Patterns Of Left Ventricular Geometry Research Articles

Clinical Correlation of Left Ventricular Geometric Patterns at King Abdulaziz Hospital Al-Ahsa Eastern Province

Objective: Exploring the prevalence of alteration in left ventricular (LV) geometry by echocardiography and their correlation with cardiovascular (CV) risk factors and cardiovascular diseases (CVD). Background: Alterations in LV geometry, by echocardiography, is an important prognostic determinant of CVD morbidity and mortality. Yet it is an underutilized tool and has yet to be established in laboratories. Methods: Left ventricular mass index (LVMI) and relative wall thickness (RWT) were calculated by M-mode echocardiography. Patients were classified into four groups based on RWT and LVMI: normal geometry, concentric remodeling (CR), eccentric left ventricular hypertrophy (eLVH), and concentric left ventricular hypertrophy (cLVH). Results: LV geometry patterns revealed normal geometry prevalence (43.46%), followed by CR (30.76%). The commonest CV risk factor was hypertension (HTN) (85%), followed by diabetes mellitus (DM) (72%). A strong association was identified between CVD and LV geometry changes (p-value < 0.005). CVD prevalence among total patients was 66.5% within this group; coronary artery disease (CAD) prevalence was 55.5% (p-value < 0.029), and heart failure (HF) prevalence was 29.6% (p-value < 0.001). Conclusion: We strongly reinforce routine echocardiograms in determining LVM, RWT, and LV geometry patterns. It is an important, underutilized diagnostic and prognostic tool in risk stratification of patients with CVD and altered LV geometry and mass. Future studies for incorporating LVM and RWT in clinical decision algorithms are warranted.

Association between serum cystatin C and early impairment of cardiac function and structure in type 2 diabetes patients with normal renal function.

Type 2 diabetes mellitus (T2DM) patients may have cardiac remodeling and dysfunction from the early stage of disease. This study aimed to determine the association between cystatin C (CysC) and early cardiac functional or structural impairment in T2DM patients without renal dysfunction. A total of 1135 T2DM patients without renal dysfunction and known heart diseases were included in our study. Cardiac function and structure were evaluated by echocardiography. Patients were diagnosed as left ventricular hypertrophy (LVH), impaired left ventricular (LV) diastolic function, and categorized into four different LV geometry patterns including normal, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy. In multivariate linear regression analyses, CysC was positively associated with interventricular septum, LV mass index, left atrial volume index, E/e' ratio, and negatively associated with Tissue Doppler e', E/A ratio (p < .05). As a continuous variable, increasing CysC levels were associated with prevalence of LVH (OR: 1.47, 95%confidence interval [CI]: 1.22-1.77), impaired LV diastolic function (OR: 1.58, 95%CI: 1.33-1.87), concentric hypertrophy (OR: 1.54, 95%CI: 1.23-1.93) and eccentric hypertrophy (OR: 1.34, 95%CI: 1.00-1.80) according to multivariate logistic regression analyses. While as a categorical variable, the highest CysC quartile (CysC > 1.04 mg/L) was associated with LVH (OR: 2.95, 95%CI: 1.74-5.00), impaired LV diastolic function (OR: 4.09, 95%CI: 2.54-6.60), and concentric hypertrophy (OR: 3.26, 95%CI: 2.05-5.18). CysC was significantly associated with early LV remodeling and cardiac functional impairment in T2DM patients with normal renal function. It could be a reliable and convenient biomarker detecting early impairment of cardiac function and structure in T2DM patients.

Phenotyping the right heart according to left ventricular geometry patterns in severe HFrEF

