Presence Of Left Ventricular Hypertrophy Research Articles

Effects of Baseline Left Ventricular Hypertrophy and Decreased Renal Function on Cardiovascular and Renal Outcomes in Patients with Fabry Disease Treated with Agalsidase Alfa: A Fabry Outcome Survey Study

PurposeThe initiation of enzyme-replacement therapy prior to the occurrence of substantial and irreversible organ damage in patients with Fabry disease is of critical importance. The Fabry Outcome Survey is an international disease registry of patients with a confirmed diagnosis of Fabry disease. In this study, data from the Fabry Outcome Survey were used for the assessment of the risks for cardiovascular and renal events in patients who received agalsidase alfa treatment. MethodsEligible patients were males and females aged ≥18 years with Fabry disease treated with agalsidase alfa. Cardiovascular events included myocardial infarction, left ventricular hypertrophy (LVH), heart failure, arrhythmia, conduction abnormality, and cardiac surgery. Renal events included dialysis, transplantation, and renal failure. Kaplan–Meier curves and log-rank tests were used for comparing event-free probabilities and time to first cardiovascular or renal event, from agalsidase alfa initiation to a maximum of 120 months, in patients with LVH versus normal left ventricular mass index (LVMI; ≤50 g/m2.7 in males and ≤48 g/m2.7 in females) at treatment initiation (baseline), and in patients with a low estimated glomerular filtration rate (eGFR; <90 mL/min/1.73 m2) versus normal eGFR at baseline. Multivariate Cox regression analysis was used for examining the association between key study variables and the risks for cardiovascular and renal events. FindingsAmong the 560 patients (269 males; 291 females) with available LVMI data, 306 (55%) had LVH and 254 (45%) had normal LVMI at baseline. The risk for a cardiovascular event was higher in the subgroup with LVH versus normal LVMI at baseline (hazard ratio [HR] = 1.57; 95% CI, 1.21–2.05; P < 0.001), but the risk for a renal event was similar between the 2 subgroups (HR = 1.90; 95% CI, 0.94–3.85; P = 0.074). Among the 1093 patients (551 males; 542 females) with available eGFR data, 433 (40%) had a low eGFR and 660 (60%) had a normal eGFR at baseline. The subgroup with a low eGFR at baseline had a significantly higher risk for a cardiovascular event (HR = 1.33; 95% CI, 1.04–1.70; P = 0.021) or a renal event (HR = 5.88; 95% CI, 2.73–12.68; P < 0.001) compared with patients with a normal eGFR at baseline. ImplicationsIn the present study, the presence of LVH and/or reduced renal function at agalsidase alfa initiation was associated with a significantly higher risk for a cardiovascular or renal event, indicating that cardiovascular and renal pathologies in Fabry disease may be inter-related. Early initiation of agalsidase alfa treatment prior to the onset of severe organ damage may improve outcomes. ClinicalTrials.gov identifier: NCT03289065.

Disturbed glucose metabolism and left ventricular geometry in the general population – results from the Gutenberg health study

