Predictors Of Left Ventricular Hypertrophy Research Articles

Role of cardio-ankle vascular index as a predictor of left ventricular hypertrophy in the evaluation of pediatric hypertension

Aim: Cardio-ankle vascular index (CAVI) is a marker of arterial stiffness independent of blood pressure (BP) at the time of measurement. This work sought to evaluate the association of CAVI with left ventricular hypertrophy (LVH), a marker of long-standing hypertension (HTN) in the pediatric population. Methods: CAVI values from 236 children being evaluated for HTN were compared with their BP grade (normal, elevated, stage I HTN, and stage II HTN) in accordance with clinical guidelines. CAVI values were correlated to the presence of LVH and lipid profiles. One hundred seven of the studied patients had transthoracic echocardiograms available for comparison, and 126 had available lipid results. CAVI means between the groups were compared using analysis of variance. Results: There was no significant difference in CAVI values between the BP groups [median/interquartile range: normal BP (4.95/4.4–5.7), elevated BP (5.1/4.5–5.6), stage I/II HTN (5.0/4.3–5.5)]. Mean CAVI value was higher in the group that had LVH (5.53, standard deviation = 1.4 vs. 5.1, standard deviation = 1; P = 0.13) but was not statistically significant. However, higher mean CAVI value in children ≥ 15 years was significantly associated with the presence of LVH (5.9, standard deviation = 1.8 vs. 5.2 standard deviation = 0.8; P = 0.018). Conclusions: In post-pubertal children, CAVI may be a good predictor of LVH from long-standing HTN. This tool could prove useful in screening for the presence of atherosclerotic changes and provide opportunity for intervention/improved long-term outcomes.

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

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

24-h central pressure is a valuable predictor for left ventricular hypertrophy in non-dialysis patients with chronic kidney disease.

The current research on the relationship between 24-h central pressure and 24-h brachial pressure with left ventricular hypertrophy (LVH) is characterised by limited sample size and inconsistent findings. Furthermore, the association has never been explored in chronic kidney disease (CKD). A multicentre, cross-sectional study among non-dialysis patients with CKD was conducted. All participants underwent brachial and central ambulatory blood pressure monitoring using MobilO-Graph PWA, while trained cardiologists performed echocardiography. In this study, 2117 non-dialysis patients with CKD were examined. 24-h central systolic blood pressure with c2 calibration (24-h c2SBP) demonstrated a stronger association with left ventricular mass index and LVH compared with 24-h brachial systolic blood pressure (24-h bSBP) in the univariate and multivariate regression analyses. The multivariate net reclassification index (NRI) analysis revealed that 24-h c2SBP exhibited greater discriminatory power over 24-h bSBP (NRI = 0.310, 95% CI [0.192-0.429], P < 0.001). Applying 130/135 mmHg as the threshold for 24-h bSBP/c2SBP to cross-classify, the patients were divided into concordant normotension (1509 individuals), isolated brachial hypertension (155 individuals), isolated central hypertension (11 individuals), and concordant hypertension (442 individuals). With concordant normotension as the reference, the multivariable-adjusted ORs were 0.954 (95% CI, 0.534-1.640; P = 0.870) for isolated brachial hypertension and 2.585 (95%CI, 1.841-3.633; P < 0.001) for concordant hypertension. Among non-dialysis patients with CKD, 24-h c2SBP exhibits greater efficacy in identifying the presence of LVH compared with 24-h bSBP. The presence of LVH was greater in cases of concordant hypertension compared with cases of isolated brachial hypertension and concordant normotension.

24HOUR, HOME AND CLINIC BLOOD PRESSURE FOR THE PREDICTION OF LEFT VENTRICULAR HYPERTROPHY IN UNTREATED HYPERTENSIVE POPULATION

