Presence Of Left Ventricular Hypertrophy Research Articles

#1784 The potential impact of chronic subclinical hypervolemia on left ventricular hypertrophy in children on dialysis: a prospective longitudinal study

Abstract Background and Aims Hypervolemia poses a significant challenge in pediatric patients undergoing dialysis, potentially leading to severe complications such as left ventricular hypertrophy (LVH) and cardiac dysfunction. Accurately assessing fluid status in growing children on dialysis could be particularly difficult, and although several non-invasive methods are emerging, each individual measurement has its own strengths and diagnostic limitations in terms of sensitivity and specificity. To date, only a few studies in children have compared the use of different methods simultaneously to detect fluid status, and none of these have evaluated the potential cardiovascular impact of a prolonged subclinical hypervolemia. The latter can be defined as a condition of euvolemia at clinical assessment but hypervolemia at technical evaluation. We evaluated the role of three methods—lung ultrasound (LUS), bioimpedance spectroscopy (BIS), and ultrasound assessment of inferior vena cava collapsibility index (IVC-CI)—in detecting subclinical hypervolemia and examined the cardiac implications. Method In this prospective observational longitudinal study, we included 23 children (<18 years) who were receiving chronic hemodialysis or peritoneal dialysis at the regional pediatric nephrology center of Meyer University Children's Hospital IRCSS, Florence, Italy, between 01/06/2018 and 01/11/2020. We excluded patients with clinical signs of fluid overload. Each patient underwent a multiparametric evaluation of their fluid status (physical examination, LUS, IVC-CI, BIS) every 2 months, and an echocardiography every six months starting from a baseline evaluation. The LVH was defined as a left ventricular mass index (LVMI) of ≥ 95th percentile or a left ventricular wall-thickness z-score > 2 z-score. We divided the patients into two groups and arbitrarily assigned them to the subclinical hypervolemia (SH) group if they had at least two out of three parameters of fluid overload at different methods (≥5 B-lines at LUS, overhydration normalized to extracellular water “OH/ECW” > 7% at BIS, and/or IVC-CI < 40%) in the absence of clinical signs of fluid overload. The others were included in the euvolemic (EU) group. The overload rate by weight (clinical OH), prescribed by the physician clinically, was calculated as the proportional increase from the dry weight (kg of fluid overload / dry weight in kg × 100). Results The two analyzed groups did not differ regarding gender, age and BSA (Table). The clinical OH was significantly higher in the SH population than in the EU group (2.2 ± 1.84 vs 1.30 ± 2.16%, p < 0.01). In the correlation analysis, we found that clinical OH positively correlated with the number of B-lines by LUS (R = 0.2923, p < 0.001) and OH/ECW by BIS (R = 0.4144, p < 0.001), while there was a negative correlation with IVC-CI (R = −0.2597, p = 0.019). However, each method taken individually (LUS, BIS, and IVC-CI) appeared to be inaccurate in predicting fluid status in several individual cases. Although the frequency of hypertension did not differ between the SH and EU groups, uncontrolled hypertension, treatment-resistant hypertension, and hospital admission for hypertensive crises were more frequent in the SH group, with the latter being statistically significant (67% vs 0%, p < 0.01). Furthermore, in the entire cohort, we observed a significant linear correlation between LVMI values and the average values of pre-HD systolic blood pressure recorded in the prior six months (R2 = 0.16, p = 0.002). It is worth noting that the presence of LVH at the last follow-up was significantly more prevalent in the SH group (75% vs 27%, p = 0.04). Conclusion Chronic subclinical hypervolemia, detected with a multi-method evaluation (including LUS, BIS, and IVC-CI), was significantly correlated with clinical OH and associated with a higher risk of LVH. To mitigate the intrinsic limitations of each technique, adopting two or more methods simultaneously can bypass and minimize the risk of evaluative error in assessing fluid status, and help reduce cardiovascular risk.

Association of 1,25 dihydroxyvitamin D with left ventricular hypertrophy and left ventricular diastolic dysfunction in patients with chronic kidney disease.

