Penn Convention Research Articles

IMPACT OF NON-DIPPING PATTERN AND NOCTURNAL HYPERTENSION ON LEFT VENTRICULAR MASS INDEX IN UNTREATED WHITE-COAT HYPERTENSIVE SUBJECTS

Objective: Several studies have demonstrated that subjects with white-coat hypertension (WCH) have an increased risk of adverse cardiovascular outcome and target organ damage (TOD) progression compared to normotensives. The potentially detrimental effect of non-dipping or nocturnal hypertension on TOD has not been fully elucidated in subjects with WCH. The aim of our study was to investigate the impact of both dipping status and nocturnal hypertension on the left ventricle mass index (LVMI) of WCH individuals. Design and method: A total of 387 untreated WCH subjects underwent echocardiographic measurements. LVM was estimated using Devereux's formula according to the Penn Convention Protocol. LVMI was defined as LVM divided by the body surface area. The study population was divided into dippers (blood pressure (BP) nocturnal fall >10%) and non-dippers (BP nocturnal fall <10%) as well as into nocturnal hypertensives (nighttime systolic BP> = 120mmHg or nighttime diastolic BP> = 70mmHg) and nocturnal normotensives (nighttime systolic BP<120mmHg and nighttime diastolic BP<70mmHg). Statistical analysis was performed by means of independent-samples t-test, chi-square test and linear regression. Results: The percentages of non-dippers and nocturnal hypertensives in WCH subjects were 49% and 28%, respectively. The variables associated with LVMI in the univariate analyses were: age, male gender, body mass index, 24-hour diastolic BP and non-dippers. The multivariate regression analyses demonstrated significant associations of LVMI with the following factors: age (B = 5.760, 95% CI: 3.282 to 8.239; p<0.001), male gender (B = 10.941, 95% CI: 5.756 to 16.125; p<0.001), body mass index (B = 0.685, 95% CI: 0.138 to 1.232; p = 0.014), 24-hour diastolic BP (B = -6.634, 95% CI: -11.212 to -1.456; p<0.011) and non-dippers (B = 8.415, 95% CI: 3.449 to 13.380; p = 0.001). Non-dipping pattern was correlated to an increase of 8.415 g/m2 in the LVMI in WCH subjects. Conclusions: Non-dipping status is positively and independently associated with LVMI in untreated WCH patients. In contrast, statistically significant association between nocturnal hypertension and LVMI was not observed.

423.6: Salt Sensitivity in Living Kidney Donors: A New Cardiovascular Risk Factor?

Introduction: Kidney transplantation with living donor (LKD) is associated with longer graft and patient survival compared with deceased donor organs. Until recently, it was believed that the long-term risk of end-stage renal disease (ESRD), cardiovascular events (CVE) or death in LKD is similar to or even smaller than the general population. Normotensive salt-sensitive (Ss) subjects over 25 years old have a mortality similar to that of hypertensive subjects, while salt-resistant (Sr) normotensive subjects have a longer survival. Objective: To compare, in healthy subjects that we have studied to be a LKD, the levels of 24 hour mean ambulatory blood pressure monitoring (24 hs mABPM), kidney function and left ventricular mass index (LVMI) between Ss and Sr, before and a year after donation. Methods: Data from 42 LKD were included. There were 34 (82%) women, with a mean age of 49 (11) years (range 26 to 66 years). None had a history of kidney disease, diabetes, CVE or hypertension. The subjects were placed on a high-salt diet containing 250 mmol Na for 7 days and on a low-salt diet containing 30 mmol Na during the following 7 days. Compliance with the diet was assessed twice a week by measurement of 24-hour urinary Na excretion (NaUE). On the last day of both the high and low-salt periods, 24-hour ABPM was performed with an automated, noninvasive device. Salt-sensitivity (SS) was defined by a significant decrease (P<0.05) of 24 hs mABPM from high to low salt intake. Trans-thoracic m-mode echocardiograms were performed on the last day of the first period. LV mass was calculated according to the Penn convention and corrected for body surface area to produce the LVMI. Data with normal and nonparametric distribution were expressed as mean and standard deviation (SD) or median and interquartile range (ICR), Student t test and Wilcoxon test were used respectively, P values < 0.05 were considered to be statistically significant. Results: SS was found in 13 of the 42 living kidney donors (31%). The Ss group were older than Sr 53 (10) vs 47 (10) years, but it was not statistically significant (p=0.08). Pre-donation, with high-salt diet the 24 hs mABPM was significantly greater in Ss than in Sr, without any differences in creatinine clearence (CrCl), 24 hs NaUE and 24 hs potassium urinary (KUE) excretion. On the other hand with low-salt diet we did not find any significant differences in 24 hs mABPM, CrCl, NaUE and KUE between groups. LVMI was significantly greater in Ss than in Sr donors. One year after donation we found the same statistically differences in 24 hs mABPM with high-salt diet and no differences with the low-salt diet. Again LVMI was significantly greater in Ss than in Sr donors. The increase of LVMI after donation was significant only in Ss donors (23,2 vs 4,5 g/m2). Conclusion: Ss healthy LKD showed a greater LVMI than Sr ones and a greater increment one year after donation. The study of SS could be included to make kidney transplantation with living donor organs safer.