Objective: The aim of this study was to investigate which way of measuring blood pressure (BP), clinic, home or 24h-ABPM, can predict better left ventricular hypertrophy in the untreated hypertensive population. Design and method: 175 consecutive subjects (42% male) aged 57.9±14.9 years were included in the study. Subjects were never treated before for hypertension. All subjects underwent 24h-ABPM on a usual working day. Home BP monitor was provided to all patients for 7 days, while office BP was measured in the clinic using a mercury sphygmomanometer. Left ventricular hypertrophy was evaluated by a cardiologist with the use of a 3D echocardiography. Results: In the univariate analysis, only home systolic and diastolic BP were independently associated with left ventricular hypertrophy, while both clinic and 24hour systolic and diastolic BP found not to be. From ROC curves for left ventricular hypertrophy, AUC of home systolic BP monitor (0.758, p&lt;0.05) was larger than that of 24h (0.538, p&gt;0.05) and clinic BP (0.497, p&lt;0.05). As regards DBP, the ROC curves suggest no discrimination for the different ways of BP measurement. Conclusions: Home systolic BP can be a better predictor of left ventricular hypertrophy in untreated population, when compared to 24h and office systolic BP. This result shows the importance of home monitoring for the prediction of left ventricular hypertrophy, even in the untreated population.

Physical Activity and Cardiac Morphologic Adaptations

Chronic and intense exercise programs lead to cardiac adaptations, followed by increased left ventricular wall thickness and cavity diameter, at times meeting the criteria for left ventricular hypertrophy (LVH), commonly referred to as “athlete’s heart”. Recent studies have also reported that extremely vigorous exercise practices have been associated with heightened left ventricular trabeculation extent, fulfilling noncompaction cardiomyopathy criteria, as part of exercise-induced structural adaptation. These changes are specific to the exercise type, intensity, duration, and volume and workload demands imposed on the myocardium. They are considered physiologic adaptations not associated with a negative prognosis. Conversely, hypertrophic cardiac adaptations resulting from chronic elevations in blood pressure (BP) or chronic volume overload due to valvular regurgitation, lead to compromised cardiac function, increased cardiovascular events, and even death. In younger athletes, hypertrophic cardiomyopathy (HCM) is the usual cause of non-traumatic, exercise-triggered sudden cardiac death. Thus, an extended cardiac examination should be performed, to differentiate between HCM and non-pathological exercise-related LVH or athlete’s heart. The exercise-related cardiac structural and functional adaptations are normal physiologic responses designed to accommodate the increased workload imposed by exercise. Thus, we propose that such adaptations are defined as “eutrophic” hypertrophy and that LVH is reserved for pathologic cardiac adaptations. Systolic BP during daily activities may be the strongest predictor of cardiac adaptations. The metabolic demand of most daily activities is approximately 3–5 metabolic equivalents (METs) (1 MET = 3.5 mL of O2 kg of body weight per minute). This is similar to the metabolic demand of treadmill exercise at the first stage of the Bruce protocol. Some evidence supports that an exercise systolic BP response ≥150 mmHg at the end of that stage is a strong predictor of left ventricular hypertrophy, as this BP reflects the hemodynamic burden of most daily physical tasks. Aerobic training of moderate intensity lowers resting and exercise systolic BP at absolute workloads, leading to a lower hemodynamic burden during daily activities, and ultimately reducing the stimulus for LVH. This mechanism explains the significant LVH regression addressed by aerobic exercise intervention clinical studies.

Monocyte to lymphocyte ratio as a predictor of left ventricular hypertrophy in end stage renal disease patients underlying hemodialysis

Monocyte to lymphocyte ratio as a predictor of left ventricular hypertrophy in end stage renal disease patients underlying hemodialysis

357 - Role of cardio-ankle vascular index as a predictor of left ventricular hypertrophy in children with hypertension

357 - Role of cardio-ankle vascular index as a predictor of left ventricular hypertrophy in children with hypertension

Left ventricular hypertrophy in African children infected with HIV/AIDS: a case-control study.

