Normal Left Ventricular Mass Index Research Articles

Prediction of the left ventricular mass index in hypertensive patients using the product of red cell distribution width and mean corpuscular volume.

The product of red cell distribution width (RDW) and mean corpuscular volume (MCV) has been identified as an indicator of target organ damage in cases of hypertension. However, the role of the RDW-MCV product in assessing carotid alteration, renal damage, and left ventricular hypertrophy in patients with hypertension has not been elucidated. In this cross-sectional study, a total of 1115 participants with hypertension were included. The RDW and MCV at admission were measured using an automated hematology analyzer. Organ damage was determined by the left ventricular mass index (LVMI), carotid intima-media thickness, and estimated glomerular filtration rate. The prevalence rates of carotid alteration and left ventricular hypertrophy were 57.0% and 18.0%, respectively. A higher RDW-MCV product and RDW were observed in hypertensive patients who developed carotid alteration. After adjusting for potential confounding factors, the correlations of the RDW-MCV product (P = .285) and RDW (P = .346) with carotid alteration were not significant. Moreover, the analysis of variance showed no significant correlation between RDW and LVMI (P = .186). However, the RDW-MCV product was higher in individuals with a high LVMI compared to those with a normal LVMI. Multivariable linear regression analysis revealed that the RDW-MCV product was independently associated with the LVMI (β = 2.519, 95% CI: 0.921-4.116; P = .002), but not the estimated glomerular filtration rate (β = -0.260, 95% CI: -2.031-1.511; P = .773). An elevated RDW-MCV product may be a predictor for left ventricular hypertrophy in patients with hypertension.

Evaluating left atrial function changes by speckle tracking echocardiography in type 2 diabetes patients in Central Vietnam: a cross-sectional comparative study

BackgroundType 2 diabetes mellitus (T2DM) is a metabolic disorder that detrimentally affects multiple systems in the body, with a particular emphasis on the vascular and nervous systems. Despite its significant impact, limited studies have explored the influence of this condition on the left atrial (LA) function. To address this gap, our study utilized speckle tracking echocardiography (STE) to assess LA function in patients with T2DM in Central Vietnam.ResultsThe cross-sectional comparative study enrolled 134 subjects involving 66 patients with T2DM and 68 healthy individuals meeting the selection and exclusion criteria of the study. In our study, healthy individuals demonstrated higher values for LA reservoir strain (LASr), LA conduit strain (LAScd), and LA contractile strain (LASct), measuring 38.75% ± 5.43%, 19.58% ± 5.91%, and 19.16% ± 4.98%, respectively. In contrast, the T2DM group exhibited lower values for LASr, LAScd, and LASct, which measured 31.2% ± 4.56%, 14.77% ± 6.3%, and 16.36% ± 4.82%, respectively (p < 0.05). T2DM patients with normal LA volume index (LAVI) and normal left ventricular mass index (LVMI), LASr, LAScd, and LASct results were 32.07% ± 5.28%, 16.28% ± 6.95%, and 15.64% ± 5.32%. respectively.ConclusionsSTE of the LA reveals a noteworthy reduction in reservoir, conduit, and contractile functions within the T2DM group when compared to the control group (p < 0.05). Furthermore, these impaired functions persist in T2DM patients even in the absence of increased LAVI and LVMI.

Association of major adverse cardiovascular events and all-cause mortality with left ventricular geometry in elderly

Abstract Objective To investigate the association of major adverse cardiovascular events and mortality with left ventricular geometry in elderly. Methods We prospectively recruited 3363 community-dwelling elderly (43.6% male, aged 71.1±5.9 years; 56.4% female, aged 71.1±6.1 years) from local community. Echocardiographic parameters were collected, left ventricular mass index (LVMi) above 115 g/m2 in male or 95 g/m2 in female, relative wall thickness (RWT) above 0.42 were considered as abnormal. Participants then were classified into 4 mutually exclusive groups as: normal geometry (normal LVMi and normal RWT), concentric remodeling (normal LVMi and increased RWT), eccentric hypertrophy (increased LVMi and normal RWT), concentric hypertrophy (increased LVMi and increased RWT). Cardiovascular death, non-fatal myocardial infarction including non-fatal ischemic stroke were recorded as incident MACE. Adjusted Cox regression models were used to evaluate the hazard ratios of MACE and all-cause mortality. Results Mean LVMi and RWT were 87.0 ± 28.4 g/m2 and 0.39 ± 0.08. During a median follow-up of 5.4 years, we identified 224 incident MACE cases and 233 deaths. All-cause mortality was significantly greater in participants with eccentric hypertrophy (adjusted hazard ratio [HR]: 1.649; 95% confidence interval [CI]: 1.143-2.379) compared with normal geometry in multivariate analyses after adjusting for baseline covariates. Incident MACE was significant both in concentric hypertrophy (HR:1.982; 95% CI: 1.239-3.170) and eccentric hypertrophy (HR:1.846; 95% CI: 1.266-2.692) but not in concentric remodeling (HR:1.101; 95% CI: 0.759-1.597). Baseline LVMi was a significant predictor of all-cause mortality (HR:1.047 per 10g/m2 increase in LVMi; 95% CI: 1.004-1.093). Similar results were observed with non-fatal myocardial infarction, non-fatal ischemic stroke and cardiovascular death. Conclusion Increased baseline LVMi and abnormal left ventricular geometry portend an increased risk for incident MACE and all-cause mortality in community dwelling elderly. From the pathophysiology point of view, per 10 g/m2 increase in LVMi add 5% risk for all-cause mortality.TablesFigures