ASSOCIATION OF LEFT VENTRICULAR MASS INDEX WITH ALL-CAUSE MORTALITY IN CHRONIC KIDNEY DISEASE PATIENTS

Objective: Although the association of left ventricular mass (LVM) with outcome is well established in dialysis patients, the importance of this association in pre-dialysis chronic kidney disease (CKD) populations is not well documented. Aim of the study was to examine the association of LVM index with all-cause mortality in CKD patients. Design and method: Our study population consisted of 126 patients with CKD stages 3–4, referred for evaluation at the Hypertension Unit of our department. The patients underwent office blood pressure measurements and echocardiographic measurements. LVM was estimated using Devereux’s formula according to the Penn Convention Protocol. LVM index was defined as LVM divided by the body surface area. Cox regression analysis was used to evaluate the association between LVM index and all-cause mortality. Results: After a median follow-up of 3 years, 11 cardiovascular and 16 non-cardiovascular deaths occurred. The study population consisted of 95 men (75%). Mean age was 70 years, mean office BP was 143/76 mmHg. The multivariate Cox regression analyses revealed that LVM index was independently associated with all-cause mortality (HR: 1.011, 95%CI 1.000–1.023, p = 0.049) after adjustment for age, sex, history of diabetes mellitus and hyperlipidemia, smoking, antihypertensive treatment and mean office blood pressure values. Conclusions: Left ventricular mass index is an independent predictor of all-cause mortality in hypertensive patients with CKD.

Heart geometry in climacteric syndrome on the background of type 1 diabetes mellitus

Background. The climacteric period in women with type 1 diabetes mellitus (DM1) initiates an additional damaging effect on the existing cardinal pathology associated with DM. The purpose was to establish the features of geometric remodeling of the left ventricle (LV) of the heart in women with DM1 during the climacteric period. Materials and methods. The study involved 60 women with type 1 diabetes at the age of 48.74 ± 0.65 years, including 41 perimenopausal and 19 postmenopausal ones. The control group consisted of 20 women without diabetes mellitus at the age of 50.02 ± 0.71 years. According to echocardiography, taking into account the stage of menopause, the indicators of the end-diastolic volume (EDV) and size (EDS), the posterior wall thickness of the LV (LVPWT) and the interventricular septum (IVST) were analyzed. The frequency of various types of geometric remodeling of the left ventricle of the heart was analyzed using the Penn Convention formula; for this, the LV myocardial mass index (LVMI) was calculated according to the formulas LVMI=1.04 [(EDS + LVPWT + IVST)3– EDS3]– 13.6 (LVMI=ratio LVMI to the plane of the body surface (A) in m2; AM2=1 + Weight + Δh / 100, where Δh is the difference between the height of a woman and 160 cm) and the relative wall thickness of the LV (LVRWT) LVRWT=2LVPWT / EDS. Based on these data, the frequency of various types of geometric remodeling was established: normal geometry, concentric remodeling, concentric or eccentric LV hypertrophy. Results. The data obtained indicate that postmenopausal women present a significant decrease in the frequency of normal heart geometry compared to perimenopausal women (26.4 versus 75.6%, p&lt;0.001) and the frequency of concentric LV remodeling 3.5 times increases (26.3 versus 7.3%, respectively). Concentric hypertrophy and eccentric LV hypertrophy prevailed 2.5 times in postmenopausal women (31.6 versus 12.1% and 12.7 versus 4.9%). Conclusions. In perimenopausal women with type 1 diabetes mellitus, in almost a quarter of cases, geometric remodeling of the left ventricle of the heart takes place. In postmenopausal women with estrogen deficiency, the frequency of pathological forms of heart geometry exceeds 75%. The strategy of therapy for cardiac pathology in menopausal women against the background of DM1 should take into account the pathogenetic mechanisms of pathology associated with impaired carbohydrate metabolism and atherogenic measurements against the background of estrogen deficiency as well as limit polypharmacy.

Dependence of renal filtration capacity on the phenotype of chronic heart failure, indicators of systolic and diastolic heart function

The issue of changes in the filtration capacity of the kidneys depending on the structural-geometric and functional remodeling of the heart in different phenotypes of chronic heart failure, disorders of systolic and diastolic function of the left ventricle remains insufficiently studied. The aim of this work: to investigate the relationship between changes in the filtration capacity of the kidneys in patients with chronic heart failure of ischemic genesis depending on the phenotype, indicators of systolic and diastolic cardiac function. Materials and methods. After an informed consent was signed, 87 patients (men – n = 45, women – n = 42) with CHF of ischemic genesis with sinus rhythm, stage II A–B, II–IV functional class NYHA, who were divided into 2 groups, were involved in the study. Group 1 included patients with reduced (&lt;45 %) left ventricular ejection fraction (HFrEF) (n = 57; 59.6 % men), group 2 – patients with CHF with preserved left ventricular ejection fraction (HFpEF) (n = 30; 36.6 % men). Patient groups were comparable in terms of age, sex, height, weight, and body surface area. Doppler echocardiographic examination was performed using the Esaote MyLab Eight (Italy). Glomerular filtration rate (GFR) was assessed using the CKD-EPI, MDRD, and Cockcroft-Gault formulas. Results. Renal dysfunction was registered in patients with CHF in 72 % of cases when calculated using the CKD-EPI formula, 66.7 % using the MDRD formula and 52.6 % using the Cockcroft-Gault formula. Only indicators of blood creatinine level (P = 0.011) and the calculated indicator of glomerular filtration rate according to Cockcroft-Gault (p = 0.047) depended on the types of CHF. GFR for all applied formulas (СKD-EPI, MDRD, Cockcroft-Gault) depended on age (r = -0.42; P = 0.001), height (r = 0.28; P = 0.08), weight (r = 0.31; P = 0.004), body surface area (r = 0.33; P = 0.002). A direct correlation between the creatinine level and the LV myocardial mass index, calculated using the Penn Convention formula, was established, however, the dependence of the creatinine level and GFR on the types of LV geometry was not revealed. The presence of an inverse correlation between LVEF and blood creatinine level (r = -0.3172; P = 0.003), between creatinine content and S lat (r = -0.531; Р = 0.006), a direct correlation between S lat and CKD-EPI (r = 0.5586; P = 0.004), MDRD (r = 0.6254; P = 0.001), Cockcroft-Gault (r = 0.4043; P = 0.045). Conclusions. In chronic heart failure of ischemic genesis with reduced left ventricular ejection fraction, a more pronounced impairment of the filtration capacity of the kidneys than in chronic heart failure patients with preserved left ventricular ejection fraction is observed. An inverse correlation was established between the LV EF and the blood creatinine level (r = -0.3172; P = 0.003). A decrease in the systolic velocity of movement of the lateral annulus fibrosus of the mitral valve is associated with a decrease in the filtration capacity of the kidneys in terms of creatinine level (r = -0.531; P = 0.006), GFR according to the CKD-EPI (r = 0.5586; P = 0.004), MDRD (r = 0.6254; P = 0.001), Cockcroft-Gault (r = 0.4043; P = 0.045) in patients with CHF of ischemic genesis of both phenotypes. In patients with CHF of ischemic genesis of both phenotypes, the myocardial mass index, calculated according to the Penn Convention, correlates with the blood creatinine content (r = 0.95; P = 0.003). In patients with CHF of ischemic genesis, the restrictive type of diastolic filling of the left ventricle is associated with a significant increase in blood creatinine levels by 14 % (P = 0.03) compared with patients with diastolic LV dysfunction by the type of relaxation disorder.

