Normal Left Ventricular Geometry Research Articles

Moderate Aortic Valvular Insufficiency Invalidates Vortex Formation Time as an Index of Left Ventricular Filling Efficiency in Patients With Severe Degenerative Calcific Aortic Stenosis Undergoing Aortic Valve Replacement.

Transmitral blood flow produces a vortex ring (quantified using vortex formation time [VFT]) that enhances the efficiency of left ventricular (LV) filling. VFT is attenuated in LV hypertrophy resulting from aortic valve stenosis (AS) versus normal LV geometry. Many patients with AS also have aortic insufficiency (AI). The authors tested the hypothesis that moderate AI falsely elevates VFT by partially inhibiting mitral leaflet opening in patients with AS. Observational study. Veterans Affairs medical center. Patients with AS in the presence or absence of moderate AI (n = 8 per group) undergoing aortic valve replacement (AVR) were studied after institutional review board approval. None. Under general anesthesia, peak early LV filling (E) and atrial systole (A) blood flow velocities and their corresponding velocity-time integrals were obtained using pulse-wave Doppler transesophageal echocardiography (TEE) to determine E/A and atrial filling fraction (beta). Mitral valve diameter (D) was calculated as the average of major and minor axis lengths obtained in the midesophageal bicommissural (transcommissural anterior-lateral-posterior medial) and LV long-axis (anterior-posterior) TEE imaging planes, respectively. VFT was calculated as 4·(1-beta)·SV/πD(3), where SV = stroke volume measured using thermodilution. Hemodynamics, diastolic function, and VFT were determined during steady-state conditions before cardiopulmonary bypass. The severity of AS (mean and peak pressure gradients, peak transvalvular jet velocity, aortic valve area) and diastolic function (E/A, beta) were similar between groups. Moderate centrally directed AI was present in 8 patients with AS (ratio of regurgitant jet width to LV outflow tract diameter of 36±6%). Pulse pressure and mean pulmonary artery pressure were elevated in patients with versus without AI, but no other differences in hemodynamics were observed. Mitral valve minor and major axis lengths, diameter, and area were reduced in the presence versus the absence of AI. VFT was increased significantly (5.7±1.7 v 3.2±0.6; p = 0.00108) in patients with AS and AI compared with AS alone. Moderate AI falsely elevates VFT in patients with severe AS undergoing AVR by partially inhibiting mitral valve opening. VFT may be an unreliable index of LV filling efficiency with competitive diastolic flow into the LV.

Microalbuminuria is a late event in patients with hypertension: Do we need a lower threshold?

BackgroundMicroalbuminuria (MA) is a marker of vascular damage. However, many studies have observed an increased risk at lower levels of albuminuria than are currently used to define MA. AimTo verify early cardiovascular changes occurring before MA in hypertensive patients. Materials and methodsOne hundred and fifty hypertensive patients and 60 normotensive individuals were divided into normotensive individuals with normal left ventricular (LV) geometry (Group I), hypertensive patients with normal LV geometry (Group II), and hypertensive patients with abnormal LV geometry (Group III). The LV mass index, ambulatory arterial stiffness index, flow-mediated dilatation of the brachial artery, and intima-media thickness (IMT) of the common carotid were assessed. Urinary albumin/creatinine ratio was determined using a morning spot-urine sample. ResultsCompared with Group I, ambulatory arterial stiffness index and IMT were significantly increased and flow-mediated dilatation was significantly decreased in Group II; however, MA did not differ between both groups. These changes were augmented when Group III was compared with Group II. MA significantly increased in Group III compared with Group II. Receiver operating characteristic analysis revealed that MA, with a cut-off value of 19.25mg/g, predicted increased IMT, and abnormal LV geometry in a statistically significant manner. ConclusionMany vascular changes, in the form of increased IMT, reduced vasodilator capacity, and increased arterial stiffness, preceded MA and any change in LV geometry. The results presented here strengthen the usefulness of adopting a lower cut-off to define MA.