Abstract Background Prediabetes and type 2 diabetes mellitus (T2DM) have been demonstrated to alter left ventricular geometry and promote left ventricular (LV) hypertrophy (LVH). However, the impact of impaired glucose metabolism on cardiac structure is still not completely understood and controversially discussed. Purpose To investigate the impact of prediabetes and T2DM on left ventricular geometry and their potential interaction with LVH in the prediction of survival. Methods Data from the Gutenberg Health Study (N=15,010) – a population-based study with highly standardized phenotyping – were analysed. Information was obtained from computer-assisted personal interviews, medical-technical examinations, laboratory measurements in fasting state and echocardiography according to standard operating procedures with detailed quality control. Individuals with other types of diabetes or hyperinsulinemia were excluded from analysis. Study participants aged 35 to 74 years were categorized according to long-term glucose state (HbA1c) into euglycemia, prediabetes and T2DM. LV geometry was assessed according to current guideline recommendations. Multivariable regression analyses were performed to evaluate the association between glucose state and measures of left ventricular geometry. Survival analyses were carried out to assess the prognostic impact dependent on the presence of LVH. Results The analysis sample comprised 14,852 individuals aged 55.0±11.1 years (49.5% females). The prevalence of LVH was 10.2% (n=1,227) in euglycaemia, 17.2% in prediabetes and 23.8% in T2DM. Similarly, concentric and eccentric hypertrophy had the highest prevalence in T2DM (13.1% and 10.8%, respectively), followed by prediabetes (9.6% and 8.2%) and euglycaemia (5.7% and 4.5%). In multivariable regression analysis with adjustment for age, sex, traditional cardiovascular risk factors (CVRF), C-reactive protein and LV function, T2DM had a higher impact on relative wall thickness (β: 0.0135 [0.0087; 0.0182]; P&amp;lt;0.0001) and LV mass (β: 5.46 [4.89; 6.03]; P&amp;lt;0.0001) than prediabetes (β-estimaterelative wall thickness 0.00145 [−0.0031; 0.006]; P=0.53; β-estimateLV mass 2.73 [2.19; 3.28]; P&amp;lt;0.0001) compared to euglycemia. During a median follow-up of 9.0 [interquartile range 7.7; 10.4] years, prediabetes did not predict all-cause mortality independent of age, sex and CVRF in Cox regression analysis in individuals without LVH (hazard ratio (HR) 1.15 [0.90; 1.46]; P=0.27) or those with LVH (HR 1.46 [0.97; 2.18]; P=0.069). In comparison, T2DM was a strong and independent predictor of mortality both in absence (HR 1.59 [1.29; 1.96]; P&amp;lt;0.0001) and presence of LVH (HR 2.67 [1.94; 3.66]; P&amp;lt;0.0001). Conclusions Although cardiac geometry is altered both in presence of prediabetes and T2DM, only T2DM is a strong predictor of premature mortality in the general population. This merits consideration for future preventive strategies to decrease the burden of cardiovascular disease. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): The study was supported by the Federal Ministry of Education and Research (BMBF), the government of Rheinland-Pfalz and the Center for Translational Vascular Biology (CTVB) of the Johannes Gutenberg-University of Mainz, Germany.

Prognostic value of ambulatory blood pressure and clinical use of echocardiography to detect left ventricular hypertrophy in children evaluated for primary hypertension.

Hypertension (HTN) is common in children and often associated with pathologic progression to end organ damage, specifically left ventricular hypertrophy (LVH). The primary goal of this retrospective chart review is to determine if patients with higher blood pressure were more likely to complete echocardiogram (ECHO) and more likely to have LVH, among a pediatric population referred for hypertension evaluation before the 2017 American Academy of Pediatrics (AAP) guidelines. To meet this goal, the number of patients evaluated by ECHO and prevalence of LVH was examined for independent associations with blood pressure and BMI categories by logistic regression. It was found that higher blood pressure was associated with having an ECHO evaluation (p = 0.012). Among patients evaluated by ECHO, one-third had LVH but the presence of LVH was not associated with blood pressure severity or use of anti-hypertensive medication. Instead, BMI was the only factor associated with LVH cardiac remodeling in our population (p = 0.025). Newly updated AAP practice guidelines recommend evaluation of HTN via ABPM, with ECHO performed only at the initiation of pharmaceutical therapy. It is notable that BMI, the only risk factor of LVH found in this study, is not addressed in the current AAP guidelines for ECHO evaluation among hypertensive children. This study suggests that ECHO evaluation may be warranted in a larger subset of children as is recommended by current European Society of Hypertension pediatric guidelines.

Blood Pressure Control, Left Ventricular Hypertrophy and Treatment Practice Among Hypertensive Patients in Ethiopia.