Features of structural and geometric remodeling of the heart and changes in heart diastolic filling in patients with chronic heart failure of ischemic genesis with reduced left ventricular ejection fraction

Chronic heart failure (CHF) does not lose its leading position among the problems of cardiovascular disease. Pathological cardiac remodeling combines the processes of hypertrophy and dilatation of cavities and is the main cause of heart failure progression, and consequently results in high cardiac mortality, especially in CHF patients with reduced left ventricular ejection fraction (LV EF). Despite a substantial range of studies on the features of structural and geometric remodeling of the heart, changes in systolic and diastolic function of the ventricles in CHF patients, this issue still presents a challenge and needs to be improved. The aim of the work – to examine changes in structural and geometric parameters and diastolic function of the heart in patients with CHF of ischemic genesis with reduced LV EF. Materials and methods. The study included 79 patients (men – n = 49; women – n = 30) with CHF of ischemic origin with reduced LV EF, sinus rhythm, stage II AB, NYHA II-IV FC (the main group), and 90 patients with coronary heart disease without signs of CHF (men – n = 40, 44.5 %; women – n = 50, 55.5 %), (the comparison group). The patient groups were age-, sex-, height-, weight-, body surface area-matched. Doppler echocardiographic examination was performed on the device Esaote MyLab Eight (Italy). Results. In CHF patients with reduced LV EF, the following indicators prevailed: EDD LV by 18 % (P = 0.001), LV EDV by 45.8 % (P = 0.001), LV EDV index by 44.6 % (P = 0.001), LV ESD by 44.9 % (P = 0.001), PW by 17.7 % (P = 0.001), LV mass index by 66.6 % (P = 0.001) according to the Penn Convention, and by 62.1 % (P = 0.001) according to the ASE; 16.1 % (P = 0.010) increased RV cavity without changes in its wall thickness. In patients with CHF of ischemic origin with reduced LV EF, the main types of LV geometry were: eccentric (70 %) and concentric (24 %) LV hypertrophy. More than half of the CHF patients with reduced LV EF had significant disorders of LV diastolic filling (25 % – “restrictive” and 28 % “pseudonormal”), a 2.3 times increase (P = 0.001) in E/e’ ratio, a 35 % (P = 0.014) increase in the left atrial volume index and 32 % (P = 0.0001) – in pulmonary capillary wedge pressure (PCWP), increased mean and systolic pressure in the pulmonary artery by 1.5 times (P = 0.002) and 1.6 times (P = 0.0001), respectively. Conclusions. Structural and geometric remodeling of the left ventricle in patients with CHF of ischemic origin with reduced LV EF occurs due to an increase in LV myocardial mass via thickening of its walls and cavity dilatation (44.6 % (P = 0.001) increase in the LV EDV index), as well as 66.6 % (P = 0.001) increase in LV mass index with the predominance of eccentric (70 %) and concentric hypertrophy (24 %) over other types of LV geometry. Severe disorders of LV diastolic filling (25 % – “restrictive” and 28 % “pseudonormal”) are attributable to the significant increase in end-diastolic pressure in the left ventricle (2.3 times increase (P = 0.001) in E/e´) with the development of postcapillary pulmonary hypertension (1.5 times increase (P = 0.002) in the mean and 1.6 times (P = 0.0001) – in systolic pressure in the pulmonary artery).

Features of structural and geometric remodeling of the heart and changes in the diastolic filling of the heart in patients with chronic heart failure of ischemic genesis with preserved left ventricular ejection fraction