Left ventricular geometry and white matter lesions in ischemic stroke patients

Abnormal left ventricular (LV) geometry is associated with extracardiac organ damage in patients with hypertension. The aim of this study was to determine the relationship between LV geometry and white matter lesions (WMLs) in ischemic stroke patients. We retrospectively analyzed data from 155 patients (median age 62; 49.8% male) with mild ischemic stroke (median National Institutes of Health Stroke Scale score 4) who underwent brain magnetic resonance imaging and echocardiography. Patients were categorized into four groups: normal LV geometry, concentric remodeling, eccentric left ventricular hypertrophy (LVH) and concentric LVH. WMLs were graded using the Fazekas scale on fluid-attenuated inversion recovery images. Extensive WMLs were defined as a Fazekas score > 2. Extensive WMLs were more prevalent in patients with concentric LVH, eccentric LVH and concentric remodeling than in those with normal LV geometry. After adjusting for hypertension, age, diabetes mellitus, hypercholesterolemia, glomerular filtration rate and ischemic heart disease, patients with concentric remodeling [odds ratio (OR) 3.94, 95% confidence interval (CI) 1.26–12.31, p = 0.02] and those with concentric LVH (OR 3.69, 95% CI 1.24–10.95, p = 0.02), but not patients with eccentric LVH (OR 2.44, 95% CI 0.72–8.29, p = 0.15), had higher risk of extensive WMLs than patients with normal LV geometry.

Insights from Cardiac Mechanics after Three Decades from Successfully Repaired Aortic Coarctation

Patients who underwent a successful repair of the aortic coarctation show chronic hyperdynamic state and normal left ventricular (LV) geometry; however, there are few data regarding the LV systolic function in the long term. Accordingly, we assessed LV systolic mechanics and factors associated with LV systolic dysfunction (LVSD) in patients with repaired CoA. Clinical and echocardiographic data from 19 repaired CoA were analyzed 28 ± 13 years after surgery. Stress-corrected midwall shortening (sc-MS) and mitral annular peak systolic velocity (S') were analyzed as indexes of LV circumferential and longitudinal systolic function, respectively. Echocardiographic data of CoA patients were compared with 19 patients matched for age and hypertension and 38 healthy controls. Sc-MS was considered impaired if <89%, S' if <8.5 cm/s (10th percentiles of healthy controls, respectively). There were no statistical differences between study groups in LV volumes, mass and geometry. LV ejection fraction and Sc-MS were similar in all groups, however, CoA group had a significantly lower peak S' in comparison with matched and healthy controls (7.1 ± 1.3, 10.3 ± 1.9, and 11.1 ± 1.5, respectively; all P < 0.001). Prevalence of longitudinal LVSD defined as low S' was 84% in CoA, 13% in matched, and 5% in healthy control group (all P<0.05). Multivariate logistic regression analysis revealed that low peak S' was independently related to higher E/E' ratio and the presence of CoA. Patients who underwent a successful repair of CoA commonly show asymptomatic longitudinal LVSD associated with worse LV diastolic function in the long-term follow-up.

Left Ventricular Hypertrophy in Asymptomatic Nonsevere Aortic Stenosis

Increased biomechanical stress on cardiomyocytes because of outflow obstruction secondary to aortic stenosis (AS) is thought to induce reexpression of the fetal gene program, which modifies myocyte efficiency, sarcomere composition, and regulation of extracellular matrix, as well as various nuclear signal transduction pathways resulting in autocrine production and secretion of cytokines, neurohormones and growth factors that ultimately promote ventricular hypertrophy.1,2 See Article by Gerdts et al The traditional view of adaptative concentric left ventricular hypertrophy (LVH) because of parallel replication of new sarcomeres is that wall thickness increases to normalize LV systolic wall stress and preserve systolic performance. This view, accepted for the past 40 years3 and perhaps counterintuitively expected to mitigate the effects of LV pressure overload on cardiovascular morbidity and mortality, has begun to be challenged by new clinical data, suggesting that moderate or severe LVH may be associated with adverse outcomes in AS4,5 and that inappropriately increased LV mass, found in 17% of patients with mild to moderate AS6 and in 67% of patients with asymptomatic severe AS, was associated with a 4.5-fold increased risk of cardiovascular events.7 Conversely, the absence of hypertrophy in one third of the patients with severe AS seems to have no adverse effects on systolic function or survival.8,9 Experimental studies in genetically modified animal models are consistent with clinical observations.10 In addition, no association was found between AS severity and the magnitude or pattern of LVH using cardiac magnetic resonance.11 Thus, it seems that the presence, severity, and the geometric pattern of LVH in AS vary widely, are …

Risk of mortality in relation to an updated classification of left ventricular geometric abnormalities in a general population: the Pamela study.