BackgroundGlobally, hypertension is the most important public health issue and is a increasing health problem in Ethiopia. Blood pressure (BP) control is an ultimate therapeutic goal of hypertensive patients in reducing early complications of hypertension. Hence, this study was sought to examine the magnitude of uncontrolled BP, left ventricular hypertrophy (LVH), and treatment practice. Predictors of uncontrolled BP and LVH were also investigated.MethodsA hospital-based cross-sectional study was conducted among 223 outpatients with hypertension on follow-up at Ayder Comprehensive Specialized Hospital (ACSH). Hypertensive patients with ≥18 years old who had been on follow-up care for at least 3 months were included in the study. Severely ill patients requiring urgent medical care and wheelchair-bound individuals or persons who had difficulty standing steady and pregnant women were excluded. Data were collected using a structured questionnaire and patients’ chart review. Data were entered and analyzed using SPSS version 22.0. To identify predictors, binary logistic regression model analysis was performed. Statistical significance was set at P-value of < 0.05.ResultsThe magnitude of uncontrolled BP (>140/90mmgH) and LVH was found to be 31.4% and 39.5%, respectively. More than half (53%) of participants were on at least two antihypertensive drug combinations of different classes. Uncontrolled BP was significantly associated with poor adherence to salt reduction in meal (Adjusted Odds Ratio (AOR) =8.552, 95% CI: 2.853, 15.638, P<0.001), non-adherence to medications (AOR =2.886, 95% CI: 1.710, 3.935, P<0.001), and taking triple-drug therapy (AOR=7.228, 95% CI: 1.110, 10.57, P=0.039). Presence of LVH was significantly associated with abdominal obesity (AOR= 2.2, 95% CI: 1.399, 4.69, P=0.003), age of ≥60 years (AOR= 2.421, 95% CI: 1.263, 4.639, P=0.008), and uncontrolled BP (AOR= 3.16, 95% CI: 1.208, 5.232, P=0.021).ConclusionIn this study, a significant proportion of patients with uncontrolled BP and LVH were found. Abdominal obesity, older age and uncontrolled blood pressure were predictors of LVH. Therefore, tailored interventions targeting BP control to reduce the magnitude of LVH and other early complications of hypertension deemed to be compulsory.

RELATION BETWEEN LEFT VENTRICULAR HYPERTROPHY AND SILENT ISCHEMIA DETECTED BY 24-HOUR HOLTER MONITOR IN HYPERTENSIVE AND TYPE 2 DIABETIC PATIENTS

Background: Hypertension is a prevalent and well-recognized cardiovascular risk factor that predisposes to the development of left ventricular hypertrophy (LVH), coronary heart disease and systolic and diastolic dysfunction. The presence of high left ventricular (LV) mass or a high left ventricular mass index (LVMI) is reportedly an independent predictor of increased cardiovascular morbidity and mortality both in the general populations and in hypertensive populations. Ambulatory ECG (Holter) monitoring is a very effective way of measuring ischemic events over 24 hrs. period, it has advantages over exercise testing. Objective: To assess presence of silent ischemia in type 2 diabetic and hypertensive patients with LVH in comparison to type 2 diabetic and hypertensive patients with normal LV geometry. Patients and methods: This study was a pilot one that was carried out on 60 type 2 diabetic and hypertensive patients (28 males and 32 females aged 53.5 ± 10.4). Thirty cases had LVH and the other 30 had normal geometry. This study was conducted from October 2018 to February 2020. All patients were subjected to complete history taking including comorbidities, risk factors and full clinical examination. Patients with baseline ST segment depression > 2 mm in 2 consecutive leads, mitral stenosis, aortic stenosis, congenital heart disease, atrial fibrillation, prior myocardial infarction (MI) or coronary artery bypass graft surgery (CABG), pericardial diseases, advanced renal or hepatic disease were excluded. Echocardiography was done and LV assessment alongside with measuring LVMI. Also, all patients were investigated by 24 hours continuous holter monitoring, and all of them underwent further investigation to assess the presence of CAD either by coronary angiography or multislice CT coronary angiogram. Results: There was a statistically significant relationship between the presence of LVH and positive Holter findings for silent ischemia. Out of 30 patients with normal geometry, 25 patients (83.3%) were negative and 5 patients (16.7%) were positive for silent ischemia. Out of the other 30 patients with abnormal geometry (LVH), 9 patients (30%) were negative and 21 patients (70%) were positive for silent ischemia. In 10 patients with mild LVH, 4 patients (40%) were negative and 6 patients (60%) were positive for silent ischemia. Out of 14 patients with moderate LVH, 4 patients (28.6%) were negative and 10 patients (71.4%) were positive for silent ischemia. As regards the last 6 patients with severe LVH, 1 patient (16.7%) was negative and 5 patients (83.3%) were positive for silent ischemia. Conclusion: The prevalence of silent ischemia markedly increased amongst diabetic and hypertensive patients with LVH in comparison to those with normal left ventricular geometry. The incidence of silent ischemia increased with increased LVMI. Ambulatory ECG monitoring may have a use in the identification of those at greatest risk of cardiovascular complications and sudden death.