Abstract Background Right ventricular (RV) failure significantly impact on heart failure with reduced ejection fraction (HFrEF) prognosis. How and whether specific functional and geometrical phenotypes of the RV function adapt and combined with left ventricular (LV) geometry is unknown. Purpose To test the RV function across LV geometrical patterns looking at respective prognostic roles. Methods We retrospectively examined a population of patients homogenously diagnosed with chronic HFrEF (defined as LV ejection fraction (EF) less than 35%) and treated with optimal therapy (OT) and all implanted with ICD for primary prevention of sudden cardiac death. Patients were categorized by echocardiography according to remodeling pattern based on left ventricular mass index and relative wall thickness into four groups: normal geometry (NG), concentric remodeling (CR), concentric hypertrophy (CH) and eccentric hypertrophy (EH). RV parameters were: tricuspid annulus plane systolic excursion (TAPSE), TAPSE/pulmonary artery pressures (PAPs), RV basal diameter and fractional area change (FAC). Outcome variable was all-cause mortality, assessed with multivariable Cox proportional hazard (PH) models. Results Among 193 patients (age 66±11 years, 81% men, 74% with ischemic etiology of HF and EF 28±5%) 21% had NG, 3% had CR, 8% had CH, and 68% had EH. Distribution of RV echo parameters across LV remodeling groups is shown in table 1. Over a median follow-up time of 4 (1.9 – 6.1) years, 65 deaths occurred. In multivariable Cox PH models adjusted for age, LVEF, ischemic etiology and LV geometry, TAPSE, TAPSE/PAPs, RV basal diameter and FAC strongly and independently predicted the outcome variable [HR 0.92 (95% C.I. 0.86–0.98), HR 0.08 (95% C.I. 0.01–0.57), HR 1.87 (95% C.I. 1.29–2.71), HR 0.97 (95% C.I. 0.95–1.00), respectively all p-value &amp;lt;0.05]. Conclusion In a homogeneously defined population of severe HFrEF outpatients receiving OT, the majority showed EH remodeling pattern, which did not predict the primary outcome. LV geometry did not further stratify patients in this high risk group. Conversely, RV dysfunction proved to be a strong predictor of mortality, independently of age, LV function and etiology of HF, regardless LV morphology. Funding Acknowledgement Type of funding sources: None.

Effect of diabetes mellitus on the development of left ventricular contractile dysfunction in women with heart failure and preserved ejection fraction

BackgroundHeart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome with sex-specific pathophysiology. Estrogen deficiency is believed to be responsible for the development of HFpEF in women. However, estrogen deficiency does not seem to be completely responsible for the differences in HFpEF prevalence between sexes. While diabetes mellitus (DM) frequently coexists with HFpEF in women and is associated with worse outcomes, the changes in myocardial contractility among women with HFpEF and the DM phenotype is yet unknown. Therefore, we aimed to investigate sex-related differences in left ventricular (LV) contractility dysfunction in HFpEF comorbid with DM.MethodsA total of 224 patients who underwent cardiac cine MRI were included in this study. Sex-specific differences in LV structure and function in the context of DM were determined. LV systolic strains (global longitudinal strain [GLS], circumferential strain [GCS] and radial strain [GRS]) were measured using cine MRI. The determinants of impaired myocardial strain for women and men were assessed.ResultsThe prevalence of DM did not differ between sexes (p > 0.05). Despite a similar LV ejection fraction, women with DM demonstrated a greater LV mass index than women without DM (p = 0.023). The prevalence of LV geometry patterns by sex did not differ in the non-DM subgroup, but there was a trend toward a more abnormal LV geometry in women with DM (p = 0.072). The magnitudes of systolic strains were similar between sexes in the non-DM group (p > 0.05). Nevertheless, in the DM subgroup, there was significant impairment in women in systolic strains compared with men (p < 0.05). In the multivariable analysis, DM was associated with impaired systolic strains in women (GLS [β = 0.26; p = 0.007], GCS [β = 0.31; p < 0.001], and GRS [β = −0.24; p = 0.016]), whereas obesity and coronary artery disease were associated with impaired systolic strains in men (p < 0.05).ConclusionsWomen with DM demonstrated greater LV contractile dysfunction, which indicates that women with HFpEF comorbid with DM have a high-risk phenotype of cardiac failure that may require more aggressive and personalized medical treatment.

Abstract P092: Longitudinal Impact Of Blood Pressure On Left Ventricular Geometry In The Hispanic Community Health Study/Study Of Latinos: Echocardiographic Study Of Latinos (Echo-SOL) Ancillary Study