We estimated the risk of cardiovascular and all-cause mortality associated with left ventricular geometric patterns, as defined by a new classification system proposed by the Dallas Heart Study, in 1716 representatives of the general population of Monza enrolled in the Pressioni Monitorate e Loro Associazioni (PAMELA) study. Cut-points for abnormal left ventricular geometric patterns were derived from reference values of the healthy fraction of the PAMELA population by combining left ventricular mass (LVM) index, left ventricular diameter and relative wall thickness. Death certificates were collected over an average 211 months follow-up period. During follow-up, 89 fatal cardiovascular events and 264 all-cause deaths were recorded. Concentric remodelling was the most common left ventricular geometric abnormality (9.4%) followed by eccentric nondilated left ventricular hypertrophy (LVH) (6.3%), concentric LVH (4.6%) and eccentric dilated LVH (3.5%). Compared with normal left ventricular geometry, concentric LVH [hazard ratio 2.20, 95% confidence interval (95% CI) 1.44-3.37, P < 0.0003], eccentric dilated LVH (hazard ratio 1.90, 95% CI 1.17-3.08, P = 0.009) and eccentric nondilated LVH (hazard ratio 1.57, 95% CI 1.07-2.31, P = 0.02) predicted the risk of cardiovascular mortality, after adjustment for baseline covariates, including ambulatory blood pressure. Similar findings were observed for all-cause mortality. Only concentric LVH maintained a significant prognostic value for both outcomes after adjustment for baseline differences in LVM index. The new classification system of left ventricular geometric patterns may improve mortality risk stratification in a general population. The risk is markedly dependent on LVM values; only concentric LVH provides a prognostic information beyond that conveyed by cardiac mass.

Echocardiographic Characteristic Of Left Ventricular Geometry Of 12-17 Years Athletes

Aim. To compare the type of left ventricular geometry associated with training among 12-17 years athletes currently competing in cycling, rowing and basketball playing and to determine the factors influencing left ventricular geometry. Methods. A total 167 male athletes 12-17 year-old, involved in basketball (n = 62), academic rowing (n =51) and cycling (n = 54) and 168 sedentary non-athletes, matched for age and sex were involved in this study. All participants underwent twodimensional, M-mode and Doppler echocardiography. To estimate left ventricular geometry relative wall thickness and left ventricular mass index were calculated. Left ventricular geometry was assessed as normal, eccentric ventricular hypertrophy, concentric left ventricular hypertrophy, concentric left ventricular remodeling. Results. Left ventricular hypertrophy was present in 48 % of all athletes, predominantly (34 %) eccentric hypertrophy. 16% of athletes had concentric hypertrophy. Only 7% of athletes manifested concentric remodeling. The prevalence of eccentric hypertrophy was more common in cyclists (54%), concentric hypertrophy was more frequent in rowers (38%), and normal left ventricular geometry was more common in basketball players (53%). Multivariate regression analysis showed that age was the important determinant of eccentric and concentric left ventricular hypertrophy. Eccentric left ventricular hypertrophy also was independently associated to training volume (hour per week) and cycling sporting discipline. Conclusion. Almost half of athletes (48%) had left ventricular hypertrophy, predominantly eccentric hypertrophy, and the age was the important determinant of left ventricular hypertrophy (eccentric and concentric). Training volume and cycling sporting discipline were significantly associated with eccentric left ventricular hypertrophy.