Left ventricular hypertrophy (LVH) and left ventricular diastolic dysfunction (LVDD) are highly prevalent predictors of cardiovascular disease in individuals with chronic kidney disease (CKD). Vitamin D, particularly 25-hydroxyvitamin D [25(OH)D], deficiency has been reported to be associated with cardiac structure and function in CKD patients. In the current study, we investigated the association between 1,25-dihydroxyvitamin D [1,25(OH)2D], the active form of 25(OH)D, and LVH/LVDD in CKD patients. We enrolled 513 non-dialysis CKD patients. The presence of LVH and LVDD was determined using transthoracic echocardiography. In multivariable analysis, serum 1,25(OH)2D levels, but not serum 25(OH)D, were independently associated with LVH [odds ratio (OR): 0.90, 95% confidential interval (CI): 0.88-0.93, P < 0.001]. Additionally, age, systolic blood pressure, and intact parathyroid hormone levels were independently associated with LVH. Similarly, multivariable analysis demonstrated that serum 1,25(OH)2D levels, but not 25(OH)D levels, were independently associated with LVDD (OR: 0.88, 95% CI: 0.86-0.91, P < 0.001) with systolic blood pressure showing independent association with LVDD. The optimal cut-off values for serum 1,25(OH)2D levels for identifying LVH and LVDD were determined as ≤ 12.7 pg/dl and ≤ 18.1 pg/dl, respectively. Our findings suggest that serum 1,25(OH)2D levels have independent association with LVH and LVDD in CKD patients, underscoring their potential as biomarkers for these conditions in this patient population.

Prevalence of transthyretin cardiac amyloidosis in patients with high-degree AV block

ObjectiveTransthyretin amyloid cardiomyopathy (ATTR-CM) is an infiltrative cardiac disorder caused by deposition of wild type or mutated transthyretin. As ATTR-CM is associated with conduction disease, we sought to determine its...

Abstract TP154: Association of Left Ventricular Hypertrophy With Ischemic Lesions After Intracerebral Hemorrhage

Background: Ischemic lesions on diffusion weighted imaging (DWI) occur in one-third of intracerebral hemorrhage (ICH). Due to conflicting prior studies, it is uncertain if the degree of systolic blood pressure reduction increases the risk. Patients with severe, chronic hypertension may be more vulnerable to the development of ischemia after ICH due to altered cerebral autoregulatory limits. Using cardiac remodeling as a biomarker for severe chronic hypertension, we hypothesized that the presence of left ventricular hypertrophy (LVH) is associated with DWI lesions. Methods: Patients with spontaneous ICH enrolled in the Intracerebral Hemorrhage Outcomes Project who underwent DWI imaging and transthoracic echocardiography (TTE) during hospitalization were included. Lesions were identified as hyperintensities &gt;10mm remote from the hematoma with corresponding low ADC signal. LVH presence was identified using clinically obtained TTE reports with imaging evidence of moderate-severe left ventricular wall thickness. The relationship between LVH and DWI ischemic lesions was assessed with logistic regression modeling after adjusting for age, ICH volume, intraventricular hemorrhage, hypertension history, and blood pressure change within 24 hours. A secondary analysis using linear regression assessed the association with the number of DWI lesions adjusting for similar covariates. Results: Of 187 patients analyzed, DWI lesions were observed in 30.5% and LVH was seen in 23.5%. In our logistic regression analyses, we identified that LVH was associated with DWI lesions (adjusted OR 2.77, CI: 1.19-6.40). Separate sensitivity analyses adjusting for sex (OR 2.47, CI 1.05-5.83) and race (OR 2.52, CI 1.08-5.91) did not change these relationships. In secondary analysis, we identified that LVH was associated with increased DWI lesion number (B 1.018, CI 0.40-1.63 ). Discussion: LVH is associated with the presence and burden of DWI lesions. Further work is required to assess aggregate relationships of chronic hypertension/LVH, acute blood pressure change, ischemic lesions, and ICH outcomes to determine whether patients with LVH necessitate different acute blood pressure treatment goals.

Red flags of cardiac amyloidosis in patients with spinal stenosis and yellow ligament hypertrophy

IntroductionStudies addressing the prevalence of cardiac amyloidosis (CA) among patients with spinal stenosis (SS) are lacking. The identification of the red flags (RF) of CA could lead to early detection of cases of CA. The primary objective of this study was to address the prevalence of RF of CA among patients with SS. MethodsTransversal study including consecutive cases with SS and yellow ligament hypertrophy (YLH). A clinical assessment thar included electrocardiogram, echocardiogram anf urine and blood test was performed. A clinical suspicion of CA was defined by the presence of left ventricular hypertrophy plus any RF. Results103 patients with SS and YLH were assessed. The prevalence of RF was high: heart failure: 18.4%; aortic stenosis: 1.9%; carpal tunnel syndrome: 7.8%; bicipital tendon rupture: 1.9%; arterial hypotension: 17.4%; polyneuropathy symptoms: 51.5%; pseudoinfarction patten: 3.9%; low voltages: 15.5%; conduction abnormalities: 15.5%; decreased longitudinal strain: 25.3%; apical sparing pattern: 3.9%. The 57.3% of the cohort met the CA suspicion criteria. ConclusionThe prevalence of RF of CA is high among patients with SS and YLH. A high proportion of patients met the CA suspicion criteria.