Left Ventricular Mass, Myocardial Structure, and Function in Severe Aortic Stenosis: an Echocardiographic and Cardiac Magnetic Resonance Imaging Study

In severe aortic stenosis (AS), there are conflicting data on the prognostic implications of left ventricular (LV) hypertrophy (LVH). We aimed to characterize the LV geometry, myocardial matrix structural changes, and prognostic stratification using cardiac magnetic resonance imaging (CMR) and echocardiography in subjects with severe AS with and without LVH. Consecutive patients who had severe isolated AS and sufficient quality echocardiography and CMR within 6months of each other were evaluated for LVH, cardiac structure, morphology, and late gadolinium-enhancement imaging. Kaplan-Meier curves, linear models, and proportional hazards models were used for prognostic stratification. There were 93 patients enrolled (mean age 74 ± 11years, 48% female), of whom 38 (41%) had a normal LV mass index (LVMI), 41 (44%) had LVH defined at CMR by LVMI >2 SD higher than normal, and 14 (15% of the total) with >4 SD higher than the reference LVMI (severely elevated). The Society of Thoracic Surgeons scores were similar among the LVMI groups. Compared with those with normal LVMI, patients with LVH had higher LV end-diastolic and end-systolic volumes, increased late gadolinium-enhancement burden, and lower LV ejection fraction. Most notably, CMR feature-tracking global radial strain, 2-dimensional speckle-tracking echocardiography global longitudinal strain, and left atrial reservoir function were significantly worse. On the survival analyses, LVMI was not associated with a composite of all-cause mortality and/or heart failure hospitalization. In conclusion, compared with normal LVMI, elevated LVMI was not associated with a higher risk of adverse outcomes.

ASSOCIATION OF MAJOR ADVERSE CARDIOVASCULAR EVENTS AND ALL-CAUSE MORTALITY WITH LEFT VENTRICULAR GEOMETRY IN ELDERLY: THE NORTHERN SHANGHAI STUDY

Objective: To investigate the association of major adverse cardiovascular events and mortality with left ventricular geometry in elderly. Design and method: We prospectively recruited 3363 community-dwelling elderly (43.6% male, aged 71.1 ± 5.9 years; 56.4% female, aged 71.1 ± 6.1 years) from local community. Echocardiographic parameters were collected, left ventricular mass index (LVMi) above 115 g/m2 in male or 95 g/m2 in female, relative wall thickness (RWT) above 0.42 were considered as abnormal. Participants then were classified into 4 mutually exclusive groups as: normal geometry (normal LVMi and normal RWT), concentric remodeling (normal LVMi and increased RWT), eccentric hypertrophy (increased LVMi and normal RWT), concentric hypertrophy (increased LVMi and increased RWT). Cardiovascular death, non-fatal myocardial infarction including non-fatal ischemic stroke were recorded as incident MACE. Adjusted Cox regression models were used to evaluate the hazard ratios of MACE and all-cause mortality. Results: Mean LVMi and RWT were 87.0 ± 28.4 g/m2 and 0.39 ± 0.08. During a median follow-up of 5.4 years, we identified 224 incident MACE cases and 233 deaths. All-cause mortality was significantly greater in participants with eccentric hypertrophy (adjusted hazard ratio [HR]: 1.649; 95% confidence interval [CI]: 1.143-2.379) compared with normal geometry in multivariate analyses after adjusting for baseline covariates. Incident MACE was significant both in concentric hypertrophy (HR: 1.982; 95% CI: 1.239-3.170) and eccentric hypertrophy (HR: 1.846; 95% CI: 1.266-2.692) but not in concentric remodeling (HR:1.101; 95% CI: 0.759-1.597). Baseline LVMi was a significant predictor of all-cause mortality (HR: 1.047 per 10g/m2 increase in LVMi; 95% CI: 1.004-1.093). Similar results were observed with non-fatal myocardial infarction, non-fatal ischemic stroke and cardiovascular death. Conclusions: Increased baseline LVMi and abnormal left ventricular geometry portend an increased risk for incident MACE and all-cause mortality in community dwelling elderly. From the pathophysiology point of view, per 10 g/m2 increase in LVMi add 5% risk for all-cause mortality.

Relationship Between Left Ventricular Hypertrophy and Diabetes Is Likely Bidirectional: A Temporality Analysis.