37. Restoration of normal left ventricular geometry after percutaneous mitral annuloplasty – Case report and review of literature

Surgical mitral valve intervention is not considered suitable in patients with severe functional mitral regurgitation due to severe dilated cardiomyopathy and severe systolic dysfunction. In such patients percutaneous mitral valve intervention is the next best alternative. We are presenting case report of a patient who presented with severe dyspnea progressing to orthopnea and paroxysmal nocturnal dyspnea. He was found to have severe functional mitral regurgitation and severe left ventricle systolic dysfunction. Surgical mitral intervention was not considered suitable and percutaneous mitral annuloplasty was done. At one month follow-up significant improvement in symptoms were noted with improvement in severity of mitral regurgitation severity. At six months follow-up further improvement in symptoms were noted along with significant improvement in the severity of mitral regurgitation and normalization of left ventricle geometry. At one year follow-up his symptoms further improved, left ventricle geometry remained normal and mitral regurgitation severity remained mild to moderate. Our case demonstrate that in patient with severe LV systolic dysfunction, severe mitral regurgitation and LBBB percutaneous mitral annuloplasty can obviate the need for CRT-D due to significant improvement in LV function and geometry along with regression in severity of mitral regurgitation. Improvement in mitral regurgitation severity and LV geometry started early and kept improving with excellent result at 6 and 12 months.

Analysis of left ventricular hypertrophy predictors in women with different levels of obesity

Introduction. Previous studies have shown that patients with obesity had left ventricular hypertrophy (LVH) in 27–69,4% cases along with normal geometry of left ventricle (LV).Aim. To investigate new possible clinical and hormonal predictors of LVH in women with obesity of different degrees.Materials and methods. We conducted trans-sectional study in women with obesity, we performed clinical examination and echocardiography with calculation of mass of myocardium of LV (MMLV), indexed MMLV (IMMLV) to body surface area and relative wall thickness (RWT). LVH was diagnosed at IMMLV≥95 g/m2, increase of RWT when RWT≥0.42. Blood levels of fasting insulin, leptin and adiponectin were investigated. Differences between groups were assessed with Student’s t-test for independent samples, U-criterion of Mann-Whitney and Chi-square test (χ2). Correlation was estimated with Spearman's coefficient (rs). Multiple and logistic regression analyses were performed for detection of predictors. Statistics were performed with SPSS (version 13.0), differences were significant at level p0.05.Results. We assessed the results in 113 women (age 44.34±11.18 years, body mass index 35.0±5.3 kg/m2). Total 67 women were diagnosed with LVH (59.3%), 56.5% among them had arterial hypertension (AH). Increase of RWT was revealed in 25 participants (22.1%), 80% of them had arterial hypertension (AH). Levels of fasting leptin, insulin and adiponectin did not differ in groups of women with or without LVH, with or without increase of RWT. In multiple regression age (β=1.67, p=0,005), body mass (BM) (β=2.63, p=0.004) and mean blood pressure (BP) (β=1.07, p=0.009) were independent predictors of MMLV increase; age (β=0.83, p=0.006) and mean BP (β=0.56 p=0.007) – predictors of IMMLV increase. In logistic regression age (odds ratio (OR)=1.058, p=0.036) and BM (OR=1.065, p=0.05) were independent predictors of LVH; presence of AH (OR=4.011, p=0.05) and level of adiponectin (OR=2.618, p=0.048) – predictors of RWT increase.Conclusions. Women with obesity with or without AH had LVH in 59.3% cases. Age and BM were independent positive predictors of LVH, presence of AH and adiponectin – independent positive predictors of increase of RWT of LV.

The influence of left ventricular geometry on left atrial phasic function in hypertensive patients

