Left Ventricular Hypertrophy Odds Ratio Research Articles

Female-specific reference values for blood pressure and its relationship with subclinical echocardiographic findings in women with a history of preeclampsia: the Queen of Hearts study

Abstract Introduction Hypertension is the most crucial modifiable risk factor for cardiovascular disease (CVD). Sex differences in what is considered optimal blood pressure (BP) might deviate from current sex-blinded guidelines for hypertension. In women, an obstetric history of preeclampsia relates to postpartum hypertension and substantially increases the risk of premature CVD. Purpose To establish female-specific reference values for BP in relatively young women and assess its association with subclinical aberrant echocardiographic findings in a high-risk female population. Methods Data was used from the Queen of Hearts study; a cross-sectional cohort study on early detection of heart failure among young women with a history of preeclampsia and a control group of low-risk healthy women with a history of uncomplicated pregnancy. The control group was used to non-parametrically establish reference values for BP (95th percentile). The association between the derived reference values and the risk of subclinical aberrant echocardiographic findings was evaluated in the former preeclamptic group using logistic regression. All women were admitted to a standardized cardiovascular assessment including transthoracic echocardiography and 30-minutes BP measurement. Subclinical echocardiographic findings included left ventricular (LV) hypertrophy (LVH), LV concentric remodelling (LCVR), diastolic dysfunction (DD) and impaired LV ejection fraction (LVEF, <55%). Results A total of 429 women in the healthy control group and 856 in the former preeclamptic group were included (44±8 and 38±8 years, respectively). In the healthy control group, 97.7% and 99.8% of women had a systolic (SBP) and diastolic BP (DBP) value below the European Society of Cardiology (ESC) guidelines for hypertension. Overall, the derived reference value for SBP and DBP in our control group was 133 and 82 mmHg, respectively. Age-specific reference curves are presented in Figure 1 and 2. In the subgroup of former preeclamptic women 10.4% and 14.6% had SBP and DBP levels above 133 mmHg and 82mmHg, respectively. In this group, the Odds Ratio (OR) for subclinical aberrant echocardiographic findings when having SBP ≥133mmHg was 5.3 (95% CI 2.3–12.3) for LVH, 1.4 (95% CI 0.6–3.2) for LVCR, 5.9 (95% CI 3.3–10.7) for DD and 1.3 (95% CI 0.3–6.0) for impaired LVEF. For DBP ≥82mmHg, the OR for LVH was 3.5 (95% CI 1.5–8.0), LVCR 1.3 (95% CI 0.6–2.7), DD 3.4 (95% CI 1.9–6.0) and impaired LVEF 1.5 (95% CI 0.4–5.3). Conclusions Upper limits for SBP and DBP values in current guidelines correspond with the value of less than 2% of women in our healthy (no pre-eclampsia) population. We derived new reference values with the upper limit corresponding with the upper 5th centile. Values above this level, even below decision limits for hypertension, are associated with abnormal subclinical cardiac function and geometry in a high-risk young female population. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Dutch Heart Foundation

ASSOCIATION BETWEEN TRIGLYCERIDE GLUCOSE INDEX AND LEFT VENTRICULAR HYPERTROPHY AMONG CHINESE POPULATION WITH HIGH CARDIOVASCULAR RISK

Objective: The triglyceride glucose (TyG) index has been proposed to be a reliable surrogate of insulin resistance. In the present study, we aimed to examine the relationship between TyG index and left ventricular hypertrophy (LVH) among Chinese population with high cardiovascular risk. Design and method: This cross-sectional study included 20,921 participants with measurable echocardiographic parameters from the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project in Guangdong Province. Participants with high cardiovascular risk, which was defined as a predicted 10-year risk of cardiovascular disease greater than 20%, according to the 2019 cardiovascular disease risk charts for east Asia by WHO, or those with previous myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting, or stroke, were identified. They were divided into four famine exposure groups according to the quartiles of TyG index. The association between TyG index and LVH was examined by Logistic regression and restricted cubic spline regression, and the results were presented in odds ratio (OR) with 95% confidence interval (CI). Subgroup analyses were also conducted to examine potential interactions between demographics and TyG index. Results: Among 20,921 participants, 1799 (8.6%) of them had LVH. The multivariate OR for every SD increment in TyG index was 1.22 (95% CI, 1.14–1.31). When comparing to the lowest quartile of TyG index, the multivariate ORs for LVH were 1.22 (0.96–1.54) for Q2, 1.61 (1.28–2.01) for Q3, and 1.73 (1.38–2.16) for Q4 (P for trend < 0.001). The restricted cubic spline regression also showed a linear association. No interaction was found between subgroup variables and the association between TyG index and the LVH. Conclusions: Higher TyG index associated with the elevated risk of LVH in Chinese population with high cardiovascular risk. The data suggest that TyG index may serve as a simple and effective tool for LVH risk assessment in daily clinical practice.