Introduction: Abnormal left ventricular geometry (LVG) is an independent predictor of cardiovascular mortality. We assessed the longitudinal transitions of LVG among Hispanic/Latino adults. Methods: Echo-SOL provided serial 2D echocardiograms of Hispanic adults. Each subject was identified as hypertensive or normotensive and categorized into four LVG patterns: normal, concentric remodeling (CR), concentric hypertrophy (CH), or eccentric hypertrophy (EH). Hypertensive adults were stratified on whether they maintained blood pressure (BP) control (&lt;140/90mmHg) by visit 2. The normotensive adults were stratified on whether they developed incident hypertension (HTN) by visit 2. Logistic regression was used to evaluate the outcome of normal vs. abnormal LVG at visit 2 adjusting for age, sex, and follow-up time. Results: There were 1818 adults at visit 1 (mean age 56 years; 42.6% male, 44.7% hypertensive), with 1643 obtaining serial echocardiograms an average of 4.3 years later. At visit 1, LVG was distributed as follows: normal, 65.3%; CR, 30.6%, CH 3.1%, and EH 1.1%. Among hypertensive adults at visit 1, 59.7% had normal LVG and 34.1% had CR. By visit 2, there was a progression from normal LVG to CR among those with and without BP control; CR prevalence increased to 58.5% and 55.2%, respectively (Fig. 1). For visit 1 hypertensive adults, the incidence of abnormal LVG did not differ with regards to BP control (adjusted OR 1.1, 95% CI: 0.7-1.7). Among normotensive adults at visit 1, 69.8% had normal LVG. If they remained normotensive by visit 2, this prevalence decreased to 52.2%. If they developed HTN, there was an associated progression toward abnormal geometry (adjusted OR 2.5, 95% CI: 1.4-4.2), with the majority (59.2%) demonstrating a CR phenotype. Conclusion: Our findings suggest that BP control to 140mmHg is not adequate to prevent progressive LV remodeling among Hispanic/Latino adults. Further study is needed to understand this maladaptive process and how it contributes to cardiovascular disease in this population.

61. LEFT VENTRICULAR GEOMETRY PATTERN OF HYPERTENSION PATIENTS WHO UNDERTAKING ECHOCARDIOGRAPHY AT AL-IHSAN HOSPITAL BANDUNG ON 2018-2019

Background: Hypertension can induce changes in structures and functions of the heart as the Hypertension Mediated Organ Damage (HMOD). The most common subclinical symptoms of HMOD are Left Ventricular Hypertrophy (LVH), which is one of the Left Ventricular (LV) geometry. LV Geometry has prognostic significance. Objective: To describe LV geometry pattern of hypertension patients who undertaking echocardiography at Al-Ihsan Hospital Bandung. Method: This is a descriptive, cross-sectional study using medical record and the echocardiography result from January 2008–December 2019. Hypertension was defined as patient diagnosed with a code I10 (essential hypertension), I11 (hypertensive heart disease) based on ICD X, and/or patients with a history of hypertension. The exclusion criteria were samples with incomplete data of medical records and echocardiography results. The LV geometry was determined by re-calculation of relative wall thickness (RWT) and left ventricular mass index (LVMI). Result: There were 123 of 6247 hypertension patients, female (66.7%), age 60 ± 12 years, obesity (49.6%), CAD (24.4%), DM II (27.6%), rEF (23.6%), VHD (30.1%). LV geometry patterns were concentric LVH (49 pts/40%), eccentric LVH (41 pts/33%), normal geometry (22 pts/18%), and concentric remodeling (11 pts/9%). Concentric LVH tends to occur in women, age &gt;65 years, and obese patients. Eccentric LVH tends to occur in patients with comorbid CAD, VHD, rEF, and DM II. Concentric remodeling and normal geometry are never dominant as the most pattern of geometry in hypertension patients. Conclusion: The LV geometry of hypertension patients majority have experienced LVH with the most pattern is concentric LVH.

Smoking Status, Intensity of Smoking, and Their Relation to Left Ventricular Hypertrophy in Working Aged Korean Men.

Smoking is an established risk factor for atherosclerotic cardiovascular disease. However, the effect of smoking on left ventricular (LV) structure has been less studied. This study was designed to assess the association of smoking status and smoking intensity with left ventricular hypertrophy (LVH). Study subjects were 53,666 working aged Korean men who received echocardiography as an item of health check up. They were grouped by smoking status (never, former, and current smokers), pack-year of smoking (never, <10, 10-19.9, and ≥20 pack-year), and urine cotinine excretion (<100, 100-999, ≥1000 ng/mL). Multivariate logistic regression analysis was used in calculating adjusted odds ratios (ORs) and 95% confidence interval for LVH (adjusted odds ratios [95% confidence interval]). The proportions of abnormal LV geometry patterns were compared among groups. Former and current smokers had the higher levels in LV mass index, relative wall thickness, and the prevalence of LVH than never smoker. The association with LVH increased in order of never (reference), former (1.44 [1.01-2.04]), and current smokers (2.10 [1.44-3.05]). LVH showed the proportional relationship with pack-year of smoking (never smoker: reference, <10: 1.45 [1.01-2.08], 10-19.9: 1.73 [1.17-2.57], ≥20: 2.43 [1.58-3.74]) and urine cotinine excretion (never smoker: reference, 100-999: 1.70 [1.21-2.37], >1000: 1.97 [1.43-2.72]). The proportions of abnormal LV geometry patterns were higher in smoking groups than never smoking group. Exposure to tobacco use and intensity of smoking was associated with LVH in working aged population. In working aged Koreans with mean age of 39.9 ± 7.0 years, former and current smokers are more likely to have LVH than never smoker. Dose-dependent relationship was found between the smoking status (never, former, and current smokers), pack-year of smoking, urine cotinine excretion, and LVH. These findings indicate that smoking has an adverse influence on LV structure even in relatively young age group.