Chronic heart failure (CHF) is the most common cardiovascular disease worldwide, estimated at 23 million. With the increase in the growing of the elderly population, the prevalence of hypertension, atrial fibrillation, obesity, diabetes, as well as the improvement of ultrasound diagnostic methods, a further increase in the number of cases of CHF with preserved left ventricular EF.&#x0D; Despite the large number of studies dedicated to analyzing the features of structural and geometric remodeling of the heart, changes in the systolic and diastolic function of the ventricles in patients with CHF, this issue hasn’t been definitively resolved and needs further improvement.&#x0D; The aim of the work – to investigate changes in structural and geometric parameters and diastolic function of the heart in patients with CHF of ischemic origin with preserved LV EF.&#x0D; Materials and methods. The study was included 43 patients (men – n = 19; women – n = 24) for CHF of ischemic origin with preserved LV EF, with sinus rhythm, stage II AB, II-IV FC for NYHA (main group), and 90 patients on coronary heart disease without signs of CHF (men – n = 40 (44.5 %); women – n = 50 (55.5 %)), (comparison group). Groups of patients were comparable in age, sex, height, weight, body surface area. Doppler echocardiographic examination was performed on the device Esaote MyLab Eight (Italy).&#x0D; Results. In patients with CHF preserved LV EF, the indicators prevailed: the size of the LA by 25 % (P = 0.005), the long axis of the LA by 11 % (P = 0.001), the LV EDV index of the LV by 13 % (P = 0.042), the LV mass index by 16 % (P = 0.013) according to the Penn Convention and (P = 0.004) the ASE. Eccentric left ventricular hypertrophy was diagnosed in 56 % of patients.&#x0D; Diastolic left ventricular dysfunction was absent in 2 % of patients with CHF. In 72 % of cases, the type of “relaxation disorder” was established, and in 26 % – “pseudonormal” LV filling profile. In none of the cases was a “restrictive” LV filling profile recorded. The following indicators of left ventricular diastolic function were lower in patients with CHF: e’ of the medial fibrous ring of the mitral valve by 26 % (P = 0.0001) and e’ lateral by 21 % (P = 0.0001), and the A’ the medial fibrous ring of mitral valve by 9 % (P = 0.022), and greater ratios of velocities E/e’ medial by 41 % (P = 0.0001), and E/e’ lateral fibrous ring of the mitral valve by 28 % (P = 0.0001), mean E/e’ by 36 % (P = 0.0001), which indicates a significant increase in end-diastolic pressure in the left ventricle.&#x0D; Conclusions. Structural and geometric remodeling of the heart in patients with CHF with preserved LV EF was characterized by dilatation of the left atrium, a moderate increase in the LV EDV index by 13 % (P = 0.042), a 16 % increase (P = 0.013) in the LV mass index, with the formation eccentric (56 %) and concentric (18 %) LV hypertrophy.&#x0D; Diastolic left ventricular dysfunction was absent in 2 % of patients with CHF. Disorders of diastolic filling of the left ventricle (72 % “relaxation disorder” and 26 % “pseudonormal” type) were occurred due to an increase in end-diastolic pressure in the left ventricle (increase by 41 % (P = 0.0001) ratio E/e’ medial fibrous ring MK), in LA (increase of more than 2 times (P = 0.0001) pulmonary capillary wedge pressure), and was accompanied by the development of postcapillary pulmonary hypertension (increase by 34 % (P = 0.0001) systolic pressure in the pulmonary artery).&#x0D; Despite the preserved LV EF, patients with CHF had significantly lower left and right ventricular contractility (10 % MAPSE med (P = 0.031), 18 % S med (P = 0.001) and 19 % (P = 0.007) RV EF).

НЕКОТОРЫЕ ОСОБЕННОСТИ СОСТАВА ПЕРИФЕРИЧЕСКОЙ КРОВИ У ПАЦИЕНТОВ С ИШЕМИЧЕСКОЙ БОЛЕЗНЬЮ СЕРДЦА И АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИЕЙ

Objective: To study some parameters of peripheral blood depending on changes of echocardiographic indicators reflecting the presence of myocardial hypoxia in patients with coronary artery disease (CAD), arterial hypertension (AH), and in their combination. Methods: Examined 98 men at the age of 45 to 70 years, suffering from various clinical forms of CAD (n=41), stage I-III AH (n=35), and a combination of CAD and AH (n=22). The disease variants were spread as follows: acute myocardial infarction (n=4), atherosclerotic (n=9), post-infarction (n=5) cardiosclerosis, unstable (n=1), stable angina II-III functional classes (FC) (n=6), heart failure II-III FC (n=4), type 2 diabetes (n=4) patients. In all surveyed patients was taken the blood sampling from a vein in the morning on an empty stomach to obtain serum. The study program included cardiac echo with an assessment of standard parameters. The LV mass (LVM) was determined using the Penn Convention formula. The obtained volume indicators were indexed in relation to the surface area of the body, calculating the LV mass index (LVMI). Results: In patients with CAD and with combined CAD and AH in comparison with patients with AH (without CAD) indicators of LVM and LVMI were comparatively lower (due to high blood pressure), though they more often revealed the cases of segmental LV hypokinesis and diastolic dysfunction of the LV. It could be partly due to the changes of morphofunctional properties of erythrocytes, the presence of a chronic inflammatory response, and the worsening of coagulation and rheological properties of peripheral blood. Conclusions: In patients with CAD and a combination of CAD and AH, in comparison with patients with AH (in the absence of CAD), there is increased deformability of erythrocytes, availability of indicators attesting the reaction of chronic inflammation, and a large degree of pathological changes in the rheological properties of blood. Keywords: Coronary artery disease, arterial hypertension, blood cells, chronic sluggish inflammation, coagulation properties of blood, dyslipidemia.

Left Ventricular Mass Index as a Diagnostic Predictor for Hypertrophy of the Left Ventricle in Hypertensive Patients

Background&#x0D; Patient suffering from hypertension are at increased incidence of suffering from increase in size of left ventricular mass (hypertrophy) due to associated risk factor like male sex, advanced age, males including addiction to smoking and alcohol. Measurement of left ventricular mass index helps in detecting the increase in size of left ventricular mass (hypertrophy).&#x0D; Objectives&#x0D; To evaluate increase in size of left ventricular mass (hypertrophy) in relation to ventricular mass index of left ventricle in hypertensive patients.&#x0D; Method&#x0D; A total 100 patients were grouped into 2 groups and named as Group I who served as Normal-Left ventricular mass index-N-LVMI) and Group II who served as Increased Left ventricular mass index-I-LVMI (More than 118g/m2 in males and 109 g/m2 in females. All patients were evaluated for past history and related cardiovascular parameters. About 67 patients among 100 had normal LVMI and 33 patients as per Penn's convention formula had increased LVMI. Body surface area was calculated by using formula 0.20247 x Height (m) 0.725 x Weight (Kg) 0.425 according to DuBois and DuBois formula. LVMI for males is 118gm/m2 and 109 gm/m2 in females as per normal Indian population and a value above suggests increase in size of left ventricular mass (hypertrophy).&#x0D; Statistics&#x0D; Chi-square test.&#x0D; Results&#x0D; Mean with ± standard deviation in age (in years) was 50 ± 10.3 and 58± 9.8 in patients without LVH and un patients with LVH respectively. Lateral shift of the apex was seen more in Group II (24.2%) when compared to Group I which showed 4.6%. Apical impulse was found to be 33.3% in Group II as compared to Group I. Chest X ray showed 27.2% in Group II compared to Group I which was 15% for Group I in-terms of cardiac enlargement. Patients having LVH were 51.5% in Group II as compared to 17.9% in Group I for SOKOLOV LYON INDEX and in terms of ROMHILT ESTES, Group II with 42.4% and Group II with 8.9% patients. Patient having concentric LVH as per results of 2 D ECHO patients in Group II was 78.8% compared to patients in Group I which was 11.9%.&#x0D; Conclusion&#x0D; There was a substantial and positive association that shows a strong association between LVMI and increase in size of left ventricular mass (hypertrophy) in hypertensive patients as evident from our study.