Left Ventricular Structural and Functional Alterations in Patients With Pheochromocytoma/Paraganglioma Before and After Surgery

ObjectivesThis study sought to evaluate left ventricular (LV) structure and function in pheochromocytoma and paraganglioma (PPGL) patients before and after curative surgery. BackgroundData on catecholamine-induced effects on LV structure and function in patients with PPGL are limited and conflicting. MethodsThe study evaluated 81 consecutive patients with a PPGL, among whom 66 were evaluated 12 months after tumor removal. Fifty patients matched for age, sex, hypertension presence, and blood pressure (BP) levels served as a control group (non-PPGL group). Echocardiography was employed to assess the LV mass index (LVMI), systolic function including speckle tracking echocardiography, and diastolic function. ResultsPatients with PPGL were characterized by higher LVMI (median 103 [interquartile range (IQR): 88 to 132] g/m2 vs. median 94 [IQR: 74 to 106] g/m2; p = 0.006) and frequency of LV hypertrophy (44.4% vs. 24.0%; p = 0.018) compared with the non-PPGL group. Patients with PPGLs were characterized by lower global longitudinal strain (GLS) and early diastolic mitral annular velocity compared with patients in the non-PPGL group (median –17.2% [IQR: 15.6% to 18.9%] vs. median –19.3% [IQR: 17.7% to 20.6%]; p < 0.001; and median 11.1 [IQR: 8.3 to 13.0] cm/s vs. median 12.3 [IQR: 10.6 to 14.6] cm/s; p = 0.018, respectively). Presence of LV hypertrophy and GLS were independently associated with plasma free metanephrine concentrations. In operated patients, there were lower frequencies of LV hypertrophy (39.4% vs. 22.7%; p = 0.003), LVMI (median 98 [IQR: 85 to 115] g/m2 vs. median 90 [IQR: 76 to 109] g/m2; p < 0.001), and the ratio of transmitral early diastolic velocity to early diastolic mitral annular velocity (median 6.8 [IQR: 5.5 to 8.6] vs. median 6.0 [IQR: 5.0 to 7.6]; p = 0.005) but higher values for GLS (median –17.4 [IQR: –15.8 to 19.1] vs. median −18.5 [IQR: –17.1 to 20.1] p < 0.001) after compared with before surgery. ConclusionsCatecholamine excess in patients with PPGLs can lead not only to LV hypertrophy, but also to impairment of systolic LV function and subclinical alterations of diastolic LV function, independently of BP levels. These structural and functional changes are reversible after surgical intervention.

Increased red blood cell distribution width might predict left ventricular hypertrophy in patients with atrial fibrillation.

The presence of left ventricular hypertrophy has been confirmed to be an independent risk factor for stroke and death in patients with atrial fibrillation. This retrospective study aimed to evaluate the potential risk factors for left ventricular hypertrophy in patients with atrial fibrillation.A series of consecutive patients diagnosed with atrial fibrillation between June 2018 and December 2019 were included. The patients’ clinical data were analyzed. The cut-off values, sensitivity and specificity of the independent risk factors were calculated using a receiver operating characteristic curve.Among 87 patients with atrial fibrillation, 39 patients with left ventricular hypertrophy and 48 patients without left ventricular hypertrophy were included. Multivariate logistic regression analysis showed that red blood cell distribution width (odds ratio [OR] 4.89, 95% confidence interval [CI]: 1.69–14.13, P < .05) was an independent risk factor, while the concentration of low-density lipoprotein (OR 0.37, 95% CI: 0.17–0.83, P < .05) and left ventricular ejection fraction (OR 0.88, 95% CI: 0.82–0.95, P < .05) were inversely associated with left ventricular hypertrophy in atrial fibrillation patients. The receiver operating characteristic curve demonstrated that the area under the curve was 0.80 (95% CI: 0.71–0.90, P < .05) with a cut-off value of 13.05, and the red blood cell distribution width predicted left ventricular hypertrophy status among atrial fibrillation patients with a sensitivity of 72.1% and a specificity of 76.9%.Red blood cell distribution width was associated with left ventricular hypertrophy in patients with atrial fibrillation.