Objective. We aimed to investigate left atrial (LA) phasic function in hypertensive patients with different geometric patterns using two-dimensional (2DE) and three-dimensional (3DE) echocardiography. Methods. This cross-sectional study included 213 hypertensive subjects who underwent a complete 2DE and 3DE examination. The new updated criteria for left ventricular (LV) geometry, which consider LV mass index, LV end-diastolic diameter and relative wall thickness, were applied. According to this classification, the subjects were divided into six groups: normal geometry, concentric remodeling, eccentric non-dilated left ventricular hypertrophy (LVH), concentric LVH, dilated LVH and concentric-dilated LVH. Results. 2DE and 3DE LA volumes gradually increased from normal LV geometry to concentric and concentric-dilated LVH. LA reservoir and conduit functions, estimated by 2DE and 3DE LA total and passive emptying fractions, were decreased in subjects with concentric and concentric-dilated LVH. LA booster pump function was increased in patients with concentric, dilated and concentric-dilated LVH compared to subjects with normal LV geometry. The same results regarding LA phasic function were provided by 2DE strain analysis. Concentric, dilated and non-concentric dilated LVH were associated with LA enlargement independently of main demographic and clinical features. Conclusion. LV geometric patterns significantly influence LA phasic function. Concentric and dilated LVH patterns have the most prominent negative effect on LA enlargement assessed by both 2DE and 3DE.

PP.04.18

Objective: To study ethnic characteristics of cardiac remodeling and distribution of various types of remodeling in arterial hypertension (AH). Design and method: Participants were 66 patients (21 men and 45 women) with hypertension II degree, aged 30–65 years. Two ethnic groups were presented: Russian - 31, Kazakh - 35. The average age was 58,1 (CI 54,9; 61,3) years. For presentation, the following parameters by echocardiography were determined: end-diastolic dimension (CRA) of the left ventricle (LV), interventricular septum thickness (IVST) and posterior wall of the left ventricle (TPWLV), left ventricular mass (LVM), the index of left ventricular mass (LVMI). Depending on the values of the index of relative wall thickness (RWT) index and left ventricular mass (LVMI) patients were divided into 4 groups: 1 - patients with normal LV geometry (RWT <0.45); 2 - patients with concentric left ventricular restructuring (RWT > 0,45); 3 - patients with concentric LV hypertrophy (OTS > 0,45 and increased LVMI); 4 - patients with eccentric LV hypertrophy (RWT < 0.45 and increased LVMI). Results: All types of cardiac remodeling were identified among hypertensive patients. Frequently diagnosed type is concentric LVH (42%), less often - the type of eccentric LVH (20%) and significantly less - concentric LV restructuring (8%), while 30% patients were identified with normal LV geometry. Hypertensive patients among Russian population most frequently have concentric type of LVH (38%, p = 0.75), less often - the type of eccentric LVH (31%, p = 0.098) and left ventricular concentric restructuring (8%, p = 0.78). Normal LV geometry was found in 21% of cases (p = 0.23). Hypertensive patients among Kazakh population concentric LVH was significantly prevailed in 42% of cases, normal LV geometry (in 35% of patients). Concentric restructuring was found in 10% of cases and eccentric LVH - 13% of male. Conclusions: Various types of remodeling and ethnic differences were identified. Concentric LVH was determined as a leading option of cardiac remodeling among Russian and Kazakh patients with hypertension, concentric left ventricular restructuring – less often. Significant percentage of patients with normal LV geometry was diagnosed in both study groups.

8A.04

Objective: We estimated the risk of cardiovascular and all-cause mortality associated with left ventricular (LV) geometric patterns, as defined by a new classification system proposed by the Dallas Heart Study, in 1716 representatives of the general population of Monza enrolled in the Pressioni Monitorate e Loro Associazioni (PAMELA) study. Design and method: Cut-points for abnormal LV geometric patterns were derived from reference values of the healthy fraction of the PAMELA population by combining LV mass (LVM) index, LV diameter and relative wall thickness. Death certificates were collected over an average 211 months follow-up period. Results: During follow-up, 89 fatal cardiovascular events and 264 all-cause deaths were recorded. Concentric remodeling (CR) was the most common LV geometric abnormality (9.4%) followed by eccentric non-dilated LVH (6.3%), concentric LVH (4.6%) and dilated LVH (3.5%). Compared to normal LV geometry, concentric LVH (HR = 4.04, 95% CI: 2.05–7.97, p < 0.0001), dilated LVH (HR = 3.83, 95% CI: 1.93–7.60, p = 0.0001) and eccentric non-dilated LVH (HR = 2.61, 95% CI: 1.39–4.92, p = 0.003) predicted the risk of cardiovascular mortality, after adjustment for baseline covariates, including ambulatory blood pressure. Similar findings were observed for all-cause mortality. Only concentric LVH maintained a significant prognostic value for both outcomes after adjustment for baseline differences in LVM index. Conclusions: The new classification system of LV geometric patterns, may improve mortality risk stratification in a general population. The risk is markedly dependent on LVM values; only concentric LVH provides a prognostic information beyond that conveyed by cardiac mass.

