactive substances (TBARs), ultimate products of lipid peroxidation (Shiff bases), catalase activity and plasma general antioxidant activity. Control group consisted of 35 healthy menstruating women (mean age 39,2±4,2). Statistical methods such as Cruskell-Walles criteria and χ2 test were used. Results Only 39 postmenopausal women (19,2%) had normal LV geometry; 89 pts (43,8%) demonstrated LV concentric hypertrophy, 57 pts (28,1%) – concentric remodeling and 18 women (8,9%) –eccentric hypertrophy. All postmenopausal women showed signs of activation of oxidative stress while reducing the power of antioxidant protection systems, however, these changes were most pronounced in groups of patients with eccentric and especially concentric LV hypertrophy Nobody of included postmenopausal women had LV systolic function failure. Presence of LV diastolic function disturbance was the same in the patients with surgical and natural menopause (54,1% (33 pts) and 59,1% (84 pts), respectively, p=0,231) and did not depend on BP level: 59,1% (52 pts) in hypertensive and 56,5% (65 pts) in normotensive women, p=0,118. We detected that Shiff bases level in postmenopausal women with diastolic dysfunction was increased in 1,5 times in comparison with healthy menstruating women and in 1,3 times in comparison with those postmenopausal women who had no diastolic function disturbance (p&lt;0,01). The level of erythrocyte TBARs in this group was increased in 1,3 and 1,2 times respectively (p&lt;0,05). Erythrocyte catalase activity and plasma general antioxidant activity were decreased in all postmenopausal women in comparison with healthy ones (p&lt;0,01). The presence of LV diastolic dysfunction correlated positively with erythrocyte Shiff bases level (τ=0,47, p&lt;0,01) and negatively – with erythrocyte catalase activity and plasma general antioxidant activity (τ=−0,35 and τ=−0,35, p&lt;0,01 respectively) Conclusions Thus, oxidative stress may play important role in left ventricular remodeling and diastolic dysfunction formation in postmenopausal women.

P2447Defining the values of left ventricular ejection fraction, volumes and strain by 2-dimensional echocardiography in subjects with normal cardiac geometry - a single center study

Abstract Background Left ventricular ejection fraction (LVEF), end diastolic, end systolic volumes (EDV, ESV) and global longitudinal strain (GLS) are very important parameters that are frequently reported in cardiology. Normal cardiac geometry was not considered in articles that published normal values. It is important to know normal parameters for population studies. Our hypothesis is to analyze how EF, volumes and GLS may vary by age groups, gender and BMI in a population with normal cardiac geometry. Purpose To define the values in EF, volumes and GLS measurements in a healthy population with normal cardiac geometry stratified by age groups, gender and body mass index (BMI). Methods This is a single center retrospective study conducted from 2008 to 2018. We selected 4557 subjects (2605 females, 1952 males) &gt;18 years with ≤ mild valvular heart disease, who underwent 2D-echocardiography (2DE) at Mayo clinic, Rochester. All selected subjects had normal LV geometry (i.e., LV mass index≤88g/m2 in females and ≤102g/m2 in males and relative wall thickness ≤0.42 measured by 2DE) and without any cardiovascular risk factors or structural or functional abnormality determined by 2DE. Based on age groups, gender and BMI, we assessed the variability in volumes indexed to body surface area, EF and GLS by Mean ± SD and two sample t-test. Results Mean age was 54±15 years (females = 53±15, males = 56±16), body surface area was 1.9 m2±0.2 (females = 1.8±0.2, males = 2.1±0.2), LV GLS −20.7% ±2 SD (females = −21.2±2, males= −20.2±1.9) ranging −16.1 to −27.6 in both genders (Figure); LVEF by Biplane volume method 62.6% ± 4 SD (females = 63±4.3, males=62±4.5). The end diastolic volume 63.6±11.7 cc/m2 (female = 59.9±10.3, males = 68.1±11.8) and end systolic volume 23.9 cc/m2±5.4 (female = 22.3±4.8, males = 25.9±5.5). LV GLS, Biplane EF values were higher in females and EDV and ESV values were higher in males. LV GLS values decreased with age in females (P&lt;0.0001). While EF increased with age in both genders (P&lt;0.0001), EDV and ESV values decreased with age (P&lt;0.0001). When each gender is sub-divided based on their BMI (&lt;25 and ≥25), GLS, EDV and ESV values were higher in population with BMI &lt;25 (P&lt;0.0001). Normal geometry variables Conclusion To our knowledge, this is the biggest single center study to evaluate LV GLS values, LV EF, ED, ES volumes. These results can be used as reference values in a normal population. Acknowledgement/Funding None

Genetic Determinants of Allograft Hypertrophy- A Human Myocardial Biopsy Study

Background Cardiac Allograft Hypertrophy (CAH) assessed by left ventricular mass (LVM) on imaging at 1 year has been validated as an early predictor of mortality and vasculopathy. The biology of such changes could be starting much earlier in the life of the graft and reflect the beginning of a continuum of remodeling of the transplanted heart that finally leads to chronic rejection and graft failure. However, definitive mechanisms and predictors have not been established. Therefore, we aimed to study the molecular mechanisms of CAH characterized by abnormal echo mass in heart transplant patients. We hypothesized there is a specific genetic signature in the myocardium that can predict the morphological mechanisms of CAH. Methods We used data from our heart transplant biopsy repository where consented patients agree for an extra biopsy and blood to be stored for research during their protocol visits. Biopsies are stored at -80C in RNA later. We used samples from 6 month time-point in a small cohort of randomly selected patients and performed full gene expression profiling using Ilumina Beadarray Microarray Technology. Additionally, clinical and echocardiogram parameters were collected at the same time-point. LVM index and relative wall thickness at 6m from transplant were used to define CAH according to ASE Guidelines. Results A total of 16 patients were included in the analysis. 5 patients had normal LV geometry, 8 had concentric remodeling and 3 concentric hypertrophy (CH). Patients in the abnormal group were significantly older than the patients in the normal group (53.4 vs 60.7 years, respectively, p=0.0478) while there were no other statistically significant differences in the rest of the baseline and clinical parameters. Gene expression data showed a distinct signature on the heatmap for CH (Figure 1). There were 40 genes that were differentially expressed in CH group compared to the rest. Conclusion Only 31% of the patients have a normal echo LVM by 6 months and there is a distinct genetic signature for CH suggesting that there is a specific biological change occurring in the heart as early as 6 months that contribute to hypertrophy. We hope to elicit the biological basis of these changes so as to create therapeutic interventions to temper these changes and promote longevity of grafts.