Background The temporal relationship between type 2 diabetes (T2DM) and left ventricular hypertrophy (LVH) is not well established. This study aims to examine the temporal sequence between T2DM and LVH/cardiac geometry patterns in middle-aged adults. Methods and Results The longitudinal cohort consisted of 1000 adults (682 White individuals and 318 Black individuals; 41.1% men; mean age, 36.2 years at baseline) who had data on fasting glucose/T2DM, left ventricular mass index (LVMI), and relative wall thickness collected twice at baseline and follow-up over 9.4 years on average. The cross-lagged path analysis model in 905 adults who did not take antidiabetic medications and the longitudinal prediction model in 1000 adults were used to examine the temporal relationships of glucose/T2DM with LVMI, LVH, relative wall thickness, and remodeling patterns. After adjustment for age, race, sex, smoking, alcohol drinking, body mass index, heart rate, hypertension, and follow-up years, the path coefficient from baseline LVMI to follow-up glucose was 0.088 (P=0.005); the path from baseline glucose to follow-up LVMI was -0.009 (P=0.758). The 2 paths between glucose and relative wall thickness were not significant. The path analysis parameters did not differ significantly between race, sex, and follow-up duration subgroups. Incidence of T2DM was higher in the baseline LVH group than in the normal LVMI group (24.8% versus 8.8%; P=0.017 for difference). Incidence of LVH and concentric LVH was higher in the baseline T2DM group than in the group without T2DM (50.0% versus 18.2% for LVH [P=0.005 for difference]; 41.7% versus 12.6% for concentric LVH [P=0.004 for difference]), with adjustment for covariates. Conclusions This study suggests that the temporal relationship between T2DM and LVH is likely bidirectional. The path from LVMI/LVH to glucose/T2DM is stronger than the path from glucose/T2DM to LVMI/LVH.

The preliminary study on cardiac structure and function in Chinese patients with primary hyperparathyroidism.

Recent evidences show that primary hyperparathyroidism (PHPT) patients have a high prevalence of cardiovascular diseases. However, the reported changes in cardiac status are inconsistent in previous studies. The present work evaluated the cardiac structure and function in PHPT patients by echocardiography. PHPT patients and age- and sex-matched healthy controls were enrolled in this case-control study. Biochemical parameters were retrospectively collected from PHPT patients. Cardiac function and structure were assessed in all subjects using echocardiography. A total of 153 PHPT patients and 51 age- and sex-matched healthy controls were enrolled in this study. The mean serum calcium and parathyroid hormone (PTH) levels in PHPT patients were 2.84 ± 0.28mmol/L and 206.9 (130.0, 447.5) pg/ml, respectively. Left ventricular ejection fraction (LVEF) and early to late mitral annular velocity (E/A) were significantly lower in PHPT patients than in healthy controls (68.2 ± 6.0 vs. 70.7 ± 16.7%, 1.0 ± 0.5 vs. 1.4 ± 0.5, respectively, p both < 0.05). The left ventricular mass index (LVMI) and the relative wall thickness (RWT) were not significantly different between the two groups. However, the difference in LVEF between PHPT patients without hypertension and diabetes and the control groups disappeared. The majority of PHPT patients had normal cardiac geometry; however, a proportion of them exhibited concentric remodeling (normal LVMI, RWT≥0.42). Serum calcium, corrected calcium, ionized calcium and PTH were inversely related to E/A, whereas serum phosphorus and 24-hour urine calcium were positively related to E/A. Furthermore, biochemical parameters were not correlated with LVEF. These findings demonstrate that PHPT patients exhibit diastolic cardiac dysfunction reflected by decreased E/A, as well as possible cardiac structural abnormalities. The serum calcium, phosphorus, and parathyroid hormone levels may influence cardiac structure and function.

Adherence to the Mediterranean Diet Is Associated with a More Favorable Left Ventricular Geometry in Patients with End-Stage Kidney Disease.

Introduction. The aim of the study was to examine the impact of adherence to a Mediterranean-style diet (MD) on left ventricular hypertrophy (LVH) and cardiac geometry in chronic kidney disease patients on dialysis (CKD-5D), given the high prevalence of cardiovascular morbidity in this population. Methods. n = 127 (77 men and 50 women) CKD-5D patients (69 on hemodialysis and 58 on peritoneal dialysis) with a mean age of 62 ± 15 years were studied. An MD adherence score (MDS) (range 0–55, 55 representing maximal adherence) was estimated with a validated method. Echocardiographic LVH was defined by LV mass index (LVMI) > 95 g/m2 in women and >115 g/m2 in men. Based on LVMI and relative wall thickness (RWT), four LV geometric patterns were defined: normal (normal LVMI and RWT), concentric remodeling (normal LVMI and increased RWT > 0.42), eccentric LVH (increased LVMI and normal RWT), and concentric LVH (increased LVMI and RWT). Results. Patients with LVH (n = 81) as compared to patients with no LVH (n = 46) were older in age (66 ± 13 vs. 55 ± 16 years; p < 0.001) had lower MDS (24 ± 2.7 vs. 25 ± 4.3; p < 0.05) and higher malnutrition-inflammation score (5.0 ± 2.7 vs. 3.9 ± 1.9; p < 0.05), body mass index (27.5 ± 4.9 vs. 24.1 ± 3.5 kg/m2; p < 0.001), prevalence of diabetes (79% vs. 20%; p < 0.05), coronary artery disease (78% vs. 20%; p < 0.05) and peripheral vascular disease (78% vs. 20%; p < 0.01). In a multivariate logistic regression analysis adjusted for all factors mentioned above, each 1-point greater MDS was associated with 18% lower odds of having LVH (OR = 0.82, 95% CI: 0.69–0.98; p < 0.05). MDS was inversely related to LVMI (r = −0.273; p = 0.02), and in a multiple linear regression model (where LVMI was analyzed as a continuous variable), MDS emerged as a significant (Β = −2.217; p < 0.01) independent predictor of LVH. Considering LV geometry, there was a progressive decrease in MDS from the normal group (25.0 ± 3.7) to concentric remodeling (25.8 ± 3.0), eccentric (24.0 ± 2.8), and then concentric (23.6 ± 2.7) group (p < 0.05 for the trend). Conclusions. The greater adherence to an MD is associated with lesser LVH, an important cardiovascular disease risk factor; MD preserves normal cardiac geometry and may confer protection against future cardiac dysfunction in dialysis patients.