Percutaneous left ventricular restoration.

The ventricular partitioning device known as Parachute is the first and only percutaneously implantable device aimed at restoration of normal left ventricular geometry in humans. Since its conception, this technology has undergone extensive animal and human testing, with proved feasibility and safety, and is currently being studied in a pivotal randomized clinical trial. This article discusses ventricular remodeling and therapies attempted in the past, details the components of the ventricular partitioning device, describes the implanting technique, and reviews the most current experience of this device in humans.

Abstract 18623: Evaluation of Left Ventricular Geometry Changes in Patients with Tight Aortic Stenosis Using Multi-detector Computed Tomography

Background: Although aortic stenosis (AS) is a prototype of left ventricular hypertrophy (LVH) due to pressure overloading, patterns of LV geometric changes in patients with tight AS and their potential impact remain to be established. Methods: LV mass index (LVMI), LV end-diastolic volume (LVEDV) and regional LV wall thickness in 16 segments were measured in 147 patients with tight AS (indexed aortic valve area [AVA] &lt; 0.6 cm 2 /m 2 ) using multi-detector computed tomography and compared with those of 32 normal controls. LVH was defined as LVMI &gt;95 th percentile of normal controls and LV remodeling as increased LVM/LVEDV with normal range of LVMI. Asymmetric remodeling or hypertrophy were used for patients with septal wall thickness &gt;1.5 fold compared to the opposite segment. Patients with increased LVMI but normal range of LVM/LVEDV were classified to have eccentric LVH and those with eccentric LVH and decreased LV systolic function were defined to have de-compensation. Results: AS patients with mean indexed AVA of 0.36 ± 0.08 cm 2 /m 2 showed 7 different patterns of LV geometry including normal LV geometry (n=44), remodeling (n=7), asymmetric remodeling (n=7), concentric hypertrophy (n=16), asymmetric hypertrophy (n=23), eccentric hypertrophy (n=38), and de-compensation (n=12). Peak transaortic velocity (r=0.31, p&lt;0.001) and E/E’ (r=0.29, p&lt;0.001) showed positive correlation with LVMI: compared to other groups, patients with LVH (concentric or asymmetric or eccentric) showed higher peak velocity and E/E’ with smaller AVA (all, p&lt;0.001). Despite similar AVA and mean pressure gradient, patients with E/E’ ≥ 15 (n=110) showed different LV remodeling patterns (p=0.028) with higher LVMI (97.8 ± 21.1 vs 86.4 ± 20.2 g/m 2 , p=0.005). Conclusions: Various remodeling patterns of LV geometry were observed in tight AS and individual variation in LVH severity under similar LV pressure overloading could explain different severity of diastolic dysfunction.

The impact of the metabolic syndrome on the outcome after aortic valve replacement.

The aim of this study was to examine the influence of the metabolic syndrome on the left ventricular geometry as well as on the early and mid-time outcome in patients with aortic stenosis who underwent aortic valve replacement. The study included 182 patients who underwent aortic valve replacement due to aortic stenosis. The metabolic syndrome was defined by the presence of at least three AHA-NHLB (American Heart Association/National Heart, Lung and Blood Institute) criteria. All the patients were followed for at least 2 years after the surgery. The metabolic syndrome did not influence the severity of aortic stenosis (mean gradient and aortic valve area). However, the metabolic syndrome was associated with the reduced prevalence of the normal left ventricular geometry and the increased risk of concentric left ventricular hypertrophy in patients with aortic stenosis. Among the metabolic syndrome criteria, only increased blood pressure was simultaneously associated with the short-term and mid-term outcome, independently of other risk factors. Increased fasting glucose level was an independent predictor of the only 30-day outcome after the valve replacement. The metabolic syndrome and left ventricular hypertrophy were, independently of hypertension and diabetes, associated with the 30-day outcome, as well as incidence of major cerebrovascular and cardiovascular events in the 2-year postoperative period. The metabolic syndrome does not change severity of the aortic stenosis, but significantly impacts the left ventricular remodeling in these patients. The metabolic syndrome and left ventricular hypertrophy, irrespective of hypertension and diabetes, are predictors of the short-term and mid-term outcome of patients with aortic stenosis who underwent aortic valve replacement.