Increased epicardial adipose tissue thickness is associated with microalbuminuria in hypertensive patients with left ventricular hypertrophy

ABSTRACT Objective Epicardial adipose tissue (EAT) is a cardiometabolic risk factor, and its possible relationship with hypertension has been previously reported. Microalbuminuria (MA) is associated with target-organ damage, especially in patients with hypertension with left ventricular hypertrophy (LVH) and suggest endothelial dysfunction. This study aimed to investigate the relationship between echocardiographic EAT thickness and presence of MA in patients with hypertension. Methods A total of 297 newly diagnosed hypertension patients who applied to the outpatient clinic were enrolled consecutively in this study. Patients were divided into two groups regarding the presence of LVH in echocardiography. An age and gender matched control group was set including 156 healthy patients without HT. All subjects underwent transthoracic echocardiography for the measurement of EAT thickness. Spot urine samples were collected for the assessment of MA. Results In hypertensive patients with LVH, the EAT thicknesses (6.6 ± 1.8 vs 5.3 ± 1.5 vs 5.1 ± 1.3, p < .001; respectively) and prevalence of MA (41.2 vs 20.1 vs 3.2%; p < .001 respectively) were significantly higher than the other two groups. In hypertensive patiens without LVH, no relationship was found between the presence of MA and EAT thickness. In multivariate regression analyses, EAT thickness (OR: 3.141, 95%CI: 2.425–6.123, p < .001) and left ventricular mass index (OR: 1.339, 95%CI: 1.145–2.143, p = .003) were determined as independent predictors for MA development in hypertensive patients with LVH. Conclusion Measurement of EAT thickness may help to identify high-risk hypertensive patients for target-organ damage especially among patients with LVH.

Is heart failure misdiagnosed in hospitalized patients with preserved ejection fraction? From the European Society of Cardiology - Heart Failure Association EURObservational Research Programme Heart Failure Long-Term Registry.

AimsIn hospitalized patients with a clinical diagnosis of acute heart failure (HF) with preserved ejection fraction (HFpEF), the aims of this study were (i) to assess the proportion meeting the 2016 European Society of Cardiology (ESC) HFpEF criteria and (ii) to compare patients with restrictive/pseudonormal mitral inflow pattern (MIP) vs. patients with MIP other than restrictive/pseudonormal.Methods and resultsWe included hospitalized participants of the ESC‐Heart Failure Association (HFA) EURObservational Research Programme (EORP) HF Long‐Term Registry who had echocardiogram with ejection fraction (EF) ≥ 50% during index hospitalization. As no data on e', E/e' and left ventricular (LV) mass index were gathered in the registry, the 2016 ESC HFpEF definition was modified as follows: elevated B‐type natriuretic peptide (BNP) (≥100 pg/mL for acute HF) and/or N‐terminal pro‐BNP (≥300 pg/mL) and at least one of the echocardiographic criteria: (i) presence of LV hypertrophy (yes/no), (ii) left atrial volume index (LAVI) of >34 mL/m2), or (iii) restrictive/pseudonormal MIP. Next, all patients were divided into four groups: (i) patients with restrictive/pseudonormal MIP on echocardiography [i.e. with presumably elevated left atrial (LA) pressure], (ii) patients with MIP other than restrictive/pseudonormal (i.e. with presumably normal LA pressure), (iii) atrial fibrillation (AF) group, and (iv) ‘grey area’ (no consistent description of MIP despite no report of AF). Of 6365 hospitalized patients, 1848 (29%) had EF ≥ 50%. Natriuretic peptides were assessed in 28%, LV hypertrophy in 92%, LAVI in 13%, and MIP in 67%. The 2016 ESC HFpEF criteria could be assessed in 27% of the 1848 patients and, if assessed, were met in 52%. Of the 1848 patients, 19% had restrictive/pseudonormal MIP, 43% had MIP other than restrictive/pseudonormal, 18% had AF and 20% were grey area. There were no differences in long‐term all‐cause or cardiovascular mortality, or all‐cause hospitalizations or HF rehospitalizations between the four groups. Despite fewer non‐cardiac comorbidities reported at baseline, patients with MIP other than restrictive/pseudonormal (i.e. with presumably normal LA pressure) had more non‐cardiovascular (14.0 vs. 6.7 per 100 patient‐years, P < 0.001) and cardiovascular non‐HF (13.2 vs. 8.0 per 100 patient‐years, P = 0.016) hospitalizations in long‐term follow‐up than patients with restrictive/pseudonormal MIP.ConclusionsAcute HFpEF diagnosis could be assessed (based on the 2016 ESC criteria) in only a quarter of patients and confirmed in half of these. When assessed, only one in three patients had restrictive/pseudonormal MIP suggestive of elevated LA pressure. Patients with MIP other than restrictive/pseudonormal (suggestive of normal LA pressure) could have been misdiagnosed with acute HFpEF or had echocardiography performed after normalization of LA pressure. They were more often hospitalized for non‐HF reasons during follow‐up. Symptoms suggestive of acute HFpEF may in some patients represent non‐HF comorbidities.