SERUM URIC ACID, LEFT VENTRICULAR MASS AND CARDIOVASCULAR DEATH. THE URIC ACID RIGHT FOR HEART HEALTH (URRAH) STUDY

Objective: A relationship between serum uric acid(UA)and CV events has been documented in the URRAH study.The association between UA and left ventricular mass index(LVMI)has been investigated with heterogeneous results.Aim of this study was to investigate the association between UA and LVMI and whether UA and LVMI or they combination may predict the incidence of death for CV disease(CVM)in a large Italian cohort in the frame of the Working Group on Uric Acid and Cardiovascular Risk of the Italian Society of Hypertension(SIIA) Design and method: URRAH study is a nationwide,multicentre,observational cohort study involving data on subjects aged 18to95years,recruited on a community basis from all regions of Italy under the patronage of the SIIA.CVM was defined as death due to fatal myocardial infarction,stroke,sudden cardiac death,or heart failure.Multivariate Cox regression models having CVM as dependent variables,adjusted for age,sex,BMI, SBP,glycemia,total cholesterol,triglycerides,HDL-cholesterol,smoking and estimated glomerular filtration rate(eGFR)were used to search for an association between UAandLVMI as a continuous variable and CVM.LVH was defined asLVMI&gt; 95 g/m2 in women and 115 g/m2 in men Results: 10733 subjects(mean age,54years;51%female)with echocardiographic LVMI measurements were included in the analysis study.A significant association between UA and LVMI was confirmed in multiple regression analysis in both sexes(men:beta0,095,F5.47,P &lt; 0.001;women:beta0,069,F4.36,P &lt; 0.001).During follow-up(median 130months),319subjects died for a CVevent,including myocardial infarction, angina pectoris, congestive heart failure and cerebrovascular disease.Previously identified sex specific cut off values(5.6 mg/dl men,5.1 mg/dl women)and LVH were used to define 4 different groups(normal UA and LVMI,increased UA and no LVH,normal UA and LVH,increased UA and LVH).Kaplan–Meier curves showed a significantly poorer survival rate in the group with higher UA and LVMI(log-rank chi-square298.105;P &lt; 0.0001).Multivariate Cox regression analysis showed that in women LVH alone[HR2,25(1.076to4,721);P = 0.03]and the combination of higher UA and LVH[HR3,785(1.789to8.008);P = 0.001],but not hyperuricemia alone,were associated with a higher risk of CVD,while in men hyperuricemia without LVH[HR2.338(1.292to4.232);P = 0.005],LVH without hyperuricemia[HR3.008(1.750to5.449);P = 0.001]and their combination[HR5.273(3.044to9.135);P = 0.001]were all associated with a higher incidence of CVM Conclusions: Our findings demonstrate that UAis independently associated with LVMI and suggest that combination of hyperuricemia with LVH is an independent and powerful predictor for CVM both in men and women.The association between UAandCVD events may be explained in part because of a direct association of UAwithLVMI

Abstract 13854: Association Between Pulmonary Function, Cardiac Structure and Function, and Cardiovascular Outcomes in the General Population

Introduction: We investigated the association between the lung function and cardiac structure and function, and how the lung function affects the prognostic value of cardiac structure and function in the general population. Methods: All participants from the 4 th Copenhagen City Heart Study examination round who had an echocardiography and spirometry performed were included in the present analysis. Participants were classified as having either normal lung function with a forced expiratory volume in one second (FEV1) &gt;=80% of expected or decreased lung function with FEV1&lt;80%.The endpoint consisted of cardiovascular death, acute myocardial infarction, or incident heart failure. Results: Participants (n=2,149) were followed for a median 14.4 years (IQR 10.8-14.9), and there was a total of 371 (17%) events. The mean age was 57 ± 16 years, 57% were women, 44% had hypertension, and 64% were current or previous smokers. Decreased lung function at baseline was associated with a lower left ventricular ejection fraction (LVEF), a higher left ventricular mass index (LVMI), and a higher E/e’. In univariable analysis, LVEF, LVMI, E/e’, and left atrial volume (LAV) were predictors of the composite outcome in both groups. After multivariable adjustment for clinical and echocardiographic parameters, only LVMI remained an independent predictor of the composite outcome in both groups (normal lung function: HR 1.04, 95% CI (1.01-1.07), p=0.010; decreased lung function: HR 1.06, 95% CI (1.01-1.10), p=0.009). LVEF and LAV remained predictors of the composite outcome only in participants with normal lung function. Conclusions: In participants from the general population, a FEV1 below 80% was associated with a lower LVEF, a higher LVMI and a higher E/e’. For participants with normal lung function, LVEF, LVMI, and LAV were independent predictors of adverse cardiovascular events. For participants with a FEV1 below 80%, only LVMI was an independent predictor of adverse cardiovascular events.