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.

Left Ventricular Geometry and N-terminal Pro-Brain Natriuretic Peptide in Egyptian Children with Chronic Kidney Disease.

Introduction: Cardiovascular disease is the main cause of death in Chronic Kidney disease (CKD) patients especially for those on dialysis. Left ventricular echocardiography changes are common. N-terminal pro-Brain Natriuretic peptide (NAP) is a sensitive predictor for ventricular stress. Aim of the Study: Our aim is to assess left ventricular Echocardiography abnormalities in CKD patients and their relation to serum NT pro BNP levels. Methods: TheStudy included; 51 patients with different stages of CKD (21 patients were (CKD1-4) on predialysis conservative treatment, 30 patients with (CKD 5) on hemodialysis), and 20 healthy control group. Patients were subjected to echocardiography and serum measurement of BNP by enzyme linked immunosorbent assay. Results: Abnormal left ventricular geometry patterns were seen in 17/21 (81%) CKD pre dialysis patients (concentric hypertrophy in 8 patients, eccentric hypertrophy in 8 patients and concentric remodeling in one patient). Those on dialysis 28/30 (93%) showed abnormal left ventricular geometry patterns (23 had concentric hypertrophy, 4 had eccentric hypertrophy and one patient had concentric remodeling). Mean NT pro BNP level was significantly higher in ESRD on dialysis (182.49 ± 136.57) vs pre dialysis group (29.72 ± 34.77) and control group (1.13 ± 2.97) (p < 0.001). Total patient sample (51cases) showed significant positive correlations between NT pro BNP level with hypertension, left ventricular mass (LVM), LVM2.7, LVM2, relative wall thickness (RWT) and serum creatinine (p = 0.0007, 0.01, 0.0007, 0.0005, 0.0002 respectively),significant negative correlation with ejection fraction (P = 0.04). Conclusion: Measuring plasma concentration of BNP, may be useful for the identification of CKD patients with abnormal left ventricular Geometry. Recommendations: Routine echocardiography is recommended in early stages of CKD.

Kronik böbrek hastalarında anormal kalp geometrisi ve sol ventrikül hipertrofisi

Purpose: The aim of this study was to investigate the incidence of left ventricular geometric patterns in patients with chronic kidney disease (CKD).Materials and Methods: A total of 162 patients (100 males) with stage 2–5 CKD were included in the study. Patient age was between 17 and 79 years. Left ventricular geometry (LVG) patterns were calculated as left ventricular normal geometry (LVNG), left ventricular concentric remodeling (LVCR), concentric left ventricular hypertrophy (cLVH) and eccentric left ventricular hypertrophy (eLVH) by echocardiographic parameters.Results: The incidence of LVH was 45.1%. LVG patterns were found as follows: eLVH in patients 18(11.1%), cLVH in 42(25.9%), LVCR in 51(31.5%), and LVNG 51(31.5%). LVNG was found 10.38% and 34.27% in CKD stage 2 and dialysis, respectively. LVCR was as high as 62.3% in CKD stage2. cLVH and eLVH were found as 35.92% and 29.13% in stage 5 non-dialysis and dialysis, respectively. There was a relationship between clinical characteristics and LVG as follows age and GFR with LVCR, HbA1C and serum levels of albumin and sodium with cLVH, and age and serum albumin with eLVHConclusions: In our CKD patients, abnormal LVG was found as earlier as CKD stage 2. The incidence of cLVH and eLVH was higher in advanced stages of CKD. Nontraditional factors such as volume status and nutrition were also crucial for left ventricular remodeling.

Transcatheter Aortic Valve Replacement and Left Ventricular Geometry: Survival and Gender Differences