Structural and functional state of left ventricular myocardium in patients with stage II hypertension depending on galectin-3 and aldosterone levels

The analysis of structural and functional state of the left ventricular myocardium was conducted in the article, which concerned the determination of the general morphological and functional echocardiographic parameters of the heart according to the existing recommendations of the American Echocardiographic Society and the European Society of Cardiovascular Imaging; assessment of the relative dimensions/volumes of the LA (left atrium); determination of the structural-geometric remodeling variant of the left ventricular (LV) according to Ganau (1992) also determining the functions of the heart valves in patients with stage II 1-3 degrees hypertension, of different age and gender depending on plasma levels of galectin-3 and aldosterone. Determined the end-systolic (mm) and end-diastolic dimensions of the LV (mm), the thickness of the interventricular septum (mm) and the posterior wall of the LV (mm) in diastole, aortic diameter (AD, mm), size right atrium (RA, mm) and right ventricle (RV, mm), anterior-posterior size of the left atrium (LA, mm) and its index (ILA, mm/m2), LA volume (LPV, ml) and ejection fraction left ventricle (FV globe, %) by the modified Simpson method. LV mass (LVM, g) was estimated by the Penn Convention formula, and LVM index (LVM, g / m2) as the ratio of LVM to body surface area using the Du Bois nomogram (m2). The EchoCG in color Doppler mode measured the early (Ve) and late transmittal (Va) (m\s), their ratio (Ve\Va), the early LF filling time (DT), and the isovolumic LF relaxation time (IVRT) (ms). Statistical processing of the study results was performed using standard methods using the StatSoft Statistica v application package. 12.0 as recommended. In the case of quantitative values, the results were presented as medians and interquartile ranges (25 and 75 percentiles), in the case of relative values, as percentages (%). Comparison of the quantitative values in the groups was performed using the U-Mann-Whitney and Kruskal-Wallis ANOVA test, the relative values by the criterion χ2. A difference of p&lt;0.05 was considered plausible. The obtained data demonstrate that relatively high levels (RH) of both galectin-3 (&gt;2.4 pg/ml) and aldosterone (&gt;325 pg/ml) are identified with significant morphological and functional changes in heart parameters, namely: worse structural-geometric remodeling of LV (increase in cases of concentric hypertrophy (CH) and decrease in cases with normal geometry (NG) of LV). In order to exclude the fact of cross-influence of neurohormones on echocardiographic parameters of the heart, the alignment of the groups in terms of aldosterone and galectin-3 levels was conducted. The analysis turned to be optimal in groups with galectin-3 level of -&gt;2.0 and ≤2.0 pg/ml and aldosterone level of - &gt;290 and ≤290 pg/ml. As a result, it was detected that galectin-3 has a greater pathophysiological effect than aldosterone on such indices as: an increase in aortic diameter; increase in right and left heart chambers dimensions; LVMMI (left ventricular myocardial mass index) value and increase in systolic, diastolic myocardial stress, increase in the number of cases with CH (concentric hypertrophy) and decrease in cases with normal geometry (NG) of LV. Aldosterone level is associated with an increase in dimension/volume indices of LA, calculated per patient’s body area.

Features of estimation of left ventricular geometry in patients with arterial hypertension

Aim: To compare the influence of the methods of calculating MMLV for Penn Convention and ASE on the distribution of left ventricular geometry types in patients with hypertension, to find out additional echographic criteria that will help to offset differences in the estimation of types of geometry. Materials and methods: The study involved 100 patients with essential hypertension ІІ degree, ІІ stage, aged from 18 to 79 years (mean age 54.71 ± 13.93 years, 44% men). Echocardiography was performed on Esaote My Lab Seven (Italy) according to generally accepted rules. The distribution according to the types of left ventricular geometry was carried out in accordance with the recommendations for quantifying the structure and function of the left ventricle. Under normal index of MMLV, the main types of geometry were: normal geometry and concentric remodeling; in elevated – concentric and eccentric LVH. Additionally, all the patients underwent dopplerography of transvalvular flows in pulsed-wave and continuous-wave modes, and the velocity of the fibrous rings of mitral and tricuspid valves were determined. Statistical processing of the material was carried out using the software package Statistica 6.0 (StatSoft, Tulsa, OK., S.S.A.) and Analyse-it for Microsoft Excel 4.80.1 (Analyse-it Software, Ltd.). The t-criterion of the Student, Mann-Whitney, Kruskal-Wallis, χ2 was used. The ROC-analysis was used to determine the cut-off value of quantitative indicators. The significance of differences was considered at the level of p<0.05. Results. Using the ASE formula, the normal left ventricular geometry was determined significantly more often (43% vs. 26%, p = 0.0122) than when calculated by the Penn Convention formula. Concentric remodeling also probably prevailed when calculated by ASE (13% vs. 5%, p = 0.0495). When calculating using the Penn Convention method, the number of cases of eccentric hypertrophy was significantly higher (44% vs. 27%, p = 0.0128) than with the application of the ASE formula. The use of the additional echographic criterion – the speed of the early movement of the medial fibrous ring MK <8 cm / s allows the same percentage distribution of patients with GC according to the types of LV geometry, regardless of the used formula for calculating MMLF (ASE or Penn Convention). Conclusion. The formula for the calculation of the Penn Convention of the index of MMLV overestimates the degree of pathological changes in the myocardium in patients with arterial hypertension, mainly due to an increase in the specific gravity of cases of eccentric hypertrophy, while the formula for calculating the index of MMLV for ASE increases the number of patients with EH with normal LV geometry. The inverse correlation between the mass of the myocardial infarction and the speed of early motion of the medial fibrous ring of MK was found (r = -0,29; p = 0,004). Consideration of an additional criterion for the speed of the early movement of the medial fibrous ring Ea medial <8 cm / s completely alleviates the error in the distribution of types of geometry that arises when using only two criteria – the RST and the index of MMLV calculated by any formula (ASE or Penn Convention).