left ventricular hypertrophy (LVH) measured by echocardiography seen in human immunodeficiency virus/acquired immunodeficiency disease (HIV/AIDS) affects the morbidity and mortality. The hemodynamic and metabolic changes in (HIV/AIDS) affect the heart adversely causing hypertrophic remodeling with left ventricular hypertrophy. The aim of this study was to determine the prevalence and risk factors associated with LVH in African children with HIV/AIDS. an analytical case-control study was conducted using echocardiography to assess cardiac function. Descriptive statistics was used to determine percentages and univariate analysis to find association between dependent variable and independent variables. Independent variables that had an association in a univariate were included in the multivariate model to determine strength of association. the mean age of the study population was 7.8 ± 2.07 years for controls and 8.3 ± 3.04 years for cases respectively. They were made up of 51.2% (n= 86) males and 48.8% (n = 82) females (M: F=1.05: 1). We studied eighty-four (n= 84) cases, and LVH was seen in 67.7% (n= 56) of the patients. Mean left ventricular mass index (g/m2) was significantly higher in the cases (90.37± 35.50) than controls (89.37 ± 14.25, p= 0.04.) Relative wall thickness (mm) was within normal in the control, 0.35 ± 0.06 and high in the cases, 0.67 ± 0.17, p= 0.01. Eccentric hypertrophy was the most common type seen in 36.9% (n= 31) of the patients. Multiple linear regression analysis, revealed that the presence of LVH was associated with 0.212 (95% CI: 0.001 - 0.014; p= 0.001) lower Body mass index (BMI) for age and 0.396 (95% CI; 0.002 - 0.066; p= 0.03) lower CD4+ cell count as predictors of LVH. the prevalence of LVH was high. Lower body mass index (BMI) and CD4+cells count predicted LVH. This supports the recommendation by the National Heart, Lung and Blood Institute (NHLBI) working group on research priorities for cardiovascular complications in HIV/AIDS, for baseline and periodic echocardiography in the management of children with HIV/AIDS.

Systemic immune inflammation index and neutrophil to albumin ratio can predict left ventricular hypertrophy in geriatric hemodialysis patients

Introduction: A link exists between inflammation and left ventricular hypertrophy, which is a risk factor for cardiovascular disease in patients with end-stage renal failure. Neutrophil, lymphocyte, and platelet counts are used to calculate the systemic immune inflammation index. To calculate the neutrophil to albumin ratio, we divided the total number of neutrophils by the albumin concentration. Some articles have illustrated the value of systemic immune inflammation index and neutrophil to albumin ratio for diagnosing disorders associated with inflammation. The purpose of this study was to investigate whether a connection exists between left ventricular hypertrophy and inflammation, as measured by systemic immune inflammation index and neutrophil to albumin ratio, in hemodialysis patients aged &gt;65 years. Materials and Method: This study included 51 patients who had been receiving HD for at least three months. Test results and echocardiography measurements were obtained from patient files. Results: Average patient age was 72.88±5.12 years. Patients were divided into two groups based on left ventricular hypertrophy status. C reactive protein, systemic immune inflammation index and neutrophil to albumin ratio were considerably lower in the left ventricular hypertrophy (-) group, and multivariate logistic regression analysis revealed that high neutrophil to albumin ratio was an independent predictor of left ventricular hypertrophy (odds ratio [OR]:8.83, 95 percent confidence interval [CI]:1.32-28.83, P .0005), in conjunction with a high C reactive protein level (OR:3.45, 95 percent CI:1.905-6.645, P .005). Conclusion: Neutrophil to albumin ratio correlates with C-reactive protein and left ventricular hypertrophy, thereby predicting the inflammation characteristic of left ventricular hypertrophy. Keywords: Inflammation; Hypertrophy, Left Ventricular; Renal Dialysis.

Abstract 13586: In Patients With Left Bundle Branch Block, QRS Duration is a Stronger Predictor of Left Ventricular Hypertrophy and Dilation Than QRS Voltage