The aim of this study was to examine the relationship between baseline left ventricular (LV) geometry and outcomes after transcatheter aortic valve replacement (TAVR). Patients undergoing TAVR (n=206) had baseline LV geometry classified as (1) concentric hypertrophy, (2) eccentric hypertrophy, (3) concentric remodeling, or (4) normal. Descriptive statistics, Kaplan-Meier time-to-event analysis, and Cox regression were performed. Distribution of baseline LV geometry differed between male and female patients (χ2=16.83, P=.001) but not at 1month (χ2=2.56, P=.47) or 1year (χ2=5.68, P=.13). After TAVR, a majority of patients with concentric hypertrophy evolved to concentric remodeling. Survival differed across LV geometry groups at 1year (χ2[3]=8.108, P=.044, log-rank test) and at 6.5years (χ2[3]=9.023, P=.029, log-rank test). Compared with patients with concentric hypertrophy, patients with normal geometry (hazard ratio, 2.25; 95% CI, 1.12-4.54; P=.023) and concentric remodeling (hazard ratio, 1.89; 95% CI, 1.12-3.17; P=.016) had higher rates of all-cause mortality. Baseline concentric hypertrophy confers a survival advantage after TAVR. Although baseline patterns of LV geometry appear gender specific (with women demonstrating more concentric hypertrophy), this difference resolves after TAVR.

Extracellular Superoxide Dismutase Is Associated With Left Ventricular Geometry and Heart Failure in Patients With Cardiovascular Disease.

BackgroundExtracellular superoxide dismutase (Ec‐SOD) is a major scavenger of reactive oxygen species. However, its relationships with abnormal left ventricular (LV) geometry patterns and heart failure (HF) are still unknown in patients with cardiovascular disease.Methods and ResultsA cross‐sectional study was carried out to evaluate the association of serum Ec‐SOD activity with LV geometry, as well as HF in 1047 patients with cardiovascular disease. All participants underwent standard echocardiography examination and measurement of serum Ec‐SOD activity. Overall, we found a significantly decreased trend of serum Ec‐SOD activity from subjects with normal geometry (147.96±15.94 U/mL), subjects with abnormal LV geometry without HF (140.19±20.12 U/mL), and subjects with abnormal LV geometry and overt HF (129.32±17.92 U/mL) after adjustment for potential confounders (P for trend <0.001). The downward trends remained significant in the concentric hypertrophy and eccentric hypertrophy groups after stratification by different LV geometry patterns. Multinomial logistic regression analysis showed that each 10 U/mL increase in serum Ec‐SOD activity was associated with a 16.5% decrease in the odds of concentric remodeling without HF (odds ratio [OR], 0.835; 95% CI, 0.736–0.948), a 40.4% decrease in the odds of concentric hypertrophy with HF (OR, 0.596; 95% CI, 0.486–0.730), a 16.1% decrease in the odds of eccentric hypertrophy without HF (OR, 0.839; 95% CI, 0.729–0.965) and a 34.0% decrease in the odds of eccentric hypertrophy with HF (OR, 0.660; 95% CI, 0.565–0.772).ConclusionsSerum Ec‐SOD activity was independently associated with abnormal LV geometry patterns with and without overt HF. Our results indicate that Ec‐SOD might be a potential link between LV structure remodeling and the development of subsequent HF in patients with cardiovascular disease.RegistrationURL: https://www.clinicaltrials.gov; Unique identifier NCT03351907.

Lipid profile and left ventricular geometry pattern in obese children

BackgroundLeft ventricular hypertrophy (LVH) is an important risk factor for cardiovascular and all-cause mortality. Previous studies reported conflicting results concerning the relationship between serum lipid levels and left ventricular geometry pattern. We sought to explore the relationship between standard serum lipid profile measures with left ventricular geometry pattern in obese children.Patients and methodsIn this cross-sectional study, a total of 70 obese children were examined. Fasting blood samples were taken to measure total cholesterol, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), triglycerides (TGs), glucose, and insulin. Based on these values TG/HDL ratio, BMI and HOMA index were calculated. We also measured the average 24-h ambulatory systolic blood pressure (SBP) and two-dimensional (2/D) transthoracic echocardiography was performed to determine left ventricular mass index (LVMI) and relative wall thickness (RWT). Multiple regression analyses were conducted to explore relationships between study variables and the LVMI or RWT as outcome variables. The final model with LVMI included TG/HDL ratio, BMI, 24 h-average SBP, age and sex, while for the RWT we included BMI, insulin, age and sex.ResultsOur study included 70 children (65.71% boys and 34.29% girls) median age (14 years, IQR = 12–16)." We demonstrated independent and positive association of TG/HDL ratio, BMI and 24 h-average SBP with LVMI (effect = 3.65, SE = 1.32, p < 0.01; effect = 34.90, SE = 6.84, p < 0.01; effect = 0.32, SE = 0.12, p < 0.01, respectively). On the other hand, in model with RWT as outcome variable, only BMI and insulin were significantly linked (BMI: effect = 13.07, SE = 5.02, p = 0.01 Insulin: effect = 2.80, SE = 0.97).ConclusionIncreased TG/HDL ratio in obese children is associated with the development of eccentric left ventricular hypertrophy while increased BMI and insulin were associated with concentric left ventricular hypertophy.