PP.35.26

Objective: Aim: to study of antihypertensive, antiremodelling efficacy and clinical tolerability of monotherapy with zofenopril in patients with mild to moderate arterial hypertension (AH). Design and method: The study included 30 patients with mild to moderate AH (I-II stage of AH, ESC/ESH 2013), in average age 49,93 ± 9,0 yrs. Blood pressure BP was measured by Korotkof method. Echocardiography performed according to Penn Convention Method, endothelium dependent vasodilatation (EDVD) of brachial artery was determined in reactive hyperemia test, intima-media thickness (IMT) of common carotid artery measured by ultrasound, blood lipid and glucose levels were determined using biochemical methods, all measurements performed before and after 12 weeks of treatment with zofenopril (Zocardis, Berlin-Chemi, Menarini Group). Results: During the 12 weekly monotherapy with zofenopril in daily dose 36.0 ± 19.54 mg there were significantly decrease of systolic and diastolic BP on 19.53 ± 5.93% and 18.64 ± 7.18% respectively, with achieved goal BP level in 83.3% cases. Cardioprotective efficacy of zofenopril expressed in significantly regress of left ventricular hypertrophy: left ventricular mass index reduce from 117.84 ± 32.5 m/g2 to 106.15 ± 28.6 m/g2, (p = 0.0001), with improvement and normalization EDVD of brachial artery: D% from 9.86 ± 3.82% to 14.13 ± 6.17% (p = 0.0001), and significantly decrease of IMT: from 1.0 ± 0.3 mm to 0.91 ± 0.24 mm (p = 0.002). There were no significantly changes in blood lipid and glucose levels. Tolerability of zofenopril was good without any side effects. All patients finished 12-weekly therapy. Conclusions: During the monotherapy with zofenopril were shown significantly high antihypertensive, antiremodelling efficacy with metabolic neutrality and good clinical tolerability of drug in patients with mild to moderate AH.

Abstract W P250: The Impact of Acute Hypertensive Response on Mortality After Intracerebral Hemorrhage Differs Among Patients With and Without Left Ventricle Hypertrophy

Background: While acute hypertensive response (AHR) predicts worse outcome in intracerebral hemorrhage (ICH), the INTERACT-2 trial recently failed to definitively demonstrate a major benefit of intensive blood pressure reduction on these patients. A possible explanation is that the detrimental effect of AHR on outcome may differ among ICH patients with and without previous chronic hypertension. Objective: to explore whether the prognosis of patients with AHR during the acute phase of ICH differs according to the presence or absence of left ventricle hypertrophy (LVH), which is a marker of chronic hypertensive organ damage. Method: we performed a retrospective analysis of a prospective cohort of patients with primary ICH presenting to an academic hospital between January/2000 and December/2012 with age &gt; 18 years, who had a transthoracic echocardiogram available. LVH was defined according to Penn convention. AHR was defined as systolic blood pressure &gt; 180 mmHg on admission. Mantel-Haenszel test was initially used to assess if LVH status influenced the effect of AHR on mortality. For subsequent analyses, ICH patients were divided in 3 groups: without AHR (reference); AHR without LVH; AHR with LVH. A multivariate logistic regression model was then used to identify independent predictors of mortality at 30-days. Results: 430 patients met inclusion criteria. AHR was present in 196 (46.6%), LVH was present in 233 (54.2%); 30-day mortality was 15.6%. On Mantel-Haenszel test, we found a trend (p=0.09) suggesting that absence of LVH increased AHR effect on mortality (OR:1.64; 95% CI: 0.95-2.8; p=0.07). On multivariate analysis, patients with AHR without LVH had significantly higher mortality (OR: 2.65; 95%CI: 1.15 to 6.1; p=0.022) when compared to patients without AHR, after adjusting for baseline characteristics. There was only a trend towards increased mortality in the group of patients with AHR and LVH (OR:2.22; 95% CI: 0.99-5.0; p=0.053). Conclusions: Patients without chronic hypertension appear to be more susceptible to the detrimental effects of AHR during the acute phase of ICH. Stratification of patients with ICH may help to identify those that will have greater benefit with intensive blood pressure reduction in the acute phase of ICH.