Association of Urine Albumin/Creatinine Ratio below 30 mg/g and Left Ventricular Hypertrophy in Patients with Type 2 Diabetes.

Several studies show that even a level of urine albumin/creatinine ratio (UACR) within the normal range (below 30 mg/g) increases the risk of cardiovascular diseases. We speculate that mildly increased UACR is related to left ventricular hypertrophy (LVH) in patients with type 2 diabetes mellitus (T2DM). In this retrospective study, 317 patients with diabetes with normal UACR, of whom 62 had LVH, were included. The associations between UACR and laboratory indicators, as well as LVH, were examined using multivariate linear regression and logistic regression, respectively. The diagnostic efficiency and the optimal cutoff point of UACR for LVH were evaluated using the area under the receiver operating characteristic curve (AUC) and Youden index. Our results showed that patients with LVH had significantly higher UACR than those without LVH (P < 0.001). The prevalence of LVH presented an upward trend with the elevation of UACR. UACR was independently and positively associated with hemoglobin A1c (P < 0.001). UACR can differentiate LVH (AUC = 0.682, 95% CI (0.602–0.760), P < 0.001). The optimal cutoff point determined with the Youden index was UACR = 10.2 mg/g. When categorized by this cutoff point, the odds ratio (OR) for LVH in patients in the higher UACR group (10.2–30 mg/g) was 3.104 (95% CI: 1.557–6.188, P=0.001) compared with patients in the lower UACR group (<10.2 mg/g). When UACR was analyzed as a continuous variable, every double of increased UACR, the OR for LVH was 1.511 (95% CI: 1.047–2.180, P=0.028). Overall, UACR below 30 mg/g is associated with LVH in patients with T2DM. The optimal cutoff value of UACR for identifying LVH in diabetes is 10 mg/g.

Uric acid and left ventricular hypertrophy: another relationship in hemodialysis patients.

BackgroundThe impact of serum uric acid (UA) on morbidity and mortality in hemodialysis (HD) patients is quite controversial in relation to the general population. The aim of this study was to evaluate the association of serum UA with both mortality and left ventricular hypertrophy (LVH) in HD patients.MethodsThis longitudinal study enrolled 225 prevalent HD patients who were classified into three groups according to their follow-up-averaged UA (FA-UA) levels: low FA-UA (FA-UA <400 µmol/L), intermediate/reference FA-UA (FA-UA between 400 and 450 µmol/L) and high FA-UA (FA-UA >450 µmol/L). Echocardiography was performed on a nondialysis day and the presence of LVH was defined based on a left ventricular mass index (LVMI) >131 and >100 g/m2 for men and women, respectively. The patients were followed during a 60-month period.ResultsThe mean FA-UA level was 425 ± 59 µmol/L (range 294–620). There was a consistent association of higher FA-UA with better nutritional status (higher body mass index, normalized protein catabolic rate, creatinine, albumin and phosphorus), higher hemoglobin, but lower C-reactive protein and LVMI. During the 5-year follow-up, 81 patients died (36%) and the main causes of death were cardiovascular (CV) related (70%). When compared with the reference group, the hazard ratio for all-cause mortality was 1.75 [95% confidence interval (CI) 1.02–2.98; P = 0.041] in the low FA-UA group, but there was no significant association with the high FA-UA group. In contrast, FA-UA did not show an association with CV mortality neither with the lower nor with the high FA-UA group. The unadjusted odds ratio (OR) of LVH risk in the low FA-UA compared with the reference FA-UA group was 3.11 (95% CI 1.38–7.05; P = 0.006), and after adjustment for age, gender, diabetes and CV disease, ORs for LVH persisted significantly only in the low FA-UA group [OR 2.82 (95% CI 1.16–6.88,); P = 0.002].ConclusionsLow serum UA is a mortality risk factor and is associated with LVH in HD patients. These results are in contrast with the association of UA in the general population and should be the subject of further research.