Assessment of carotid cross-sectional area in hypertensive patients: phenotyping and prognostic validation in The Campania Salute Network

Increased intima-media thickness (IMT) of common carotid artery (CA) is considered the hallmark of vascular hypertension-mediated target organ damage, even if vessel remodeling due to mechanical stress may also induce changes in diameter. We developed a method computing both diameter and IMT of CA, to assess correlates and prognostic impact of carotid cross-sectional area (CCSA) in a large registry of treated hypertensive patients. We selected 6300 hypertensive patients of the Campania Salute Network registry free of overt cardiovascular (CV) disease and with available CA ultrasound (54 ± 11 years; 57% male). CCSA was computed as:[Formula: see text]CCSA was considered high if >90th percentile of the sex-specific distribution (>48 mm2 in men and >41 mm2 in women). Patients with high CCSA were male, with older age, higher pulse pressure (PP), more prevalent obese and diabetic, with higher total and LDL cholesterol (p < 0.01 for all). During a median follow-up of 60 months (IQR 19-87), 206 incident composite major and minor CV events occurred. In Cox regression analysis high CCSA was associated with more than 100% increased risk of incident CV events ((HR 2.11, 95%CI 1.46-3.1, p < 0.0001), independently of the effect of older age, male sex, PP > 60 mmHg, presence of left ventricular hypertrophy (LVH), carotid plaque (CP), and less anti-RAS therapy (p < 0.05 for all). In treated hypertensive patients, increased CCSA is associated with worse metabolic and lipid profile and predict incident CV events, independently of high PP, presence of LVH and CP.

P1250LOW SERUM URIC ACID LEVEL AND LEFT VENTRICULAR HYPERTROPHY : THE NEW PARADOXICAL ASSOCIATION IN HEMODIALYSIS PATIENTS

Abstract Background and Aims The association between serum uric acid (UA) and left ventricular hypertrophy (LVH) is controversial in chronic kidney disease, whereas in hemodialysis (HD) patients has not been studied until now. Thus, we evaluated the relationship of baseline and time-averaged UA with echocardiographic LVH over a 5-year period in HD patients. Method This longitudinal study was conducted on 225 prevalent HD patients over a 5-year period. Patients were stratified into 3 groups according to their baseline and time-averaged UA levels: lower group (UA&amp;lt;400µmmol/l), intermediate/reference group (UA between 400-450µmol/l) and higher group (UA&amp;gt;450µmol/l). Echocardiography was performed on a non-dialysis day and the presence of LVH was defined based on the left ventricular mass index (LVMI) &amp;gt;131 and &amp;gt;100 g/m2, for men and women, respectively. The patients were followed during a 60 month period. Results During the 5-year follow-up, 81 patients died (36%), and the main causes of death were cardiovascular (CV) related (70%). Survival analysis show that patients with time-averaged UA&amp;lt;400 µmmol/l had a significantly higher all cause (log rank, p=0.003) and CV mortality (log rank, p=0.004) rate, compared to those with time-averaged UA between 400-450 µmmol/l and time-averaged UA&amp;gt;450µmol/l, but this difference was not statistically significant in terms of baseline UA level. A negative correlation was observed between LVH and time-averaged UA (r=-0.26, p=0.001), but not with LVH and baseline UA. Patients in lower time-averaged UA group had significantly higher LVMI compared to patients in intermediate and higher group (153.10± 59.89, 131.62±40.99, 131.19±44.49 g/m2, p=0.029), but from the lowest to the highest baseline UA levels, LVH was not significantly different (146.99±59.20, 141.38±37.52, 126.85±42.48 g/m2, p=0.07). Unadjusted odd ratio of LVH risk in the lower time-averaged UA compared to the reference time-averaged UA group was 3.11 (95% CI=1.38-7.05; p=0.006); and after adjustment for age, gender, diabetes and CV disease, ORs for LVH persisted significant only in the lower time-averaged UA group (OR = 2.82, 95% CI = 1.16–6.88, P = 0.002). On the contrary, baseline UA did not affect unadjusted and adjusted LVH. Conclusion In HD patients the prolonged exposure to hypouricemia is associated with LVH. This paradoxical association can only be explained by the hypothesis that uremic milieu in HD patients changes the influence of uric acid. However, these results should be the subject of further research.