ИЗМЕНЕНИЕ ЛИПИДНОГО ПРОФИЛЯ ПЛАЗМЫ КРОВИ, ПАРАМЕТРОВ ХОЛТЕРОВСКОГО МОНИТОРИРОВАНИЯ И ЭХОКАРДИОГРАФИИ У ПАЦИЕНТОВ С ИШЕМИЧЕСКОЙ БОЛЕЗНЬЮ СЕРДЦА И ГИПОТИРЕОЗОМ

The article presents the results of a study of changes in the lipid spectrum of the blood plasma and certain indicators of Holter monitoring and echocardiography data in patients with coronary heart disease (CHD) and hypothyroidism who were in a cardiology hospital. The incidence of hypothyroidism in cardiac patients was 2.8 %. In patients with ischemic heart disease and hypothyroidism, no reliable correlation has been established between the presence of hypothyroidism and dyslipidemia, but a high incidence of hypercholesterolemia and increased levels of low-density lipoprotein cholesterol was found in patients with ischemic heart disease in combination with hypothyroidism, as in the control group. Extrasystole was determined in all patients with coronary artery disease, regardless of the presence of hypothyroidism. Only 2.7 % of patients with coronary artery disease and hypothyroidism had a decrease in myocardial contractile function according to the assessment of left ventricular ejection fraction (EF). The detection rate of left ventricular hypertrophy (LVH) in patients with coronary artery disease and hypothyroidism was 83.7 %. There was a significantly significant moderate correlation in the group of patients with coronary artery disease, regardless of the presence of hypothyroidism, between the number of premature atrial complexes (PAC) and the number of premature ventricular complexes (PVC). There was no effect of TSH level on EF values and the presence of LVH in patients with coronary artery disease in combination with hypothyroidism and in the absence of the latter.

Left atrial mechanics evaluated by two-dimensional strain analysis: alterations in essential hypertension.

Hypertension is a cardiovascular risk factor that predisposes to cardiac structural alterations namely increased left ventricular (LV) wall thickness, reduced LV compliance and diastolic dysfunction, with consequent left atrial (LA) dilation and functional impairment. In this article, we evaluated differences in left atrial structure and function using two-dimensional speckle tracking echocardiography in patients with hypertension compared with controls. This was a retrospective cross-sectional study of 208 hypertensive patients and 157 controls who underwent a comprehensive transthoracic echocardiogram. Patients with hypertension were stratified by the presence of left ventricular hypertrophy (LVH). Non-LVH hypertension patients had lower left atrial reservoir strain (LAS RES ) (34.78 ± 29.78 vs. 29.78 ± 6.08; P = 0.022) and conduit strain (LAS CD ) (19.66 ± 7.29 vs. 14.23 ± 4.59; P = 0.014) vs. controls despite similar left atrial volumes (LAV) . Left atrial contractile strain (LAS CT ) was not significantly different between non-LVH hypertension patients and controls (15.12 ± 3.77 vs. 15.56 ± 3.79; P = 0.601). Left atrial mechanical dispersion was significantly higher in the LVH group compared with the non-LVH hypertension group (42.26 ± 13.01 vs. 50.06 ± 14.95; P = 0.009). In multivariate regression analysis, LVH correlated with left atrial mechanical dispersion ( P = 0.016). An age-hypertension interaction independently correlated with LAS CT ( P < 0.001). Hypertension results in functional left atrial changes even before development of LV hypertrophy and structural left atrial changes with increased left atrial volume. We demonstrate both a likely hypertension-associated left atrial myopathy that prevents age-related compensatory increase in left atrial contractile function, and impact of LVH in hypertension on left atrial dyssynchrony.

«Banderas rojas» de amiloidosis cardiaca en pacientes con estenosis de canal lumbar e hipertrofia de ligamento amarillo

IntroductionStudies addressing the prevalence of cardiac amyloidosis (CA) among patients with spinal stenosis (SS) are lacking. The identification of the red flags (RF) of CA could lead to early detection of cases of CA. The primary objective of this study was to address the prevalence of RF of CA among patients with SS. MethodsTransversal study including consecutive cases with SS and yellow ligament hypertrophy (YLH). A clinical assessment that included electrocardiogram, echocardiogram and urine and blood test was performed. A clinical suspicion of CA was defined by the presence of left ventricular hypertrophy plus any RF. ResultsOne hundred and three patients with SS and YLH were assessed. The prevalence of RF was high: heart failure: 18.4%; aortic stenosis: 1.9%; carpal tunnel syndrome: 7.8%; bicipital tendon rupture: 1.9%; arterial hypotension: 17.4%; polyneuropathy symptoms: 51.5%; pseudoinfarction pattern: 3.9%; low voltages: 15.5%; conduction abnormalities: 15.5%; decreased longitudinal strain: 25.3%; apical sparing pattern: 3.9%. The 57.3% of the cohort met the CA suspicion criteria. ConclusionThe prevalence of RF of CA is high among patients with SS and YLH. A high proportion of patients met the CA suspicion criteria.