Introduction: ECG criteria for left ventricular (LV) hypertrophy in absence of left bundle branch block (LBBB) rely on QRS amplitudes. ECG correlates of LVH in setting of LBBB are not well established. We sought to evaluate quantitative LBBB ECG predictors of echocardiographic LV measurements [LV mass, end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF)]. Hypothesis: QRS duration (QRSd) is a better predictor of LV hypertrophy than QRS amplitudes. Methods: We included adult patients with typical LBBB having ECG and echocardiogram performed within 3 months of each other in 2010-2020. Digital 12-lead ECGs were processed to reconstruct orthogonal X, Y, Z leads using Kors matrix. Amplitudes and voltage-time-integrals (VTIs) from all 12 leads, X, Y, Z leads and 3D (root-mean-square) ECG, and QRSd were evaluated. We used age, sex and BSA-adjusted linear regressions to predict LV measurements, and separately generated ROC curves for identifying LV abnormalities. Results: We included 413 patients (53% women, age 73±12 yr). Among all the ECG variables, QRSd was most strongly correlated with all 4 LV measurements (all p&lt;0.00001, see Table 1a showing QRSd compared to VTI and amplitude from 3D QRS). Table 1b shows area under ROC curves to identify LV abnormalities. QRS duration ≥150 ms in women had sensitivity 56.3%, specificity 64.4% for LVMi &gt;95 g/m 2 and sensitivity 62.7%, specificity 67.8% for LVEDVi &gt;61 mL/m 2 . QRS duration ≥160 ms in men had a sensitivity 63.1%, specificity 72.1% for LVMi &gt;115 g/m 2 and sensitivity 58.3%, specificity 74.5% for LVEDVi &gt;74 mL/m 2 . Conclusions: In patients with LBBB, QRS duration ≥150 in women and ≥160 in men is a superior predictor of adverse LV remodeling esp. eccentric LV hypertrophy/dilation. The weak correlation of QRS amplitude with hypertrophy may be due to the dominant effect of electrical dyssynchrony on voltage, and the heterogeneous effects of fibrosis, infiltrative cardiomyopathy, epicardial fat and LV dilation.

Lower serum magnesium is a predictor of left ventricular hypertrophy in patients on dialysis.

Left ventricular hypertrophy (LVH) represents one of the main risk factors for cardiovascular mortality in dialysis patients. Low serum magnesium Mg is related with increased mortality in general and dialysis population. Aim of our study was to evaluate the association of Mg with LVH and cardiac geometry in dialysis patients. Hemodialysis (HD) and peritoneal dialysis (PD) patients from nine nephrology departments were included. Echocardiographic LVH was defined by LV mass index > 95g/m2 in women and > 115g/m2 in men. Four LV geometric patterns were defined: normal, concentric remodeling, eccentric LVH and concentric LVH. Demographic and laboratory data were collected. 133 patients (68 HD, 65 PD) with a median age of 63years (IQR 52-74) were studied. Mg correlated positively with creatinine, HDL and negatively with CRP levels and BMI. There were no significant differences in Mg between the modality groups. 80 patients presented LVH (43 HD and 37 PD patients). Patients with LVH were older (median age 68 vs 55years, p < 0.001), with higher BMI (median 26.9 vs 24.7kg/m2, p = 0.009), had a history of PVD or CAD (55% vs 30.2%, p = 0.003), had higher pulse pressure (median 60 vs 50, p = 0.017), MIS score (median 5 vs 4, p = 0.011), lower albumin (median 3.5 vs 3.8g/dl, p = 0.011) and Mg levels (median 2.1 vs 2.4mg/dl, p < 0.001). In univariate analysis age, CVD comorbidities, pulse pressure, CRP, BMI, albumin, Mg, MIS and use of b-blockers or calcium blockers were LVH predictors. In multivariate analysis, Mg was an independent predictor of LVH, adjusted for age, MIS and b-blockers. Considering LV geometry, lower Mg levels were mainly correlated with concentric LVH. Low serum magnesium levels seem to be an independent factor for LVH in hemodialysis and peritoneal dialysis patients.

Clinical Data, Chest Radiograph and Electrocardiography in the Screening for Left Ventricular Hypertrophy: The CAR2E2 Score.

Left ventricular hypertrophy (LVH) is associated with adverse clinical outcomes and implicates clinical decision-making. The aim of our study was to assess the importance of different approaches in the screening for LVH. We included patients who underwent cardiac magnetic resonance (CMR) imaging and had available chest radiograph in medical documentation. Cardiothoracic ratio (CTR), transverse cardiac diameter (TCD), clinical and selected electrocardiographic (ECG)-LVH data, including the Peguero-Lo Presti criterion, were assessed. CMR–LVH was defined based on indexed left ventricular mass-to-body surface area. Receiver operating characteristics analyses showed that both the CTR and TCD (CTR: area under the curve: [AUC] = 0.857, p < 0.001; TCD: AUC = 0.788, p = 0.001) were predictors for CMR–LVH. However, analyses have shown that diagnoses made with TCD, but not CTR, were consistent with CMR–LVH. From the analyzed ECG–LVH criteria, the Peguero-Lo Presti criterion was the best predictor of LVH. The best sensitivity for screening for LVH was observed when the presence of heart failure, ≥40 years in age (each is assigned 1 point), increased TCD and positive Peguero-Lo Presti criterion (each is assigned 2 points) were combined (CAR2E2 score ≥ 3 points). CAR2E2 score may improve prediction of LVH compared to other approaches. Therefore, it may be useful in the screening for LVH in everyday clinical practice in patients with prevalent cardiovascular diseases.