Assessment of the left ventricular myocardium function of hypertension with normal left ventricular geometry using speckle tracking imaging

Objective: To evaluate the value of speckle tracking imaging (STI) in assessing left ventricular myocardium function of hypertension patients with normal left ventricular geometry. Methods : Forty hypertension Patients with normal filling (group A), 40 with abnormal relaxation (group B) and 30 normal controls (group NC) were studied. The global Peak systolic longitudinal strain rate, the mean Peak early diastolic longitudinal strain rate and the mean peak LV systolic longitudinal strain rate during atrial systole of whole-layer myocardium and subendomyocardium were measured. twist at aortic valve closure, twist at mitral valve opening, untwisting rate and twisting half-time of left ventricular were calculated. Results : Compared with those in group NC, the patients in group A had lower values of subendomyocardium GSrL S, but higher values of subendomyocardium GSrL A ( P <0.05), group A and group B had higher values of MV-Prot, AP-Prot,lower values of UntwRand HTU increased ( P <0.05). Compared with group A, AP-Prot increased in group B ( P <0.05), but UntwR decreased ( P <0.05). Conclusion : STI is of great value in quantitative analysis of the left ventricle myocardium function through detecting the subendomyocardium global peak systolic longitudinal strain rate and twisting parameters with essential hypertension. It is also a useful tool to assess the early damage of left ventricle myocardium in patients.

Cardiometabolic Phenotype in Children with Obesity

To investigate the anthropometric and metabolic correlates of different patterns of left ventricular (LV) geometry in a cohort of outpatient children with high prevalence of obesity. Anthropometric measures, lipid profile, blood pressure (BP), fasting plasma glucose (FPG), and echocardiographic variables were evaluated in 281 white children (6-16 years), of whom 105 were obese and 105 were morbidly obese. Patterns of LV geometry were defined as follows: normal geometry, eccentric LV hypertrophy (LVH), concentric LV remodeling, and concentric LVH. One hundred forty-eight children exhibited normal LV geometry, 53 eccentric LVH, 36 concentric LV remodeling, and 44 concentric LVH. The 4 groups differed in body mass index, waist circumference, waist-to-height ratio, triglycerides/high-density lipoprotein cholesterol ratio (Tg/HDL-C), and BP (P < .05-.0001). A statistically significant impairment of diastolic function (expressed as greater E/E', P < .002) was observed across patterns of LV geometry. Among anthropometric measures, waist-to-height ratio showed better performance in relation to LVH, with an optimal cut-point of 0.58, compared with body mass index and waist circumference. Children with concentric LVH exhibited the worst metabolic risk profile, with greater prevalence of visceral obesity, high Tg/HDL-C, high BP, and high-normal FPG, than children with normal LV geometry. In children with high levels of obesity, an unfavorable "cardiometabolic phenotype" can be identified, which includes concentric LVH, visceral obesity, high BP, high Tg/HDL-C, and high-normal FPG.

Evaluation of left atrial function in hypertensive patients with and without left ventricular hypertrophy using velocity vector imaging.