Blood Pressure Variability and Left Ventricular Mass Index in Children

Clinical implications of blood pressure variability (BPV) on subclinical organ damage in children are unknown. The authors sought to explore the potential utility of two newly derived BPV indices: weighted standard deviation (wBPSD) and real average variability (ARV), as well as two standard ambulatory blood pressure indices: average 24-hour systolic blood pressure (SBP) and 24-hour SBP load, to identify children at high risk for left ventricular (LV) hypertrophy (LVH). The study group consisted of 67 consecutive children who were referred to our institution for evaluation of suspected hypertension. LV mass was estimated by M-mode echocardiography using Devereux's formula according to the Penn convention and indexed for height(2.7) . We found a statistically significant, positive correlation between 24-hour wBPSD and LV mass index (LVMI) (ρ=0.389; P=.002) and no correlation between 24-hour ARV and LVMI (P>.05). However, partial correlation analysis of 24-hour wBPSD adjusted for body mass index (BMI) and LVMI showed only a weak correlation (ρ=0.3; P=.022). By using multiple linear regression analysis in a model with LVMI as a dependent variable and 24-hour wBPSD, 24-hour ARV, and BMI as independent variables, only BMI showed statistically significant independent positive associations with LVMI (P=.028). Results of our study showed that currently used BPV indices (24-hour wBPSD and 24-hour ARV) are not clinically reliable parameters to identify children at risk for LVH. Apparent contribution of the 24-hour wBPSD parameter to LVMI is negligible and is secondary to its close correlation with BMI (ρ=0.335 P=.009).

Left Ventricle Hypertrophy is Common in Patients with Cerebral Amyloid Angiopathy-Related Intracerebral Hemorrhage and Is Independently Associated with Long-Term Mortality.

Background: A post-hoc analysis of the PROGRESS trial suggested that long-term anti-hypertensive therapy prevents intracerebral hemorrhage (ICH) in patients with cerebral amyloid angiopathy (CAA). However, the burden of underlying hypertension in patients with CAA is unclear, and it is also unclear whether this hypertensive burden contributes to long-term outcome in survivors of CAA-related ICH. Left ventricle (LV) hypertrophy is a measure of the chronicity and severity of hypertension and could be used to assess hypertensive end-organ damage in patients with CAA. Objective: To test the hypothesis that LV hypertrophy is common in patients with CAA-related ICH and is associated with increased long-term mortality and shorter survival in those patients. Methods: This was a retrospective analysis of a prospectively collected cohort of consecutive patients with primary ICH presenting to a single academic center. We included patients presenting between January/2000 to December/2010, age &gt; 55 years, who received a transthoracic echocardiogram (echo) during follow-up and were diagnosed with definitive, probable or possible CAA according to the Boston criteria. LV mass index (10g/m2) was calculated according to Penn convention. Ninety-day survivors were followed prospectively for long-term mortality or censoring at January/2012. Cox proportional hazards models were used to identify predictors of mortality as time-dependent variables adjusting for potential confounders. Results: Among 211 patients who met inclusion criteria, the mean time to follow-up was 4.28 ± 2.7 years; the median time to echocardiogram was 3 days (IQR:49). The mean age was 75.7 ± 9.1 years; 103 (49%) were male. LV hypertrophy was present in 55 (31.8%) patients and 152 (72%) patients survived more than 90 days. In multivariate analysis, after adjusting for baseline characteristics, LV mass index (10g/m2) was associated with higher long-term mortality (HR: 1.20; 95%CI: 1.01-1.4; p=0.039). On Cox-regression, LV hypertrophy was independently associated with shorter long-term survival (HR 1.91; 95%CI 1.05-3.47; p=0.034). Conclusions: LV hypertrophy is common in patients with CAA-related ICH and is associated with increased risk of subsequent mortality among 90-day survivors.

Evaluation of Right Ventricular Haemodynamics by Two-dimensional Strain in Patients with Chronic Pulmonary Thromboembolism

Background:Normal ranges for LVvolume index (LVVI) and LV mass index (LVMI) with echocardiography, cardiac CT and MRI are derived from measurements at end-diastole. CT angiography (CTA) image acquisition is usually performed with prospective ECG-triggering at a mid-diastolic phase (∼70% of R–R interval) when coronary artery motion is minimised. We compared twodimensional (2D)mid-diastolic (70%RR) and end diastolic CTAmeasurements of LV volume andmass indexwith 3D measurements at end diastole (ED). Methods: Twenty-five patients (age 60± 15 years, 36% female) who underwent full volume prospectively gated 320 slice CTAwere evaluated. LVMI and LVVI were calculated at ED using 3D software. Two-dimensional LVVI was calculated by the prolate ellipse method from the basal and mid LV at both 70%RRand ED. LV mass index was measured by Penn convention from the basal and mid LV at the same times. Results: LV volume index and LVMI derived from 2D measurements performed at ED from the basal LV significantly overestimate mass index and underestimate volume, but there is no significant difference in LVMI or LVVI derived from EDmid LV cavity measurements. Twodimensional calculations of LV volume at 70%RR from the basal and mid LV give a significantly smaller volume than end diastolic 3D, and the LVMI is overestimated by basal measurement, but there is no significant difference in LVMI when measured from the mid LV at 70%RR. Conclusion: LV mass index derived from 2D measurements is best done in the mid ventricle and is accurate at both end diastole and 70%RR when compared to end diastolic 3D. LV volume is significantly underestimated at 70%RR by 2Dmeasurements from both the basal andmid LV.

205 LEFT VENTRICULAR HYPERTROPHY AND CARDIOVASCULAR RISK FACTORS AT PATIENTS WITH ARTERIAL HYPERTENSION AND METABOLIC SYNDROME