Preclinical signs of liver and cardiac damage in youth with metabolically healthy obese phenotype

Background and aimsWe aimed to evaluate whether the metabolically healthy obese (MHO) phenotype was associated with hepatic steatosis (HS) or left ventricular hypertrophy (LVH) in young people with overweight (OW), obesity (OB) and morbid obesity (MOB) and whether the prevalence of these comorbidities was affected by OB severity. Methods and resultsAn abdominal ultrasound was performed in 1769 children and adolescents, mean age 10.6 years (range 5–18) with MHO phenotype, defined as the absence of traditional cardiometabolic risk factors, in order to identify HS. In a subsample of 177 youth the presence of LVH, defined by 95th percentile of LV mass/h2.7 for age and gender, was also analyzed. The prevalence of HS increased from 23.0% in OW to 27.8% in OB and 45.1% in MOB (P < 0.0001). The proportion of LVH increased from 36.8% in OW to 57.9% in OB and 54.5% in MOB (P < 0.05). As compared with OW, the odds ratio (95% CI) for HS was 2.18 (1.56–3.05), P < 0.0001) in OB and 6.20 (4.26–9.03), P < 0.0001) in MOB, independently of confounding factors. The odds ratio for LVH was 2.46 (1.20–5.06), P < 0.025) in OB and 2.79 (1.18–6.61), P < 0.025) in MOB, as compared with OW. ConclusionIn spite of the absence of traditional cardiometabolic risk factors, the prevalence of HS and LVH progressively increased across BMI categories. MHO phenotype does not represent a “benign” condition in youth.

Abstract 14866: Hyperglycemia is an Independent Predictor of Left Ventricular Hypertrophy

Background: Diabetes mellitus (DM) is a risk factor for cardiovascular morbidity and mortality. In the current study we examine the association of hyperglycemic with left ventricular hypertrophy (LVH) independent of major correlates of LVH, such as, age, body size, blood pressure (BP) and aortic stiffness. Methods: We conducted a population-based, cross-sectional survey in 8,080 South Indians over the age of 20 years. The study included anthropometric, socioeconomic, psychosocial, BP, blood lipids, insulin, HbA1C, glucose tolerance test and carotid-femoral pulse wave velocity (PWV) assessments. Insulin resistance (IR) was defined as the 25% of the population with the highest values for homeostasis model assessment of insulin resistance (HOMA-IR). LV mass and relative wall thickness (RWT) were determined using echocardiography. LVH was defined as LV mass index (LVMI) &gt;109 g/m 2 for men and &gt;89 g/m 2 for women. Results: After the exclusion of people with hypertension, 5,841 subjects (mean age 41 years, 59% women) constituted the study sample. The mean LVMI in subjects with normoglycemia (n=3585), pre-DM (impaired fasting and/or post prandial blood sugar; n=1315) and DM (n=888) was 78.5 ± 17.5, 80.7 ± 19.4 and 87.2 ± 20.3, while mean RWT was 0.46 ± 0.09, 0.48 ± 0.09 and 0.51 ± 0.1, respectively (p&lt;0.01). After adjustments for age, sex, BMI, BP, PWV, blood lipids, history of coronary artery disease, socioeconomic and smoking status, and physical activity, when compared to persons with normoglycemia, the odds ratio (95% CI) for LVH in pre-DM and DM men was 1.12 (0.89, 1.42) and 1.37 (1.04, 1.8), respectively; the odds ratio in pre-DM and DM women was 1.07 (0.89, 1.28) and 1.4 (1.08, 1.82), respectively. Among the persons with normoglycemia those with IR the odds ratio for LVH was 1.23 (0.85, 1.78) in men and 1.01 (0.79, 1.30) in women. In the multi-linear regression models HbA1c was independently correlated with LVMI. The correlation coefficients were higher in men (β= 0.07, p &lt;0.001) compared to women (β= 0.037, p = 0.032). Conclusion: Hyperglycemia is an independent predictor of LVH in South Asian population. These findings indicate potential adverse myocardial effects of DM independent of associated risk factors, such as obesity, BP and aortic stiffness.

Cardiovascular Events in Patients With Fabry Disease: Natural History Data From the Fabry Registry

These analyses were designed to determine the incidence of major cardiovascular (CV) events and the natural history of CV complications in patients with Fabry disease. Fabry disease, a genetic disorder caused by deficiency of alpha-galactosidase A activity, is associated with CV dysfunction. Major CV events (myocardial infarction, heart failure, or cardiac-related death) were analyzed in 2,869 Fabry Registry patients during the natural history period (i.e., before enzyme replacement therapy or among patients who never received therapy). Multivariate logistic regression analyses were performed to identify significant predictors of CV events. Eighty-three of 1,424 men (5.8%) and 54 of 1,445 women (3.7%) experienced CV events at mean ages of 45 and 54 years, respectively. Heart failure was the most common first CV event, reported by 50 men (3.5%) and 33 women (2.3%). Hypertension and left ventricular hypertrophy were the risk factors most strongly associated with CV events. When these parameters were used as covariates in logistic regression analyses, the odds ratio (OR) for hypertension in men was 7.8 (95% confidence interval [CI]: 2.1 to 28.6, p = 0.0019), and the OR for hypertension in women was 4.5 (95% CI: 1.6 to 12.3, p = 0.0037). The OR for left ventricular hypertrophy was 4.8 in men (95% CI: 1.03 to 22.2, p = 0.0463) and 8.2 in women (95% CI: 2.6 to 26.0, p = 0.0003). Major CV events occurred in approximately 5% of Fabry Registry patients during the natural history period. All patients with Fabry disease should be monitored for possible CV risk factors, particularly hypertension and left ventricular hypertrophy.