Echocardiographic assessment of patients with end-stage renal disease undergoing maintenance hemodialysis

Objectives: Chronic kidney disease is a global health problem. End-stage renal disease (ESRD) patients have a high frequency of cardiac functional and structural abnormalities associated with higher mortality. Echocardiography is a valuable tool to assess cardiac structural and functional changes, which helps in stratifying prognostic risk factors and measuring the effectiveness of therapeutic intervention. Materials and Methods: We conducted a prospective, cross-sectional, hospital-based study for 1 year from 2076/11/05 to 2077/11/05 B.S (February 17, 2020, to February 17, 2021, A.D. Total of 65 patients with the diagnosis of ESRD undergoing maintenance hemodialysis (MHD) at Chitwan Medical College Hospital meeting inclusion criteria were enrolled. Detailed history, examinations, echocardiographic, and laboratory findings were recorded, and their association was compared with different explanatory variables. Data were analyzed using Statistical Package for the Social Sciences version 25. Results: The most common echocardiography finding among the 65 patients was valvular heart disease (VHD) (78.50%). Among them, 86.2% were undergoing hemodialysis (HD) twice weekly. About 92.7% had hypertension and 52.3% had diabetes mellitus. All had anemia with a mean hemoglobin of 7.86 ± 1.30 g/dL. The most common echocardiography finding was VHD (78.50%). There were statistically significant associations between the age of patients with a prevalence of VHD and systolic dysfunction; the presence of global hypokinesia with body mass index; and the presence of left ventricular hypertrophy (LVH) with calcium levels. Furthermore, a statistically significant difference in the duration of HD was observed with LVH. Conclusion: Cardiovascular diseases are the major cause of morbidity and mortality among ESRD patients undergoing MHD. The study identifies various factors influencing echocardiographic parameters in ESRD patients and highlights VHD as the most prevalent echocardiographic finding. It also emphasizes the importance of echocardiography as a valuable tool for assessing cardiac changes in these patients, aiding in risk stratification and the evaluation of therapeutic interventions.

РАСПРОСТРАНЕННОСТЬ НЕПРОПОРЦИОНАЛЬНО ВЫСОКОЙ МАССЫ МИОКАРДА ЛЕВОГО ЖЕЛУДОЧКА СРЕДИ ПАЦИЕНТОВ С РАЗЛИЧНЫМИ ЗАБОЛЕВАНИЯМИ

Abstract. Introduction. According to the inappropriate left ventricular mass concept proposed by G. de Simone et al. (1998), in some cases, an increment in the left ventricular myocardium mass occurs inadequately to the hemodynamic load of high blood pressure. Studying the prevalence and interrelation of disproportionately high left ventricular myocardia ВЕСТНИК СОВРЕМЕННОЙ КЛИНИЧЕСКОЙ МЕДИЦИНЫ 2023 Том 16, вып. 6 131ОБЗОРЫ mass continues to remain topical to the present, due to the increased risk of cardiovascular events among affected people, and at the same time independently of the presence of left ventricular hypertrophy. Aim. To analyze the scientific medical literature data obtained in studying the prevalence of disproportionately high left ventricular myocardial mass in patients with different diseases. Materials and Methods. We reviewed and analyzed the scientific results from national and foreign medical literature in electronic databases PubMed, Medline, and eLibrary over the years 1998- 2023. Results and Discussion. Research papers dealing with studying the prevalence of disproportionately high left ventricular myocardial mass mainly present patients with cardiovascular diseases. Prevalence of disproportionately high left ventricular myocardial mass in patients with arterial hypertension varies quite widely, from 9% to 82,4%; at the same time, gender and racial differences were found. It is also common in patients with coronary heart disease, aortic stenosis, chronic kidney disease, rheumatoid arthritis, type 2 diabetes mellitus, and primary aldosteronism. It turned out that the frequency of abnormally high left ventricular myocardial mass tends to increase in cases with a combination of chronic kidney disease and type 2 diabetes mellitus. Conclusions. To thoroughly study how disproportionately high left ventricular myocardial mass contributes to bad cardiovascular prognosis, further research is needed in this theme, including studying its prevalence in patients with different diseases, both isolated and combined.