To study left atrial deformation characteristics using Velocity vector imaging (VVI) in hypertensive patients with and without left ventricular hypertrophy (LVH), and to explore its value for detection of left atrial dysfunction in these patients. Sixty-four patients with essential hypertension were divided into normal left ventricular geometry (LVN, 37 cases) and LVH (27 cases) groups, according to their left ventricular mass index. Twenty-five age-matched healthy participants were included as control group. Two-dimensional dynamic images of the apical four- and two-chamber echocardiographic views were obtained, and strain/strain rate (SR) curves of eight atrial segments were derived by VVI software. Peak systolic strain (ε(sys)), systolic SR (SRs), early and late diastolic SR (SRe, SRa) were measured and calculated. Peak early diastolic mitral inflow and annulus velocities were also measured and their ratio (E/E') calculated. Compared with the control group, SRe decreased and SRa increased significantly in LVH group (P < 0.05), while no significant difference was found between LVN and control groups with respect to SRe, SRa, SRs and ε(sys) (P > 0.05). Also, no significant difference was observed in SRe, SRa, SRs and ε(sys) between LVH and LVN groups (P > 0.05). SRe and SRa correlated significantly with E/E' (r = -0.634, r = 0.609; both P < 0.001). Strain/SR parameters derived from VVI may reflect decreased conduit, increased booster pump function of the left atrium in hypertensive patients with LVH and correlate with left ventricular diastolic function.

Left Ventricular Geometry and All-cause Mortality in Advanced Age

Abnormalities of cardiac structure and function are common in a wide range of populations including those with and without established clinical cardiovascular disease (CVD). This study reports the prevalence of left ventricular hypertrophy (LVH), the four patterns of LV geometry and establishes clinical characteristics and five-year outcomes of each group in people of advanced age. A study conducted in general practices and Māori Health Services in three New Zealand North Island locations. One hundred participants had a full clinical echocardiogram performed and analysed in 2008 by one experienced cardiologist blinded to the participant's clinical history. Two-thirds of the participants had CVD. Thirty-two participants had echocardiographic LVH. Those with LVH had higher left atrial area [median (IQR) 26.4cm(2) (10.9) vs. 22.0cm(2) (7.0), p<0.01] and E/e' [median (IQR) 13 (6.8) vs.10.8 (4.1), p=0.01] than those without LVH. Of those with LVH, 10 demonstrated concentric hypertrophy (CH) and 22 eccentric hypertrophy (EH); 12 concentric remodelling (CR) and 40 normal geometry (NG). Both CR and EH were independently associated with higher risk of all-cause mortality (p<0.01) and hospital admissions (p<0.05) than those with NG. Those with EH also had a higher risk of CVD events (p=0.029). Despite a high prevalence of CVD and hypertension in this sample, half had normal LV geometry. Concentric remodelling and eccentric hypertrophy were associated with higher mortality and adverse CVD outcomes in people of advanced age.

Imaging Challenges in Secondary Mitral Regurgitation

Chronic secondary mitral regurgitation (SMR) is a complex entity that is often clinically underappreciated.1 It complicates either ischemic heart disease or dilated cardiomyopathy; its prevalence varies among series but may reach ≤50% in patients with heart failure.2 When present, SMR may exhibit a broad range of severity and confers an adverse prognosis, which is worse with increasing severity of mitral regurgitation (MR).3,4 The management of SMR poses a unique set of challenges, based partly on the complexity of the valve disorder and the still-evolving adoption of the optimal therapeutic approach.5 Noninvasive imaging and, in particular, echocardiography, plays a critical role for the initial and longitudinal assessment, for individual risk stratification and outcome prediction, and for guiding intervention in patients with chronic SMR.6 SMR develops because of a combination of mitral leaflet tethering secondary to left ventricular (LV) dilatation/deformation with papillary displacement/discoordination, annular dilatation/dysfunction, insufficient LV-generated closing forces attributable to reduction of LV contractility, and global LV/papillary muscle dyssynchrony.1,5 Tethering of the mitral leaflets is the principal lesion of SMR and results in restriction of systolic leaflet motion, namely type IIIb of Carpentier’s classification. SMR does not typically occur in global LV dysfunction without tethering. However, once tethering occurs, leaflet closure is further impaired by LV dysfunction because there is decreased force opposing tethering.6–9 The key event in the pathogenesis of SMR is the distortion of normal LV geometry—regional and global LV remodeling—with subsequent apical and lateral displacement of papillary muscles, which, in turn, draws the chordae tendineae away from the line of coaptation.7,8 The extent of LV systolic dysfunction and dilatation is weakly correlated to the degree of SMR unless accompanied by geometric distortion in the region of the papillary muscles.1,9 …