Determinants and Prognostic Significance of Electrocardiographic Left Ventricular Hypertrophy Criteria in Chronic Kidney Disease

The diagnosis of left ventricular hypertrophy (LVH) has prognostic value in the general population. However, among those with chronic kidney disease (CKD), the determinants of electrocardiographic (EKG) LVH and its prognostic value are not clear. A cross-sectional study was performed among 387 consenting consecutive patients from a veterans hospital with a longitudinal follow-up. The overall prevalence of EKG-LVH by the Sokolow-Lyon criteria was 8% and by the Cornell voltage-duration product was 11%. Compared with non-CKD controls, CKD patients had unadjusted odds ratio (OR) for LVH by Cornell criteria of 2.52 (95% CI 1.18 to 5.42). Significance was lost after adjustment. The unadjusted OR for LVH by Sokolow-Lyon criteria was 2.24 (95% CI 0.95 to 5.33). This OR remained statistically insignificant after multivariate adjustment. Anemia, proteinuria, and 24-hour ambulatory systolic BP were associated with EKG-LVH regardless of diagnostic criteria. After a 7.5-year median follow-up, the hazard ratio for all-cause mortality was not associated with EKG-LVH diagnosed by the Sokolow-Lyon criteria; however, multivariable adjustments made EKG-LVH significant. A statistically significant relationship was seen between mortality and Cornell criteria; however, multivariable adjustments made EKG-LVH nonsignificant. The Sokolow-Lyon and Cornell EKG-LVH criteria cannot be used interchangeably to diagnose LVH or determine prognosis. Among those with CKD, ambulatory systolic BP predicts all-cause mortality. Moreover, the duration and severity of BP elevation presumably reflected in EKG-LVH diagnosed by Sokolow-Lyon criteria is also of prognostic significance; the Cornell criteria do not carry independent prognostic information.

Abstract 4119: Utility of ECG to Detect Left Ventricular Hypertrophy Defined by Cardiac MRI in Different Ethnic Groups: The Multi-Ethnic Study of Atherosclerosis (MESA)

Background: Left ventricular hypertrophy (LVH) is a strong predictor of cardiovascular event risk. We evaluated the ethnicity-specific diagnostic utility of ECG in the detection of LVH measured by MRI as a gold standard. Methods: 12-lead ECG and MRI of 4498 asymptomatic subjects in the MESA study (49% males, mean age 61 ± 10 years) with no prior cardiovascular disease were analyzed. Left ventricular mass (LVM) was determined from MRI. Body-size predicted LV mass (pLVM) was determined from an allometric height-weight index derived from a subpopulation of 822 normal-weight, normotensive, non-diabetic MESA participants with LVH defined as LVM/pLVM &gt; 1.31 (&gt;95 th percentile). Prediction of absolute LV mass by ECG was also assessed for whites and blacks based on previously validated prediction models for these groups. Results: The study population consisted of 39% Whites, 12% Chinese, 27% Blacks and 22% Hispanics. ECG detection rate for LVH as determined by MRI was significantly more in women than men (12.3% vs 3.9% respectively, p&lt; 0.02). For a specificity &gt;= 90%, the highest overall sensitivity for LVH was shown by Perguia score (28.7%) which increased from the first (17.9%) to fourth quartile (45.3%) of LV mass. At a fixed specificity of 90%, the highest sensitivity was shown by Sokolow-Lyon voltage duration product (SLP) (38.2%). Neither Perguia nor SLP differed significantly across the four ethnic groups with respect to sensitivity and area under the ROC curve (p&lt; 0.27, p&lt; 0.52; p&lt; 0.35, p&lt; 0.88 respectively). Presence of LV strain pattern on ECG showed the highest adjusted odds ratio for LVH across all ethnic groups. ECG predicted LVM correlated significantly with MRI-determined LVM for both whites and blacks (r=0.74, p&lt; 0.001 and r=0.70, p&lt; 0.001 respectively) with no significant difference in LVH detection rates (6.1% vs 9.4% respectively, p&lt; 0.35) Conclusion: Based on LVM prediction models, ECG correlates well with MRI. ECG sensitivity to detect LVH is low and it does not differ significantly between whites and blacks. Based on individual criteria like Perguia and SLP, sensitivity and diagnostic performance of ECG did not vary significantly across different ethnic groups.