Left ventricular radial strain impairment precedes hypertrophy in Anderson-Fabry disease.

In Anderson-Fabry disease (AFD), left ventricular (LV) radial function has been scarcely investigated. We hypothesized that LV function may be affected by disease specific mechanisms and sought to comprehensively evaluate LV radial, circumferential and longitudinal function in a large population of AFD patients looking at the influence of LV geometry and fibrosis. We prospectively studied 94 consecutive AFD patients (41.5 ± 14.5 years; 41 men) with preserved LV ejection fraction (EF) utilizing speckle-tracking echocardiography. A subset of patients underwent gadolinium-enhanced cardiac magnetic resonance. Cases were compared to 48 healthy subjects matched for age and sex. LV concentric hypertrophy was found in 33 AFD patients while LV concentric remodeling (relative wall thickness ≥ 0.43) in 16 out 61 patients with normal LV mass. AFD patients had lower radial, longitudinal and circumferential strains than controls, independently by LV geometry pattern. Patients with LV hypertrophy showed reduced global longitudinal strain (p < 0.001) and early diastolic untwisting rate (p = 0.002) as compared to patients with normal geometry. In the whole AFD population, neither radial strain nor circumferential strain correlated with LV mass, while global longitudinal strain and early diastolic untwisting rate did (both p < 0.001). Late gadolinium enhancement was significantly associated with longitudinal strain, twisting rate and early diastolic untwisting rate, with twisting rate being the most powerful independent predictor (β = - 0.461; p = 0.002). Findings demonstrate impairment of LV radial strain in AFD patients with preserved EF, even in a pre-hypertrophic stage. Development of LV hypertrophy and fibrosis make worse mostly longitudinal dysfunction.

Serum uric acid and left ventricular geometry pattern in obese children

BackgroundRelative importance of traditional and non-traditional components of metabolic syndrome (MetSy) as risk factors for subclinical target organ damage in obese children is still under investigation. Recent studies highlight the role of serum uric acid (SUA) as an emerging non-traditional independent risk factor which correlates with obesity, MetSy, type 2 diabetes, preclinical cardiac and extracardiac organ damage, as well as cardiovascular events. AimsTo study the relationship between SUA and left ventricular geometry pattern in obese children with or without MetSy. Patients and methodsIn this cross-sectional study, a total of 73 obese children, 64.4% male, and 35.6% female, with median age of 15 years (IQR = 12–16) were examined. Body mass index, glycaemia, standard lipid profile, fasting insulin level, HOMA index, serum uric acid level, 24-h average systolic blood pressure, left ventricular mass index (LVMI) and relative wall thickness (RWT) were evaluated in all children. ResultsLVMI in our study group was 46 g/m2.7 (IQR = 42–55) while the RWT was 37% (IQR = 31–41). Median SUA level was 341 μmol/L (IQR = 283–387). In the entire sample of children, SUA was independently associated with the RWT (coeff = 0.02, p < 0.01). In a sub-group of metabolically unhealthy children, we found no statistically significant association between SUA and LVMI nor between SUA and RWT (coeff. = 0.002, p = 0.92; coeff. = 0.01, p = 0.20, respectively). ConclusionSerum uric acid is an important independent non-traditional risk factor for the development of concentric left ventricular geometry in obese children. These findings deserve further investigation to determine whether high SUA in obese children may be a therapeutic target.

P5651Association of left atrial fibrosis extent with left ventricular geometric remodeling and diastolic dysfunction in patients with paroxysmal atrial fibrillation