The cumulative blood pressure load and target organ damage in patients with essential hypertension.

The area under the blood pressure curve is associated with target organ damage, but accurately estimating its value is challenging. This study aimed to improve the utility of the area under the blood pressure curve to predict hypertensive target organ damage. This retrospective cohort study comprised of 634 consecutive patients with essential hypertension for >1 year. Target organ damage was defined as the presence of left ventricular hypertrophy and/or carotid artery plaques. We evaluated the associations between the cumulative blood pressure load, which was derived from ambulatory blood pressure monitoring data, and target organ damage. The predictive value of the cumulative blood pressure load for target organ damage was assessed using receiver operating characteristic curves. Left ventricular hypertrophy and carotid artery plaques were present in 392 (61.8%) and 316 (49.8%) patients, respectively. Patients with left ventricular hypertrophy and/or carotid artery plaques had higher 24‐hour blood pressure, nocturnal cumulative systolic blood pressure, and nocturnal cumulative pulse pressure load. The nocturnal cumulative systolic blood pressure load was an independent predictor of left ventricular hypertrophy (odds ratio = 1.002, 95% confidence interval: 1.001‐1.004; P = .000) and carotid artery plaques (odds ratio = 1.003, 95% confidence interval: 1.002‐1.007; P = .007). The nocturnal cumulative systolic blood pressure and cumulative pulse pressure load, relative to mean blood pressure, were superior in predicting hypertensive target organ damage. Hence, the cumulative blood pressure load is a better indicator of blood pressure consequences, and the nocturnal cumulative systolic blood pressure and cumulative pulse pressure loads could predict target organ damage.

El continuo cardiorrenal: una propuesta para la prevención de las enfermedades cardiovasculares y renales

Cardiovascular risk factors such as arterial hypertension, type 2 diabetes mellitus (DM2) and dyslipidemia are commonly involved with chronic kidney disease (CKD) and its contribution to long-term cardiovascular morbidity. Diffuse endothelial dysfunction and atherosclerosis are believed to be part of the common pathophysiology in diabetic and non-diabetic CKD, particularly in the elderly. Age is the main determinant of glomerular filtration rate (GFR) and effective renal plasma flow and has been reported that the presence of hypertension at baseline enhances the yearly decline in creatinine clearance. Dyslipidemia may directly affect the kidney by causing deleterious renal lipid disturbances (renal lipotoxicity), as well as indirectly through systemic inflammation and oxidative stress, vascular injury, hormones change and other signaling molecules with renal action. Several cross-sectional studies found that impaired glucose tolerance, as well as the presence of left ventricular hypertrophy, was associated with an increase in the slope of the inverse relationship between age and GFR in subjects with never-treated essential hypertension. Most of the drugs used to reduce the burden of risk factor on cardiovascular disease also benefit the renal function. So, we propose the cardiorenal continuum as a preventive strategy to protect both organ and reduce the deleterious impact of the cardiovascular risk factor on the renal function considering both organs as a functional and physiopathological binomial.

Ex Vivo Organ Perfusion for Heart Procurement in High-Risk Transplantations: A Multicenter Study