Abstract 072: Risk Factors for Developing Ischemic Strokes While Taking Non‐Vitamin K Antagonist Oral Anticoagulants

Introduction Over the past decade, non‐vitamin K antagonist oral anticoagulants (NOACs) have replaced warfarin as the initial strategy for stroke prevention in non‐valvular atrial fibrillation. However, ischemic strokes occurring in patients taking NOACs are becoming increasingly more frequent. In this study, we aimed to determine the clinical, echocardiographic, and neuroimaging markers associated with developing ischemic strokes in patients taking NOACs for atrial fibrillation. Methods Among atrial fibrillation patients on NOACs with and without ischemic stroke, brain MRIs were reviewed for the presence of neuroimaging markers of small vessel disease. Transthoracic echocardiography reports were reviewed to obtain left atrial volumes, presence of left ventricular hypertrophy, ejection fractions, and presence of wall motion abnormalities. Clinical and radiologic variables with significant differences between groups were entered into a multivariable regression model to determine predictors of ischemic stroke. In the ischemic stroke group, a Cox regression analysis was constructed to determine predictors of ischemic stroke recurrence during follow‐up. Results 112 patients with ischemic stroke and 94 controls (free of ischemic stroke) were included in the study. The mean age (77±9 years vs. 74±11 years, p = 0.13) and proportion of patients with CHA2DS2‐VASc&gt;2 were similar between controls and ischemic stroke patients (82% vs. 83%, p = 0.86). The variables that were significantly different between groups included apixaban use, dabigatran use, prior cerebrovascular events, hemoglobin A1c (HbA1c), left ventricular hypertrophy, left atrial volume index, and severe white matter hyperintensities. After multivariable adjustment, prior cerebrovascular events (aOR 23.86, 95% CI [6.02–94.48]), HbA1c levels (aOR 2.36, 95% CI [1.39–3.99]), left ventricular hypertrophy (aOR 2.73, 95% CI [1.11–6.71]) and left atrial volume index (aOR 1.05, 95% CI [1.01–1.08]) increased the risk of stroke, whereas apixaban use appeared to decrease the risk (aOR 0.38, 95% CI [0.16–0.92]). Among patients with ischemic stroke, there were 103 survivors, 82 (80%) of which had follow‐up data. The median follow‐up duration for these patients was 2.6 (0.5–4.7) years. Of these 82 patients, 11 (13%) experienced an ischemic stroke during the follow‐up period. Malignancy was associated with ischemic stroke recurrence (aHR 4.90, 95% CI [1.35–18.42]) after adjustment for age and chronic renal failure. Conclusion Prior cerebrovascular events, diabetes, left ventricular hypertrophy, and left atrial size are associated with the development of ischemic stroke among NOAC users. Future studies should aim to investigate nonpharmacological stroke prevention strategies in patients with the vascular risk factors and echocardiographic risk markers identified in the present study.

Hypersensitive C-reactive protein as a potential indicator for predicting left ventricular hypertrophy in elderly community-dwelling patients with hypertension

BackgroundThe aim of this study was to investigate the relationship between Hypersensitive C-reactive protein (hs-CRP) and left ventricular hypertrophy (LVH) in elderly community-dwelling patients with hypertension.MethodsA cross-sectional study was conducted, involving the recruitment of 365 elderly hypertensive residents ≥ 65 years of age from five communities. The participants were divided into two groups: an LVH group (n = 134) and a non-LVH group (n = 231), based on the left ventricular mass index (LVMI) determined by echocardiography. Spearman correlation analysis was used to assess the relationship between hs-CRP and LVH. Univariate and Multivariate analysis was performed to detect variables associated with LVH. The diagnostic value of hs-CRP for LVH was expressed as the area under the receiver operating characteristic (ROC) curve.ResultsThe incidence of LVH in elderly hypertension patients in the community was 36.7%. The hs-CRP levels were significantly higher in subjects with LVH compared to those without LVH (1.9 [0.8, 2.9] vs. 0.7 [0.4, 1.4], P = 0.002). Spearman correlation analysis demonstrated a positive correlation between hs-CRP and LVMI (r = 0.246, P < 0.001), as well as with IVST (r = 0.225, P < 0.001) and LVPWT (r = 0.172, P = 0.001). Among elderly hypertensive residents in the community, the cut-off value of hs-CRP for diagnosing LVH was 1.25 mg/L (sensitivity: 57.5%; specificity: 78.4%), and the area under the ROC curve for hs-CRP to predict LVH was 0.710 (95%CI: 0.654–0.766; P < 0.001). In the final model, hs-CRP ≥ 1.25 mg/L (OR = 3.569; 95%CI, 2.153–5.916; P<0.001) emerged as an independent risk factor for LVH. This association remained significant even after adjusting for various confounding factors (adjusted OR = 3.964; 95%CI, 2.323–6.765; P < 0.001).ConclusionsThis community-based cohort of elderly hypertensive individuals demonstrates a strong association between hs-CRP levels and the presence of LVH. The hs-CRP ≥ 1.25 mg/L may serve as an independent predictor for LVH in hypertensive subjects and exhibit good diagnostic efficacy for LVH.

Association between Morning Surge and Left Ventricular Hypertrophy in Obese Hypertensive Patients.