Abnormal left ventricular geometry in female collegiate swimmers

Abstract Background There is a paucity of data describing left ventricular geometry changes in female athletes. While some studies suggest that female athletes participating in dynamic sports exhibit higher prevalence of eccentric left ventricular hypertrophy (LVH) when compared to men, a recent study suggested more concentric geometry changes in female basketball athletes. We were unable to identify studies describing the left ventricular geometry of female collegiate swimmers. Objectives To describe LV geometry changes in a cohort of female collegiate swimmers. Methods We analyzed a cohort of female collegiate swimmers who had a pre-participation cardiac evaluation by 12-lead ECG and 2-dimensional echocardiography. Left ventricular (LV) geometry was assessed based on relative wall thickness (RWT) (defined as: 2 x posterior wall thickness (PWT) divided by LV end-diastolic diameter (LVEDD)) and LV mass (LVM) (Devereux's formula: LVM = [0.8 x 1.04 [(LVEDD + interventricular septum + posterior wall thickness)3 − (LVEDD)3]] + 0.6g) and was indexed to body surface area (BSA).LVH was defined as LV mass index &amp;gt;95 g and was defined as concentric when associated with a relative wall thickness (RWT) &amp;gt;0.42 and as eccentric when RWT was ≤0.42. Concentric remodeling was defined as normal LVM index and increased RWT. Results A total of 83 female collegiate swimmers were included. Their age was 18.5±0.5 years (mean ± standard deviation, SD), 74 (89.2%) were White, BSA was 1.78±0.11 m2, height 173±6.3 cm, weight 66.2±7.2 K. Their interventricular septum diameter was 0.89±0.14 cm, PWT 0.92±0.15 cm, LVEDD 4.9±0.5 cm and LV end-systolic diameter (LVESD) 3.2±0.4 cm. Left atrium diameter ranged from 2.6 to 4.3 cm (mean 3.4 cm ± 0.4 cm). Aortic root diameter ranged from 1.9 to 3.5 cm (mean 2.7±0.3 cm) (Figure 1). LVH was present in 27 swimmers (32.5%). Eccentric LVH was present in 17 athletes (20.5%), concentric hypertrophy in 10 athletes (12%), and concentric remodeling in 12 (14.5%) (Figure 2). No athletes with LVH or concentric remodeling had borderline or abnormal ECG findings based on international criteria. Only two women with normal LV geometry had abnormal ECG findings: prolonged QT interval and abnormal T wave inversion. There was a linear correlation between BSA with LVEDD, LVESD and LV mass (r=0.40, 0.35, and 0.48 with P&amp;lt;0.001,0.002 and &amp;lt;0.001, respectively). However, there was no statistically significant difference between LV geometry groups based on BSA or blood pressure. Conclusion Our data document a high incidence of eccentric hypertrophy among female collegiate swimmers. Concentric remodeling and hypertrophy were also relatively high. Differentiating physiologic from pathologic cardiac remodeling in these athletes is critical to prevent potential complications such as sudden cardiac death, arrhythmias, and other adverse outcomes. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): This work was supported in part by the American Medical Society for Sports Medicine (AMSSM) Foundation Research Grant 2016 awarded to KE, and the University of Florida REDCap uses the NIH National Center for Advancing Translational Sciences (NCATS) grant UL1 TR001427. Figure 1Figure 2. LV geometry in female swimmers

Echocardiographic assessment of left ventricular mass index and function in hypertensive patients with preserved ejection fraction

Background: The aim of the present study is to detect left ventricular (LV) mass and to find out sub clinical LV diastolic dysfunction in hypertensive patients with preserved LV ejection fraction (EF) using echocardiographic parameters.Methods: 96 patients with hypertension were randomly selected irrespective of their sex, race and risk factor and enrolled into this study. Left ventricular mass index (LVMI) and geometrical pattern LV structure were measured. Sub clinical diastolic dysfunction was also assessed by tissue Doppler.Results: Out of 96 patients, 24 had ECG evidence of LV hypertrophy (LVH) 66 were having increased LVMI (154±20), rest 30 had normal LVMI (108±12). They were divided by LV geometrical pattern into concentric LVH (40), eccentric LVH (26), concentric remodeling (19) and normal (11). Diastolic dysfunction in these patients were assessed by E/E´ measurement which was abnormally increased in 42 out of 66 patients with increased LVMI (20±3.4) and 16 out of 30 patients with normal LVMI.Conclusions: Echocardiographic examination help us to find out LVH precisely by calculating LVMI. It also reveals structural changes like concentric LVH, eccentric LVH, concentric remodeling. A significant number of patients with hypertension with normal LV ejection fraction has sub clinical LV diastolic dysfunction which was detected by tissue Doppler imaging (E/E′). The increase in LVMI with or without concentric LVH is an independent risk factor and prognostic marker for cardio vascular events that occur in hypertensive patients. In this study we infer that patients with increase in LVMI with concentric LVH pattern with normal ejection fraction needs more aggressive treatment and regular follow up to prevent cardiovascular complications.