HIGHER SYSTOLIC BLOOD PRESSURE IN FEMALE PATIENTS WITH MITOCHONDRIAL DISEASE

Objective: Previous research suggests that hypertension is more prevalent among patients with mitochondrial diseases. Blood pressure (BP) is linearly related to increased cardiovascular risk, and this relationship is strongest for systolic blood pressure; nevertheless, studies on systolic and diastolic blood pressure in mitochondrial diseases have not yet been performed. Design and method: In a retrospective case-control study design, BP in mitochondrial disease patients was compared to BP in a population cohort. Secondly, using multiple linear regression, we examined blood pressure differences in various genetic mitochondrial diseases. Lastly, we explored additional predictors of BP in a subgroup with the m.3243A&gt;G variant. Results: 286 genetically confirmed mitochondrial disease patients were included. Of these patients 180 carried the m.3243A&gt;G mitochondrial DNA variant. Systolic BP (SBP) was 9 mmHg higher in female mitochondrial disease patients than in the general female population (95% CI: 4.4 - 13.3 mmHg, p &lt; 0.001), while male patients had similar BP compared to controls. BP was not significantly different in patients with (1) m.8344A&gt;G and m.8363G&gt;A, (2) a mtDNA deletion or (3) a nuclear mutation compared to m.3243A&gt;G patients. Higher SBP was a predictor of left ventricular hypertrophy in the m.3243A&gt;G subgroup (p = 0.04). Conclusions: Novel aspects of the role of mitochondrial dysfunction in blood pressure regulation are exposed in this study. Compared to the general population, female mitochondrial disease patients have a higher SBP. Left ventricular hypertrophy is more prevalent in patients with higher SBP. Clinicians should be aware of this to prevent hypertensive complications in mitochondrial disease patients.

HYPERTENSIVE HEART DISEASE IN ADOLESCENCE. PRELIMINARY RESULTS OF THE PESESCAD-HTA STUDY

Objective: Identify the presence of hypertensive heart disease and its relationship with prehypertension and hypertension Design and method: A descriptive, cross-sectional study was carried out in 385 prehypertensive adolescents and 128 adolescents with essential hypertension, aged 12–15 years, from among a total of 1,545 adolescents screened in the School Screening for High Blood Pressure in Adolescents Project (PESESCAD-HTA). An echocardiogram was performed in 513 adolescents (prehypertensive plus hypertensive). For the multivariate analysis of risk factors related to LVH, a decision tree was obtained using the chi square automatic interaction detector (CHAID) technique. Results: Among prehypertensive and hypertensive adolescents, the prevalence of left ventricular hypertrophy was 6.49% (CI = 4.43–9.41) and 21.09% (CI = 14.92–58.95), respectively. In the sample of 513 individuals with prehypertension and hypertension, a decision tree was designed, using the chi square automatic interaction detector (CHAID) technique, with the presence of left ventricular hypertrophy as the dependent variable. Conclusions: The best predictors of left ventricular hypertrophy were a family history of obesity, and its interaction with the age and the sex of the adolescent.

Higher SBP in female patients with mitochondrial disease.

Previous research suggests that hypertension is more prevalent among patients with mitochondrial diseases. Blood pressure (BP) is linearly related to increased cardiovascular risk, and this relationship is strongest for SBP; nevertheless, studies on SBP and DBP in mitochondrial diseases have not yet been performed. In a retrospective case-control study design, BP in mitochondrial disease patients was compared with BP in a population cohort. Secondly, using multiple linear regression, we examined blood pressure differences in various genetic mitochondrial diseases. Lastly, we explored additional predictors of BP in a subgroup with the m.3243A > G variant. Two hundred and eighty-six genetically confirmed mitochondrial disease patients were included. One hundred and eighty of these patients carried the m.3243A>G mitochondrial DNA variant. SBP was 9 mmHg higher in female mitochondrial disease patients than in the general female population (95% CI: 4.4-13.3 mmHg, P < 0.001), whereas male patients had similar BP compared with controls. BP was not significantly different in patients with m.8344A>G and m.8363G>A, a mtDNA deletion or a nuclear mutation compared with m.3243A>G patients. Higher SBP was a predictor for left ventricular hypertrophy in the m.3243A>G subgroup (P = 0.04). Novel aspects of the role of mitochondrial dysfunction in blood pressure regulation are exposed in this study. Compared with the general population, female mitochondrial disease patients have a higher SBP. Left ventricular hypertrophy is more prevalent in patients with higher SBP. Clinicians should be aware of this to prevent hypertensive complications in mitochondrial disease patients.