Weight gain can trigger mechanisms that increase blood pressure. Nevertheless, obesity causes structural changes in the myocardium, including increased ventricular mass, atrial dilatation, and diastolic and systolic dysfunction. Additionally, blood pressure variations, like morning surge (MS) in obese hypertensive patients may have clinical relevance in cardiovascular events. Although morning blood pressure surge is a physiological phenomenon, excess MS can be considered an independent risk factor for cardiovascular events. To evaluate MS values and their association with left ventricular hypertrophy (LVH) and nocturnal dipping (ND) in obese and non-obese hypertensive patients. A cross-sectional study that evaluated BP measurements by ambulatory blood pressure monitoring (ABPM) and the presence of LVH by echocardiography in 203 hypertensive outpatients, divided into two groups: 109 non-obese and 94 obese hypertensives patients. The significance level was set at 0.05 in two-tailed tests. A MS above 20 mmHg by ABPM was detected in 59.2% of patients in the non-obese group and 40.6% in the obese group. LVH was found in 18.1% and 39.3% of patients in the non-obese and obese groups, respectively, p<0.001. In the "obese group", it was observed that a MS>16 mmHg was associated with LVH, [prevalence ratio: 2.80; 95%CI (1.12-6.98), p=0.03]. For the non-obese group, the cut-off point of MS for this association was >22 mmHg. High MS was positively associated with LVH, with a particular behavior in the hypertensive obese group.

Hypertension-mediated organ damage involving multiple sites is an independent risk factor for cardiovascular events.

Chronic pressure overload determines functional and structural alterations, leading to hypertension-mediated organ damage (HMOD), affecting multiple districts. We aim at evaluating the prognostic impact of the absence vs. presence of HMOD in one or more sites and of blood pressure (BP) and metabolic control in hypertensive patients. The study included 7237 hypertensive patients from the Campania Salute Network Registry, followed up for 5.3 ± 4.5 years. As HMOD, we analysed the presence of left ventricular hypertrophy, carotid plaques, and chronic kidney disease (CKD-EPI ≥3 stage) and evaluated the impact of zero vs. one vs. two vs. three sites of HMOD on the occurrence of major adverse cardiovascular events (MACEs). Blood pressure control and Metabolic Score for Insulin Resistance (METS-IR) were also considered. Optimal BP control was achieved in 57.3% patients. Major adverse cardiovascular events occurred in 351 (4.8%) patients. The MACE rate in patients without HMOD was 2.7%, whereas it was 4.7, 7.9, and 9.8% in patients with one, two, and three sites with HMOD, respectively. By using Cox multivariate models, adjusted for age, BP control, mean heart rate, mean METS-IR, number of HMOD sites, and drugs, MACE was found to be significantly associated with ageing, mean METS-IR, anti-platelet therapy, and multiple sites with HMOD, whereas a negative association was found with renin-angiotensin system inhibitor drugs. In hypertensive patients, the risk of MACE increases with the incremental number of districts involved by HMOD, independent of BP control and despite the significant impact of metabolic dysregulation. Hypertension-mediated organ damage involving multiple sites is the deleterious consequence of hypertension and dysmetabolism but, when established, it represents an independent cardiovascular risk factor for MACE occurrence.

Cardiac Multimodality Imaging in Hypertrophic Cardiomyopathy: What to Look for and When to Image.

Hypertrophic cardiomyopathy (HCM), now recognized as a common cardiomyopathy of complex genomics and pathophysiology, is defined by the presence of left ventricular hypertrophy of various morphologies and severity, significant hemodynamic consequences, and diverse phenotypic, both structural and clinical, profiles. Advancements in cardiac multimodality imaging, including echocardiography, cardiac magnetic resonance imaging, and cardiac computed tomography, with and without angiography have greatly improved the diagnosis of HCM, and enable precise measurements of cardiac mass, volume, wall thickness, function, and physiology. Multimodality imaging provides comprehensive and complementary information and hasemerged as the bedrock for the diagnosis, clinical assessment, serial monitoring, and sudden cardiac death risk stratification of patients with HCM. This review highlights the role of cardiac multimodality imaging in the modern diagnosis and management of HCM.

Prevalence of Microalbuminuria in Non-diabetic Hypertensive Patients and its Correlation with Changes in Left Ventricular and Left Atrial Characteristics.