Objectives: Our main hypothesis was that at patients with metabolic syndrome (MS) there are multiply risk factors which may course left ventricular mass (LVM) enlargement. Methods: We investigated 190 hypertensive (mild and moderate arterial hypertension), grade 1 and 2, moderate and high added risk patients (mean age 54,1 ±0,7 y.; 60% females) with mean body mass index (BMI) 32,8±5,9 kg/m2 by anthropometric and biochemical parameters: fasting glucose levels and lipidogram, 24-h blood pressure measurement, echocardiography. MS diagnosis was estimated according to IDF, LVM was calculated due to Penn Convention. 14 % of patients had diabetes 2 type, 56 % - insulin resistance and high fasting glucose. Result: Such risk factors as BMI (r=0,48), male gender (r=0,46), systolic (r=0,43) and diastolic (r=0,35) blood pressure (BP), fasting glucose level (r=0,32), high density lipoprotein (HDL) cholesterol level (r= - 0,34), arterial hypertension duration (y.) (r=0,26), presence of diabetes (r=0,26) and age (r=0,18), showed significant correlation (Spearmen) with LVM (all p < 0,001). These variants were analyzed in multivariate stepwise regression model. Independent LVM increasing predictors were: BMI (β = 0,32; p < 0,001), mail gender (β = 0,22; p = 0,007), systolic BP (β = 0,19; p = 0,004), glucose (β = 0,14; p = 0,026) and HDL (β = - 0,13; p = 0,029) cholesterol levels. Conclusion: At patients with metabolic syndrome who have mild and moderate arterial hypertension, LVM has independent correlation with BMI, systolic BP, fasting glucose and HDL cholesterol levels. The main role in our model as independent determinant plays BMI (β = 0,32; p < 0,001), which may course hemodynamic (pre- and postloading increasing) and nonhemodynamic (humoral) disturbances.

Prospective echocardiographic evaluation of patients with endogenous subclinical hyperthyroidism and after restoring euthyroidism

Clinical significance of, and the need for, treatment in subclinical hyperthyroidism (sHT) is still a matter of debate. The aim of the study was to assess the impact of sHT on echocardiographic parameters. Patients with endogenous sHT of nonautoimmune origin underwent full echocardiographic assessment at diagnosis and after restoring euthyroidism with radioiodine treatment. Studied group consisted of 44 patients (37 women, 7 men), aged 22-65 years (mean 45·9±11·0). Full echocardiographic assessment included estimation of cardiac chamber diameters and volume as well as cardiac contractility, according to the guidelines of the American Society of Echocardiography. Left ventricular mass was calculated according to Penn's convention. For estimation of left ventricle diastolic function, the following echocardiographic parameters were obtained: maximal early filling wave velocity (E), maximal late filling wave velocity (A), E/A ratio, isovolumetric relaxation time and early filling wave deceleration time. In the studied group, phase of sHT was associated with increased volume of heart chambers, increased diameter of ascending aorta, increased left ventricle mass and disturbed left ventricle relaxation (P<0·05). The systolic function of the left ventricle was unaffected; however, the ejection time was shortened. The changes were reversible with restoring biochemical euthyroidism (P<0·05). Moreover, a significant correlation between some of the parameters and thyroid hormones concentration was demonstrated. sHT was associated with significant changes in echocardiographic parameters, which may contribute to increased cardiovascular risk in these patients. The alterations were reversible with restoring biochemical euthyroidism, what supports the necessity of treatment introduction in sHT.

ECHOCARDIOGRAPHIC DIAGNOSIS OF LEFT VENTRICULAR MYOCARDIAL HYPERTROPHY

&amp;lt;p&amp;gt;The existence of left ventricular hypertrophy is an independent prognostic factor for cardiovascular morbidity and mortality. Heterogenous factors lead to left myocardial hypertrophy. The most frequently factors are: arterial hypertension, valvular heart disease (aortic stenosis and insufficiency, mitral insufficiency), hypertrophic myocardiopathy, left myocardial hypertrophy after myocardial infarction... For making the diagnosis of left ventricular myocardial hypertrophy used electrocardiography (&amp;amp;bdquo;voltage&amp;amp;ldquo; and &amp;amp;bdquo;repolarization&amp;amp;ldquo; criteria) and echocardiography. Echocardiography is the gold standard for diagnosis of left ventricular myocardial hypertrophy. Left ventricular mass was estimated by the modified formula 3 3 using measurements obtained in accordance with the Penn convention: MLK = 1,04 (LDDd+PWDd+IVSDd) - (LVDd) - 13,6 Where LDDd is diastolic left ventricular internal dimension, IVSDd is diastolic ventricular septal thickness and PWDd 2 is diastolic posterior left ventricular wall thickness in diastole. LV mass indexed by body surface area (g/m ). By Penn con2 2 vention left ventricular hypertrophy criteria were &amp;amp;ge;134 g/m for men and &amp;amp;ge;110 g/m for women.&amp;lt;/p&amp;gt;

THE IMPORTANCE OF EARLY WARNING SCORE IN PREDICTING IN-HOSPITAL CARDIAC ARREST

&amp;lt;p&amp;gt;Background: Cardiovascular disease is the predominant cause of morbidity and mortality in hemodialysis patients. Left ventricular hypertrophy is a major cardiovascular risk factor in hemodialysis patients.The present study was aimed at assessing the prevalence of left ventricular hypertrophy by doppler echocardiography in hemodialysis patients. Methods: We studied 20 patients on maintenance hemodialysis in Dialysis Centre in Kosovska Mitrovioca. LV mass was measured by both Doppler echocardiography. Left ventricular mass was estimated by the modified formula using measure2 ments obtained in accordance with the Penn convention. Left ventricular mass was divided by body surface area in m to obtain the left ventricular mass index. Results:This clinical observation study involved 20 patients (9 males and 11 females) with end-stage renal diseases undergoing maintenance hemodialysis with a mean age of 55,26 years, mean time on dialysis was 38,74 months. Main causes for developing chronic renal failure was arterials hypertension and polycystic kidney. Arterial hypertension (60%), diabetes mellitus (20%) and hyperholesterolemia (10%), were the most frequent risk factors for cardiovascular disease among the dialysis patients. Left ventricular hypertrophy were detected in 14 (70%) patients. Mean left ventricular mass wass 153,62g/m2 (males), and 142,71 g/m2 (females). To conclude, the present study shows that hemodialysis patients have higher left ventricular mass and higher prevalence of left ventricular hypertrophy.&amp;lt;/p&amp;gt;