Effects of blood pressure percentile, body mass index, and race on left ventricular mass in children.

To evaluate the association of systolic blood pressure percentile, race, and body mass index with left ventricular hypertrophy on electrocardiogram and echocardiogram to define populations at risk. This is a retrospective cross-sectional study design utilising a data analytics tool (Tableau) combining electrocardiogram and echocardiogram databases from 2003 to 2020. Customized queries identified patients aged 2-18 years who had an outpatient electrocardiogram and echocardiogram on the same date with available systolic blood pressure and body measurements. Cases with CHD, cardiomyopathy, or arrhythmia diagnoses were excluded. Echocardiograms with left ventricle mass (indexed to height2.7) were included. The main outcome was left ventricular hypertrophy on echocardiogram defined as Left ventricle mass index greater than the 95th percentile for age. In a cohort of 13,539 patients, 6.7% of studies had left ventricular hypertrophy on echocardiogram. Systolic blood pressure percentile >90% has a sensitivity of 35% and specificity of 82% for left ventricular hypertrophy on echocardiogram. Left ventricular hypertrophy on electrocardiogram was a poor predictor of left ventricular hypertrophy on echocardiogram (9% sensitivity and 92% specificity). African American race (OR 1.31, 95% CI = 1.10, 1.56, p = 0.002), systolic blood pressure percentile >95% (OR = 1.60, 95% CI = 1.34, 1.93, p < 0.001), and higher body mass index (OR = 7.22, 95% CI = 6.23, 8.36, p < 0.001) were independently associated with left ventricular hypertrophy on echocardiogram. African American race, obesity, and hypertension on outpatient blood pressure measurements are independent risk factors for left ventricular hypertrophy in children. Electrocardiogram has little utility in the screening for left ventricular hypertrophy.

Increased risk of heart failure is associated with chronic habitual hypohydration that elevates serum sodium above 142 mmol/l suggesting lifelong optimal hydration as preventive measure

Abstract Background With increasing prevalence of heart failure (HF) owing to the aging population, identification of preventive measures that delay onset of the disease and their implementation become increasingly important. Recent studies demonstrated that chronic subclinical hypohydration accelerates degenerative changes and increases prevalence of many age-dependent degenerative diseases including heart failure (1). Worldwide surveys find wide differences in habitual water intake between and within countries and substantial prevalence of hypohydration in general population (2). Hypohydration elevates extracellular sodium triggering activation of water conservation mechanisms when serum sodium exceeds a threshold around 142 mmol/l. These adaptive responses include secretion of antidiuretic hormone and activation of the renin angiotensin aldosterone system (3), important contributors to pathogenesis of HF. Purpose The purpose of this study was to evaluate whether serum sodium concentration at middle age of 44–66 years as a measure of hydration habits is a significant predictor for left ventricular hypertrophy (LVH) and HF events 25 years later at age of 70–90 years. Methods Data from Atherosclerosis Risk in Communities (ARIC) study were obtained from the BioLINCC data repository. In ARIC study, 15,792 44–66 year-old participants were evaluated over 5 visits spanning 25 years (Figure 1A). Two separate logistic regression models were used in the study, where the dependent variable is diagnosis of LVH and HF at visit 5 (age:70–90 years), and the predictors are serum sodium concentration measured at visits 1 and 2 (age: 44–66 years), age, gender, total cholesterol, glucose, eGFR, BMI, smoking and hypertension statuses. Results Midlife serum sodium is associated with LVH and HF diagnosis 25 years later at visit 5 both with adjustment for age only (LVH: OR=1.24, 95% CI 1.15–1.34, P&amp;lt;0.001; HF: OR=1.06, 95% CI 1.02–1.10, P=0.006) and in fully adjusted model (LVH: OR=1.20, 95% CI 1.11–1.30, P&amp;lt;0.001; HF: OR=1.11, 95% CI 1.01–1.22, P=0.031) (Figure 1B). Cornell voltage criteria used for LVH diagnosis is elevated in participants with higher serum sodium and demonstrates sharper increase with age indicating accelerated hypertrophic LV remodeling (Figure 1C). These associations are reflected in increased prevalence of HF and LVH in 70–90 year-old participants whose middle age serum sodium exceeded 142 mmol/l (Figure 1D). Conclusions Habitual life-long hypohydration increases risk to develop LVH and HF. Keeping serum sodium below 142 mmol/l by drinking appropriate amount of liquids may slow down decline in cardiac function and decrease prevalence of HF. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): NHLBI Intramural program