MO1009TWENTY-FOUR-HOUR AUGMENTATION AND CARDIAC INDEX LEVELS ARE INCREASED IN CHILDREN ON HEMODIALYSIS COMPARED TO PERITONEAL DIALYSIS PATIENTS

Abstract Background and Aims Cardiovascular disease is highly prevalent in the chronic kidney disease population and associates with higher morbidity and mortality even in young ages. The aim of the present study was to assess data from 24h ambulatory blood pressure monitoring (ABPM) and 24h pulse wave analysis (PWA) in dialyzed children and investigate their association with left ventricular mass as a marker of increased cardiovascular risk. Method Children and adolescents aged 6 to 18 years, on dialysis for more than 12 months, [16 on peritoneal dialysis (PD) and 12 on hemodialysis (HD)], underwent 24h ABPM, 24h PWA, and echocardiography. Results Peripheral and central blood pressures (BPs), mean pulse wave velocity (PWV) and left ventricular mass index (LVMI) were similar between PD and HD patients (figure 1a,b). Among PWA hemodynamic parameters, augmentation index (AIx75), cardiac index (CI), and heart rate were higher in the HD group (p&amp;lt;0.05) (figure 1c,d). LVMI was associated with hemoglobin (Hb) (R2=0.19, p&amp;lt;0.05)mean arterial pressure (MAP) (R2=0.34, p&amp;lt;0.005), central systolic BP (cSBP) (R2=0.39, p&amp;lt;0.001), AIx75 (R2=0.26, p&amp;lt;0.005), CI (R2=0.14 p&amp;lt;0.05) and PWV (R2=0.26, p&amp;lt;0.005), but not with weight, body mass index or relative overhydration. CI and AIx75 were higher in the HD group compared to PD both in patients with normal LVMI and those with left ventricular hypertrophy (LVH). CI remained higher in HD patients after adjustment for Hb, MAP, cSBP, PWV, AIx75, and LVMI (estimated marginal means 4.17, 95%CI 3.80-4.53 versus 3.40, 95%CI 3.11-369 in PD patients, p&amp;lt;0.05). Similarly, AIx75 remained higher in HD patients after adjustment for Hb, MAP, cSBP, PWV, CI, and LVMI (estimated marginal means 28.89, 95%CI 24.49-33.30 versus 22.62, 95%CI 19.15-26.08 in PD patients, p=0.05). Conclusion HD pediatric patients demonstrate higher AIx75 and CI compared to PD patients even in the absence of LVH. These results suggest distinct patterns of vascular and cardiac functional changes in HD patients that may increase cardiovascular risk beyond LVH.

Left ventricular mass index as a predictor of coronary calcification, coronary lesion and association with coronary artery tortuosity

Abstract Funding Acknowledgements Type of funding sources: None. Background Despite Coronary artery tortuosity (CAT) is a common angiographic finding, there is limited data regarding pathogenesis and aetiology of this coronary entity, one proposed hypothesis was the change in geometry of left ventricle (LV) which predispose for CAT. Very little is known about echocardiographic parameters and their significance in CAT. Purpose This study aimed to determine left ventricular mass index (LVMI) as a predictor of coronary calcium burden (represented by CT coronary calcium scoring CaCs), coronary obstructive lesions and association of LVMI with CAT in patients with chronic chest pain who were referred for coronary angiography (CA). Methods Cross-sectional study enrolled patients with chronic chest pain whom referred for CCTA and coronary angiography (CA). Demographic characteristics and CA results were collected. LVMI was calculated for each patient. Patients were grouped into those with CAT vs without CAT. Results The study recruited 150 patients including 106 (70.7%) with CAT. Among total study patients; mean LVMI was higher in elderly≥ 65 years (147.5 ± 52 vs 52.5 ± 8.4, p &amp;lt; 0.001), hypertensive (129 ± 52.4 vs 96.6 ± 38.9, p = 0.001) and diabetics (144.2 ± 65.3 vs 102.5 ± 30.7, p = 0.001). LVMI was lower in patients with CAT (115.4 ± 46.2 vs 123.6 ± 59.8 in non-CAT group, p = 0.001), in same line, among CAT group: 49% had normal LVMI vs 45.5% in non-CAT counterparts, mild increase in LVMI seen in 18.3% vs 6.6% in non-CAT group while severe increase in LVMI seen in 33.25% vs 16.5% in non-CAT patients. Mean LVMI was higher in patients with obstructive coronary artery lesions (137.9 ± 56.3 vs 93.6 ± 27.3, p = 0.001), similarly, mean LVMI was increasing with higher grade of CT coronary calcium scoring as it was 88.5 ± 27.3 in absent CaCs while mean LVMI was 154.4 ± 62.4 in severe CaCs, p = 0.001). Conclusion left ventricular mass index increased in elderly, obese, hypertensive and diabetics. Severe grade of increase in LVMI was higher in patients with coronary artery tortuosity compared to those without coronary tortuosity. Similarly, LVMI can be useful echocardiographic predictor of coronary calcification as well as obstruction, further studies are warranted to explore pathophysiological basis and clinical impacts of these findings. Abstract Figure.