Abstract Introduction Whether left atrial fibrosis (LAf) in patients with atrial fibrillation (AF) is a consequence of left ventricular (LV) diastolic dysfunction or primary atrial pathology continues to be a debatable issue. Electroanatomical mapping (EAM) allows to image and to define LAf as a substrate of AF. Purpose To study the relationship of LAf extent with LV diastolic function and geometric remodeling in patients (pts) with paroxysmal AF. Methods 56 pts with paroxysmal AF (mean age 57.1±8.4 years, 31 males), undergone catheter ablation, were enrolled in the study, including 30 pts with arterial hypertension (AH), 15 – with coronary artery disease (CAD) and AH. Comprehensive transthoracic echocardiography was carried out in all pts to assess chamber volumes, systolic and LV diastolic functions and geometry patterns according to Recommendations of ASE and EACVI. Before ablation, EAM was performed in sinus rhythm. The bipolar low voltage areas of LAf were identified with the cut-off &lt;0.5 mV. For the LAf quantification following indicators were calculated: total square of LAf (Sf, cm2) and LAf degree, estimated as an analog of the UTAH staging system, by selection of UTAH I: &lt;5% fibrosis; II: 5–19%; III: 20–35% and IV: &gt;35%. Results All patients had preserved systolic LV function. To assess the influence of LV geometry on LAf extent all pts were distributed in accordance to LV geometry patterns (p): normal geometry (pI) – 27 pts, concentric remodeling (pII) – 13, eccentric hypertrophy (pIII) – 10, concentric hypertrophy (pIV) – 6. Pts with pIII were older than pI pts: 60.8±6.4 vs 53.9±10.4 (p=0.048). All pts with pIII and pIV had AH. From 11 pts without AH, 10 had pI of LV geometry. PIII was revealed more often in CAD pts compared to those without CAD: 29.2 vs 10.5% (p=0.04). PIII pts had bigger LA volume compared to pI pts (74.3±22.5 vs 58.8±19.4 ml, p=0.019) and pII pts (61.9±14.9, p=0.05), but LA volume of pIII pts didn't differ from pIV pts (71.9±14.5, p=0.78). PIII pts had more extent Sf than pI pts (28.32±8.9 vs 13.4±6.5, p=0.05), while Sf of pII (17.3±8.7, p=0.495) and pIV pts (16.4±9.5, p=0.699) didn't differ significantly from Sf of pI pts. As for the degree of LAf, UTAH I was absent in pts with pIII and UTAH IV was revealed in 40% of these pts, while in pts with pI UTAH I was in 26% and UTAH IV - in 14.8% (p=0.049). However, Sf and UTAH degree did not depend on age, CAD and heart failure presence. As for diastolic dysfunction, in pIII and pIV pts e∼septal and e∼lateral were lower compared to pI pts: 6.3±1.9, 5.5±2.4 vs 8.5±2.2 (p&lt;0.01) and 8.2±2.7, 8.0±3.8 vs 11.3±2.9 (p&lt;0.01), respectively, while E/e∼ in pIII pts didn't differ from pI pts (8.0±1.6 vs 7.2±1.6, p=0.17), but in pIV was more than in pI pts (10.4±2.8, p=0.003). Conclusion LAf extent in paroxysmal AF is associated more with such LV geometry pattern as eccentric hypertrophy, than with diastolic disorders, which accompany both eccentric and concentric hypertrophy.

Serum Aldosterone Is Related to Left Ventricular Geometry and Function in Young Adults with Never-Treated Primary Hypertension.

Background: Although aldosterone has been demonstrated to induce left ventricular (LV) hypertrophy not only in primary aldosteronism but also in primary hypertension (HT), it can be affected by multiple factors, including age, and the effect of aldosterone on LV function is controversial. This study was to investigate the relationship of aldosterone to changes in LV geometry and function in young adults with never-treated HT. Methods: Seventy-five consecutive patients (age, 29.8 ± 6.3 years) with never-treated HT and 45 normal controls were enrolled. Echocardiographic values and LV global longitudinal strain (LVGLS) were obtained. Serum aldosterone concentration (SAC) and serum procollagen type III amino-terminal peptide (PIIINP) level were obtained in HT patients. Results: HT patients had higher LV mass index, higher relative wall thickness (RWT), and worse LV function than normal controls. LVGLS and e’ velocity were worse in HT patients with normal geometry than in normal controls. SAC was well correlated with LV mass index, RWT, e’ velocity, LVGLS, and PIIINP (all p < 0.05). LV geometry pattern was most related to SAC among clinical parameters (p = 0.019). LVGLS was most related to LV geometry and diastolic blood pressure. In contrast, e’ velocity was most related to PIIINP. Conclusion: Our findings may indicate that in young patients with never-treated HT, aldosterone significantly contributes to changes in LV geometry and functional impairment through its pro-hypertrophic and myocardial fibrosis effects beyond blood pressure.