Association between blood pressure dipping patterns and hypertension-mediated organ damage among Nigerians with newlydiagnosed hypertension

Introduction: Abnormal blood pressure (BP) dipping patterns are associated with increased cardiovascular risk among Africans. This study determined the association between BP dipping patterns and hypertension-mediated organ damage among patients with newly-diagnosed hypertension.Methods: Ambulatory BP monitoring and echocardiography were carried out on 120 participants. Participants were categorized based on the ratio of night-time to day-time systolic BP into 4 patterns: Normal dipper (≥ 10% but &lt; 20%), non-dippers (≥ 0% but &lt; 10%), reverse dippers (&lt;0%) and extreme dippers (≥ 20%).Result: Fifty-one (42.5%) were males, the mean age and body mass index were 44.2±9.8years and 27.1±4.4kg/m2 respectively. The non-dipping pattern was the most prevalent while the reverse dipping had the lowest mitral E/A ratio. Office systolic blood pressure was the only predictor of left ventricular hypertrophy (OR=1.050, 95% CI=1.004-1.098; p-value = 0.034).Conclusions: The non-dipping pattern was the most prevalent abnormal dipping pattern while the reverse dippers had the highest risk of hypertension-mediated organ damage. Office blood pressure was the only predictor of left ventricular hypertrophy. Hence, office BP measurement as well as ambulatory blood pressure measurements are potentially important tools in risk stratification in resource-poor settings of sub-Saharan Africa.

Pediatric and Adult Ambulatory Blood Pressure Thresholds and Blood Pressure Load as Predictors of Left Ventricular Hypertrophy in Adolescents.

[Figure: see text].

Ventricular hypertrophy and ischaemic changes in Children with Sickle Cell Anaemia and its relationship with the Haemoglobin Concentration in Steady State

Objective: The prevalence and burden of Sickle Cell Anaemia (SCA) in Nigeria are high and they contribute to childhood morbidity and mortality. Chronic anaemia and vaso-occlusion usually involve different organs. The involvement of the heart is a common complication of SCA, thus the need for early detection of cardiac abnormalities in children with SCA. To assess cardiac structure using ECG in children with SCA in steady-state and to determine the relationship between abnormal ECG findings and the participants’ haemoglobin concentration.&#x0D; Material and Method: It was a cross-sectional study done in one of the tertiary hospitals in southeast Nigeria. The study participants were 164 children with SCA in steady state within the ages of 2 -17 years. A 12-lead ECG was carried out on the participants and their haemoglobin concentrations determined. The relationship between the presence of cardiac abnormality and independent variables like haemoglobin concentration, age and gender were analyzed.&#x0D; Result: The prevalence of cardiac abnormality was 59.1%. The commonest cardiac structure abnormality was Left ventricular hypertrophy (LVH) (39.6%). Abnormality in the P-R interval was seen in 14.6%, while ST segment abnormality was seen in 18.3%. The mean Hb of those with abnormal ECG was lower than that of those without abnormal ECG, across each age group. Severe anaemia was a significant (p&lt; 0.01) predictor of LVH. However, there was no significant association between the degree of anaemia and the occurrence of ST-segment (p: 0.26) and PR interval abnormalities (p: 0.52).&#x0D; Conclusion: Cardiac anomalies are common findings in SCA children.