EXAGGERATED BLOOD PRESSURE RESPONSE IN EXERCISE IS ASSOCIATED WITH LACK OF LEFT VENTRICULAR HYPERTROPHY REGRESSION IN HYPERTENSIVE PATIENTS AFTER 6 YEARS FOLLOW-UP

Objective: Regression of left ventricular hypertrophy (LVH) is independently associated with improved cardiovascular outcome. In this study we aimed to investigate the role of exaggerated blood pressure response (EBPR) during exercise in LVH regression in hypertensive subjects over time. Design and method: 1413 hypertensive subjects, (mean age 57 ± 11 years), 51% males, with baseline office blood pressure (BP) 144/89mmHg were followed for a mean period of 6.4 ± 3.0 years. At baseline and last follow-up visit all patients underwent office BP, laboratory tests and echocardiographical determination of left ventricular mass index (LVMI). At baseline, all subjects underwent treadmill exercise testing (Bruce protocol) in order to identify the presence of EBPR based on the systolic BP elevation at peak exercise (&gt; or = 210 mmHg for men and &gt; or = 190 mmHg for women). Main outcome variable was LVH Regression/prevention (LVH Regr/prev), defined as: LVH at baseline visit with normal LVMI values at last visit or absence of LVH at baseline and last visit. BP control was considered optimal when the mean of office BP measurements during follow-up was &lt; 140/90 mmHg. Results: 46% of study population presented LVH Regr/prev during follow-up period. Cox-regression analysis, after adjustment for clinical and biochemical variables, revealed that low levels of baseline LVMI (HR = 0.98, 95% CI 0.97–0.99, p &lt; 0.0001), absence of EBPR (HR = 0.81, 95% CI 0.67–0.98, p = 0.02) and optimal BP control during follow-up (HR = 1.19, 95% CI 1.01–1.56, p = 0.03) were independent predictors of LVH Regr/prev during follow-up. Conclusions: In conclusion, beyond optimal BP control, EBPR is a significant predictor of structural cardiac alterations overtime. These finding strengthens the clinical importance of EBPR during the baseline evaluation of hypertensive subjects.

The Relationship Between Left Ventricular Hypertrophy and Diabetes is Likely Bidirectional: A Temporality Analysis

Objective: The temporal relationship between type 2 diabetes (T2DM) and left ventricular hypertrophy (LVH) is not well established. This study aims to examine the temporal sequence between glucose/T2DM, LVH and cardiac geometry patterns in middle-aged adults. Methods: The longitudinal cohort consisted of 1000 adults (682 whites and 318 blacks; 41.1% males, mean age=36.2 years at baseline) who had data on fasting glucose/T2DM, left ventricular mass index (LVMI) and relative wall thickness (RWT) collected twice at baseline and follow-up over 9.4 years on average. The cross-lagged path analysis model in 905 adults who did not take anti-diabetic medications and the longitudinal prediction model in 1000 adults were used to examine the temporal relationships of glucose/T2DM with LVMI, LVH, RWT and remodeling patterns. Results: After adjustment for age, race, sex, smoking, alcohol drinking, body mass index, heart rate, hypertension and follow-up years as well as baseline glucose, LVMI or RWT, the path coefficient from baseline LVMI to follow-up glucose was 0.088 (p=0.005); the path from baseline glucose to follow-up LVMI was -0.009 (p=0.758). The two paths between glucose and RWT were not significant. The path analysis parameters did not differ significantly between race, sex and follow-up duration subgroups. Incidence of T2DM was higher in the baseline LVH group than in the normal LVMI group (24.8% vs 8.8%, p=0.017 for difference). Incidence of LVH and concentric LVH was higher in the baseline T2DM group than in the non-diabetic group (50.0% vs 18.2% for LVH, p=0.005 for difference; 41.7% vs 12.6% for concentric LVH, p=0.004 for difference), with adjustment for covariates. Conclusions: This study suggests that the temporal relationship between T2DM and LVH is likely bidirectional. The path from LVMI/LVH to glucose/T2DM is stronger than the path from glucose/T2DM to LVMI/LVH. Funding Information: This study was supported by grants R03AG060619 from National Institute on Aging, R01HL121230 from the National Heart, Lung and Blood Institute, P20GM109036 from the National Institute of General Medical Sciences of the National Institutes of Health, 82073572 and 81973147 from National Natural Science Foundation of China and Z201100006820008 from the Beijing Nova Program. Declaration of Interests: The authors have no conflicts of interest. Ethics Approval Statement: All subjects gave informed consent for each survey. Study protocols were approved by the Institutional Review Board of the Tulane University Health Sciences Center.

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.

Effects of Baseline Left Ventricular Hypertrophy and Decreased Renal Function on Cardiovascular and Renal Outcomes in Patients with Fabry Disease Treated with Agalsidase Alfa: A Fabry Outcome Survey Study