Association of Microalbuminuria with Abnormal Left Ventricular Geometry Patterns in Nigerian Normotensive Type 2 Diabetic Patients

To compare left ventricular (LV) geometry patterns among normotensive type 2 diabetics (NT2DM) with normoalbuminuria, NT2DM with microalbuminuria and healthy controls. A cross-sectional study conducted at the medical outpatient department of a Teaching Hospital from January 2013 to March 2014. Sixty-three normoalbuminuric NT2DM, 71 microalbuminuric NT2DM and fifty-nine healthy controls were recruited. Microalbuminuria was tested for using Micral test strips (Roche, Germany). Trans-thoracic echocardiography was carried out on all subjects. Relative wall thickness (RWT), left ventricular mass index (LVMI) and LV geometry patterns were compared among the three groups. The three groups were age and sex-matched and appropriate statistical tests were used for comparisons with p<0.05. The proportions of abnormal LV geometry (33.3% vs 71.4% vs 84.5%), LVMI and RWT showed a significant stepwise increase from healthy controls through normoalbuminuric NT2DM and to microalbuminuric NT2DM (all p<0.01). Concentric remodeling (CR) was the commonest pattern among the three groups. Left ventricular mass index and RWT correlated significantly with duration of DM and body mass index (all p< 0.01). Microalbuminuria showed a strong direct association with abnormal LV geometry (OR 3.27, 95% CI 1.63-6.57, p<0.01) while duration of DM was found to be an independent predictor of LV geometry remodeling (OR 1.23, 95% CI 1.02-1.49, p = 0.03) among normotensive diabetics. Although CR was the commonest pattern across the three patient groups, those with microalbuminuria had the highest proportion and risk of LV remodeling. Early screening and prompt treatment of microalbuminuria in NT2DM is hereby recommended.

The Effect of Left Ventricular Geometry on Myocardial Performance Index in Hypertensive Patients

Background: The relationship between Tei Index (TI) and left ventricular (LV) geometric patterns has not been previously well described. The present study therefore set out to describe the nature of this relationship. This study examined the association between the Tei index and left ventricular geometry among hypertensive Egyptian subjects. Methods: This study included 70 subjects (60 hypertensive Patients and 10 control subjects). Hypertensive Patients and control subjects were referred from outpatient clinic to the Echocardiographic laboratory of Cardiovascular Department in Almataria Teaching Hospital between April 2017-November 2017. TI was defined as the sum of isovolumic contraction and relaxation times divided by the ejection time, and values of LV TI<0.40 were considered normal, while higher values were considered abnormal. Four patterns of LV geometry (normal, concentric remodeling, concentric LV hypertrophy and eccentric LV hypertrophy) were determined from the LV mass index and LV relative wall thickness. Statistical analysis was done using SPSS version 20.0. Bivariate correlation and stepwise multiple linear regressions were used to analyze the associations between TI and a number of variables. Results: Among the hypertensive subjects, Concentric hypertrophy was the commonest pattern of abnormal geometry (36.7%), followed by eccentric hypertrophy (20%), and concentric remodeling was demonstrated in 15% of the hypertensive population. Only 28.3% of the hypertensive population had normal geometry. Hypertensive patients with normal geometry had the highest Tei index. Those with concentric hypertrophy had higher Tei index than those with concentric remodelling. However, there was no significant difference in the Tei index between those with eccentric and concentric hypertrophy. In correlation between MPI and Echocardiography variables of LVH of hypertensive patients in bivariate correlation had a direct statistically significant with LVPWDd, IVSDd, LVIDd, LVISd, LV mass & LVMI. The MPI had inverse significant correlation with EF and FS. While by using stepwise multiple linear regressions the predictor of MPI was the LV mass index. Conclusion: This study has found that MPI is impaired in hypertensive patients before development of ventricular hypertrophy and in left ventricular hypertrophy is more prominent in concentric hypertrophy.

Left Ventricular Measurements in Black Sub-Saharan Africans and White Maghreb

Background: Evidence that blacks have greater left ventricular mass (LVM) than whites has been demonstrated by large population-based American studies. However, to our knowledge, there is no study to date comparing LVM in Black Sub-Saharan Africans (BSSA) and the Maghreb white population. We compared LVM measured echocardiographically in asymptomatic BSSA and Maghreb. Methods and Results: A total of 100 asymptomatic BSSA and 189 Maghreb, (18 to 55 years old), underwent resting two-dimensional transthoracic echocardiography. LVM and geometry were assessed according to the 2015 American Society of Echocardiography and the European Association of Cardiovascular Imaging updated guidelines for cardiac chamber quantification. Crude or indexed LVM to body surface area or height2.7 was similar in BSSA and in Maghreb (132.7 ± 37.0 vs. 134.2 ± 35.7 g; 73.1 ± 17.8 vs. 72.9 ± 16.2 g/m2; 32.1 ± 9.8 vs. 33.6 ± 9.5 g/m2.7). However, the left ventricular posterior wall was thicker in BSSA. Patterns of left ventricular geometry (normal, concentric remodeling, or concentric or eccentric hypertrophy) were equally distributed among the two ethnic groups. Conclusions: Left ventricular posterior wall thickness but not LVM is greater in BSSA than in Maghreb.