Microalbuminuria is urinary albumin excretion in the range of 30-300 mg per 24 hours and is considered as an abnormal albumin excretion rate. Microalbuminuria is associated with epithelial dysfunction and have a high risk for target organ damage resulting in stroke, retinopathy and adverse cardiovascular events. The objective of the study was to determine the prevalence of microalbuminuria in non-diabetic hypertensive patients and its correlation with cardiovascular changes. A quantitative cross-sectional study was done in 107 participants diagnosed as non-diabetic hypertensive patients visiting to Manmohan Memorial medical college and Teaching hospital and Manmohan Cardio-thoracic Vascular and transplant Centre. The assessed parameters were basic metabolic profile, urine evaluation and Echocardiography. The results showed microalbuminuria in 28 study participants and not seen in 79 participants. Similarly, microalbuminuria was observed more comparable in those with presence of left ventricular hypertrophy as compared to the absence of left ventricular hypertrophy (29.3% versus 22.8%) (p value 0.469); those with presence of left ventricular diastolic dysfunction as compared to the absence of left ventricular diastolic dysfunction (31.1% versus 19%) (p value 0.170) and those with dilated left atrium as compared to normal left atrium (26.7% versus 23.9%) (p value 0.820). In case of left ventricular ejection fraction, those with normal left ventricular ejection fraction (26.3%) had slightly higher proportion of micro-albuminuria than those with mild to moderate left ventricular systolic dysfunction (20%) (p value= 0.755) Conclusions: There was no significant difference in the level of micro-albuminuria between non-diabetics, hypertensive patients with cardio vascular changes compared to patients with no cardiovascular changes.

Prediction of low-voltage areas in the left atrium in patients with non-valvular atrial fibrillation by non-invasive markers

Aim. To develop a method for predicting the area of low-voltage area (LVA) in the left atrium (LA), associated with the minimum and maximum expected effectiveness of primary radiofrequency ablation (RFA) in patients with non-valvular atrial fibrillation (AF) using non-invasive predictors.Methods. A longitudinal single-center study included 150 symptomatic non-valvular AF pts aged 20-72 years (median 59.0 [51.0; 64.0]), including 63 women (42%) hospitalized for primary RFA; 119 pts (79.3%) had paroxysmal and 31 (20.7%) - persistent AF. All pts initially underwent general clinical examination, transesophageal and advanced transthoracic echocardiography, estimation of NT-proBNP (pg/ml) and growth differentiation factor 15 (GDF-15, pg/ml) in the blood. Electroanatomical mapping was performed in sinus rhythm before RFA. The area of LVA (&lt;0.5 mV) was calculated as percentage of total LA area. Left ventricular (LV) ejection fraction (LVEF) was &gt;50% in all pts.Results. LVA area varied from 0 to 95.3%, median was 13.7% [5.1; 30.9]. Depending on LVA area, pts were divided into 3 groups: 36 pts (&lt;5%) in gr. 1; 74 pts (5-30%) in gr. 2; 40 pts (&gt;30%) in gr. 3. Increase of LVA area was associated with age, presence, and severity of congestive heart failure (CHF), persistent AF, CHA2DS2 -VASc score ≥3 points, increase of LA volume, LV hypertrophy and increase of NT-proBNP and GDF-15 levels. In univariate analysis, LVA area &lt;5% was associated with NT-proBNP level &lt;125 pg/ml, absence of obesity and CHF, lower LA volume index (&lt;28 ml/ m2). Independent predictors of LVA &lt;5% were: NT-proBNP &lt;125 pg/ml, absence of obesity and LA volume index ≤28 ml/ m2. The model was of good quality, C-statistics was 0.775 (p&lt;0.001). In univariate analysis, LVA area &gt;30 % was associated with age &gt;60 years, NT-proBNP &gt;125 pg/ml, GDF-15 &gt;840 pg/ml, persistent AF, presence of LV hypertrophy, LVEF ≤60%, LA volume index ≥ 32 ml/m2. Independent predictors of LVA &gt;30% were: LA volume index ≥32 ml/m2, GDF-15 &gt;840 pg/ml, and LVEF ≤60%. The model was of good quality, C-statistics was 0.752 (p&lt;0.001).Conclusion. Evaluation of noninvasive parameters, including clinical characteristics, echocardiographic parameters, and blood levels of NT-proBNP and GDF-15, allows prediction of electroanatomical substrate in left atrium in pts with non-valvular AF referred to primary RFA.

Prognostic significance of echocardiographic abnormalities in patients with heart failure with preserved ejection fraction