PurposeThe initiation of enzyme-replacement therapy prior to the occurrence of substantial and irreversible organ damage in patients with Fabry disease is of critical importance. The Fabry Outcome Survey is an international disease registry of patients with a confirmed diagnosis of Fabry disease. In this study, data from the Fabry Outcome Survey were used for the assessment of the risks for cardiovascular and renal events in patients who received agalsidase alfa treatment. MethodsEligible patients were males and females aged ≥18 years with Fabry disease treated with agalsidase alfa. Cardiovascular events included myocardial infarction, left ventricular hypertrophy (LVH), heart failure, arrhythmia, conduction abnormality, and cardiac surgery. Renal events included dialysis, transplantation, and renal failure. Kaplan–Meier curves and log-rank tests were used for comparing event-free probabilities and time to first cardiovascular or renal event, from agalsidase alfa initiation to a maximum of 120 months, in patients with LVH versus normal left ventricular mass index (LVMI; ≤50 g/m2.7 in males and ≤48 g/m2.7 in females) at treatment initiation (baseline), and in patients with a low estimated glomerular filtration rate (eGFR; <90 mL/min/1.73 m2) versus normal eGFR at baseline. Multivariate Cox regression analysis was used for examining the association between key study variables and the risks for cardiovascular and renal events. FindingsAmong the 560 patients (269 males; 291 females) with available LVMI data, 306 (55%) had LVH and 254 (45%) had normal LVMI at baseline. The risk for a cardiovascular event was higher in the subgroup with LVH versus normal LVMI at baseline (hazard ratio [HR] = 1.57; 95% CI, 1.21–2.05; P < 0.001), but the risk for a renal event was similar between the 2 subgroups (HR = 1.90; 95% CI, 0.94–3.85; P = 0.074). Among the 1093 patients (551 males; 542 females) with available eGFR data, 433 (40%) had a low eGFR and 660 (60%) had a normal eGFR at baseline. The subgroup with a low eGFR at baseline had a significantly higher risk for a cardiovascular event (HR = 1.33; 95% CI, 1.04–1.70; P = 0.021) or a renal event (HR = 5.88; 95% CI, 2.73–12.68; P < 0.001) compared with patients with a normal eGFR at baseline. ImplicationsIn the present study, the presence of LVH and/or reduced renal function at agalsidase alfa initiation was associated with a significantly higher risk for a cardiovascular or renal event, indicating that cardiovascular and renal pathologies in Fabry disease may be inter-related. Early initiation of agalsidase alfa treatment prior to the onset of severe organ damage may improve outcomes. ClinicalTrials.gov identifier: NCT03289065.

Blood pressure response in exercise is associated with future cardiac structural alterations in hypertensive patients

Abstract Background/Introduction Exaggerated blood pressure response (EBPR) during the exercise treadmill test (ETT) is often observed in individuals without known cardiovascular disease. Although it is generally considered as an abnormal response and a risk factor for hypertension development, its clinical significance remains controversial. On the other hand, regression of left ventricular hypertrophy (LVH) is independently associated with improved cardiovascular outcome. Purpose In this study we aimed to investigate the role of EBPR during exercise in LVH regression in hypertensive subjects over time. Methods 1413 hypertensive subjects, (mean age 57±11 years), 51% males, with baseline office blood pressure (BP) 144/89mmHg were followed for a mean period of 6.4±3.0 years. At baseline and last follow-up visit all patients underwent office BP, laboratory tests and echocardiographical determination of left ventricular mass index (LVMI). At baseline, all subjects underwent treadmill exercise testing (Bruce protocol) in order to identify the presence of EBPR based on the systolic BP elevation at peak exercise (&amp;gt; or =210 mmHg for men and &amp;gt; or =190 mmHg for women). Main outcome variable was LVH Regression/prevention (LVH Regr/prev), defined as: LVH at baseline visit with normal LVMI values at last visit or absence of LVH at baseline and last visit. BP control was considered optimal when the mean of office BP measurements during follow-up was &amp;lt;140/90mmHg. Results 46% of study population presented LVH Regr/prev during follow-up period. Cox-regression analysis, after adjustment for clinical and biochemical variables, revealed that low levels of baseline LVMI (HR=0.98, 95% CI 0.97–0.99, p&amp;lt;0.0001), absence of EBPR (HR=0.81, 95% CI 0.67–0.98, p=0.02) and optimal BP control during follow-up (HR=1.19, 95% CI 1.01–1.56, p=0.03) were independent predictors of LVH Regr/prev during follow-up. Conclusions Beyond optimal BP control, EBPR is a significant predictor of left ventricular mass changes overtime. Hence, ETT can provide clinical relevant information, including EBPR, which may help in the improvement of risk stratification of hypertensive subjects. Funding Acknowledgement Type of funding source: None

The association between left ventricular mass index and serum sirtuin 3 level in patients with hypertension.

Sirtuin 3 (SIRT3) can protect cardiomyocytes from oxidative stress-mediated cell damage and prevent cardiac hypertrophy development. The aim of this study was to evaluate whether a relationship existed between left ventricular mass index (LVMI) and serum SIRT3 levels in patients with hypertension. This study was conducted as a cross-sectional study of 83 patients between April 2018 and October 2018. The LVMI of all patients was calculated using the formula of the American Echocardiography Association and patients were divided into two groups according to results (increased LVMI and normal LVMI). Increased LVMI was determined in 37.3% of patients, whereas 62.7% had normal LVMI. There was no significant difference between serum SIRT3 levels between those with increased LVMI and normal LVMI (5.8 versus 5.4 ng/ml; P = 0.914). Serum pro-brain natriuretic peptide levels (69 versus 41 ng/ml; P = 0.019) were found to be higher in patients with increased LVMI than in those with normal LVMI. A positive correlation between SIRT3 levels and Sm (myocardial systolic) velocity was also determined (r = 0.338; P = 0.002). The serum levels of SIRT3, a molecule which has been proposed to have protective properties against myocardial hypertrophy, were not found to be correlated with LVMI values; however, SIRT3 levels were found to be correlated with Sm velocity, which is accepted to be an indicator of myocardial early diastolic dysfunction.