Abstract Funding Acknowledgements Type of funding sources: None. Background Heart failure with preserved ejection fraction (HFpEF) is recognised as a highly heterogenous condition (1). This extends to its echocardiographic phenotype, which according to the latest ESC diagnostic criteria, can include the presence of left ventricular hypertrophy (LVH), left atrial (LA) enlargement and elevated pulmonary artery systolic pressure (PASP) amongst others (2). The relative prognostic significance of these abnormalities however has not been well-described. Purpose The aim of this study was to evaluate the relative prognostic significance of echocardiographic abnormalities in a community-based cohort of patients with HFpEF and elevated NT-proBNP. Methods We analysed the echocardiograms of patients referred from the community with clinical signs of HF and elevated NTproBNP. We specifically evaluated the presence of LVH, LA enlargement and elevated PASP according to EACVI criteria. We excluded patients with NT-proBNP &amp;lt;125 pg/ml. The primary outcome was time to all-cause mortality or cardiovascular hospitalisation. Results The total cohort included 473 patients (mean age 78 years, 66% female, median NT-proBNP 587 pg/ml). Median follow-up was 27 months. 88 individuals had an occurrence of the primary outcome (18.6%). LA enlargement was the commonest abnormality (48.2%), then LVH (37.2%) and elevated PASP (18.4%). After adjustment for age, sex and NTproBNP, LA enlargement was significantly associated with the primary outcome in patients in sinus rhythm but not atrial fibrillation (sinus: hazard ratio 2.02, 95% CI 1.09–3.73, p = 0.025; AF: hazard ratio 0.68, 95% CI 0.31–1.48, p = 0.20; interaction p value 0.013). Neither elevated PASP (HR 1.50, 95% CI 0.94–2.39, p = 0.09) or LVH (HR 0.99, 95% CI 0.64–1.55, p = 0.98) were independently associated with the primary outcome. There did however appear to be a stepwise increase in risk based on the number of echocardiographic abnormalities present, with individuals with 2 or more abnormalities being significantly more likely to have an incidence of the primary outcome than those with fewer (Figure). Conclusion There may be differences in prognosis of HFpEF patients based on echocardiographic structural and functional parameters. These may therefore require different therapeutic approaches. The number of abnormalities appear to have a cumulative adverse effect on prognosis.

PREDICTIVE FACTORS OF MASKED HYPERTENSION IN TYPE 2 DIABETES

Objective: - Primary objective: to identify masked hypertension predictive risk factors in normotensive type 2 diabetic patients in clinical measurement. Design and method: This was a case-control study. We performed 24-hour ambulatory BP in 358 type 2 diabetic patients normotensive in clinical measurement. We compared both Masked Hypertension and Normotensive groups according to clinical/laboratory parameters and target organ damage, and identify MH predictor risk factors among diabetic population Results: The percentage of participants with masked hypertension was 30,7%, in 54,5% of the cases, it is a noctural hypertension. 38,2% of the masked hypertension patients has normal high blood pressure in routine office measurement, 53,63 % of our MH are obese, 64,5% had metabolic syndrome as classified by NCEP/ATP III. Predictors of masked hypertension are: Normal high blood pressure in consultation, the presence of left ventricular hypertrophy and a microalbuminuria. In this hypertensive masked population, target organs achievement is frequent: 6,8% have peripheral arterial disease, 64,8% have left ventricular hypertrophy, 48% have microalbuminuria, 72,9% have intima-media thickness &gt; 0,9 and 56,3% have arterial stiffness evidence by a PWV&gt; 10 m/sec. Conclusions: Predictive factors assessment for masked hypertension helps to better assess cardiovascular risk in normotensive type 2 diabetic patients in routine practice.

COMPARATIVE EFFECT OF ATENOLOL AND NEBIVOLOL ON REVERSE REMODELING OF INTRAMURAL CORONARY ARTERIOLES IN THE SPONTANEOUSLY HYPERTENSIVE RAT MODEL

Objective: Arterial hypertension is an established major risk factor for ischemic heart disease. Functional and structural abnormalities at the level of the microcirculation may play a crucial role in coronary microvascular dysfunction. Indeed, coronary flow reserve is often reduced at angiography in hypertensive patients independently on the presence of left ventricular hypertrophy (Mancini M. et al. Microcirculation 2017). The aim of this study was to assess the effect of the beta-blocker Atenolol and the selective third-generation beta1-adrenergic antagonist Nebivolol on markers of remodeling and endothelial dysfunction in coronary microvascular. Nebivolol has been demonstrated to possess direct vasodilator and antioxidant properties which may improve endothelial dysfunction and reduce smooth muscle cell proliferation. Design and method: For this purpose, we used three groups of SHR rats: Hypertensive untreated group (SHR); SHR plus Atenolol 50 mg/kg/day by oral gavaging for 8 weeks (SHR + ATE); SHR plus Nebivolol 20 mg/kg/day by oral gavaging for 8 weeks (SHR + NEB). Protein expression levels of vasoactive factors, oxidative stress and remodeling markers in coronary microcirculation were determined by immunohistochemical analysis of Endothelin-1 (ET-1), inducible nitric oxide synthase (iNOS) and transforming growth factor-beta1 (TGF-beta1). Results: No differences were observed in structural parameters of mesenteric arteries among groups. SHR + NEB showed a significant reduction in ET-1, iNOS, and TGF-beta1 staining in coronary small arteries comparing to SHR and SHR + ATE. Conclusions: In comparison to atenolol, nebivolol may provide additional benefit beyond blood pressure reduction and beta-receptor blockade since show greater activity in the modulation of protein involved in vasodilation and oxidative stress protection.