Ex vivo heart perfusion is an innovative preservation technique, that permits graft assessment and extended out-of-body intervals. In times of high-risk recipients and donors with extended criteria, we hypothesized that its properties for prolonged heart preservation might be especially beneficial. We reviewed the outcome of 76 end-stage heart failure patients that underwent heart transplantation using the Organ Care System (OCS Heart, Transmedics, USA) in our institutions since 2015. Data was collected from prospective institutional databases. All recipients were potentially considered eligible, but an effort was made to apply OCS Heart particularly in challenging cases with previous cardiac surgery. Baseline characteristics. Mean age: 45,4±16,9 y, male gender: 77,6%, time on waiting list: 610±999 d, high-urgency (HU) status: 88,2%, previous cardiac surgery: 86,7%, previous VAD: 72,4%, previous BIVAD: 8,9%, previous VAD exchange: 20,0%. Donor characteristics. Mean age: 41,9±12,5 y, presence of CAD: 2,7%, presence of LV-hypertrophy: 17,3%, previous cardiac arrest: 34,7%. Operative results. Total ex situ time: 382,1±72,4 min, mean OCS run time: 268,2±54,2 min, total length of surgery: 488,8±101,7 min, ventilation time: 10,2±19,9 d, ICU stay: 19,8±24,3 d, postoperative ECMO (all types): 23,7%, incidence of bleeding: 19,7%, permanent dialysis 4%, stroke 4%. 30-day survival: 92,1%, 1-year-survival: 82,9%. Causes of death: Multi organ failure: 30,8%, pancreatitis 23,1%, acute graft rejection: 7,7%. OCS Heart allowed safe transplantation of surgically complex recipients with excellent outcomes, despite extended donor criteria and prolonged preservation times. In the context of reduced organ availability and increasing recipient complexity, ex vivo heart perfusion is a novel technology that enables otherwise infeasible allocations and contributes to increase surgical safety.

Frequency of Left Ventricular Hypertrophy Among Patients on Maintenance Hemodialysis by Voltage Criteria and Its Relationship with Biophysical-Chemical Parameters.

BackgroundAmong the dialysis population, left ventricular hypertrophy (LVH) is becoming a major cause of cardiovascular death, mainly due to myocardial infarction, heart failure, and arrhythmias. Electrocardiography (ECG) is a cheap and easily available test to detect the presence of left ventricular hypertrophy. The basic purpose of this study was to assess the frequency of left ventricular hypertrophy among the maintenance hemodialysis patients by applying different voltage criteria for the diagnosis of LVH and its relationship with various biophysical and biochemical parameters.MethodsA total of 68 patients of end-stage renal disease (ESRD) were included in the study who were on maintenance hemodialysis at the dialysis center of Sughra Shafi Hospital. Baseline characteristics were recorded from the patients' data. Blood samples were drawn and electrocardiographs were taken, both before and after hemodialysis.ResultsResults showed variability in the detection of left ventricular hypertrophy in the pre- and post-dialysis period, as it was positive for 45%, 21%, and 17% in the pre-dialysis period versus 40%, 32%, and 25% in the post-dialysis period, when the Framingham, Sokolow-Lyon, and Cornell criteria were applied, respectively. The study showed a significant relationship between left ventricular hypertrophy with a high body mass index (BMI), hypertension, and pre- and post-dialysis hypomagnesemia (P <0.05). A significant association was also seen with low serum albumin levels over the past year.ConclusionAccording to this study, almost half of the dialysis patients were having left ventricle hypertrophy when Framingham criteria were applied. Good control of factors that are significantly associated with the occurrence of left ventricular hypertrophy can reduce morbidity and mortality among dialysis patients secondary to cardiovascular events. In this study, these factors included hypertension, hypomagnesemia, hypoalbuminemia, and high BMI.

Comprehensive assessment of hypertensive heart disease: cardiac magnetic resonance in focus.

Arterial hypertension represents the most frequent cardiovascular risk factor that is associated with cardiac remodeling. Hypertensive heart disease was defined by the presence of left ventricular hypertrophy (LVH) and diastolic dysfunction, and it has been diagnosed by echocardiography in everyday clinical practice. Interstitial myocardial fibrosis is the underlying cause of hypertension-induced cardiac remodeling, and it could not be visualized with different echocardiographic methods. Cardiac magnetic resonance (CMR) and its methods such as late gadolinium enhancement, and T1 mapping provides qualitative and quantitative assessment of interstitial myocardial fibrosis in hypertensive patients. Furthermore, CMR canprovide differentiation of LVH between hypertensive patients and cardiomyopathies (hypertrophic or Fabry disease). Timely diagnosis of cardiac impairment and early treatment is essential because regression of LVH could be achieved with adequate treatment. Diffuse cardiac fibrosis in hypertensive patients might be an underlying mechanism that explains the increased cardiovascular morbidity and mortality in this population. Future longitudinal investigations are necessary to determine causal relationship between diffuse fibrosis and cardiovascular outcome in these patients. The aim of this review is to summarize the current knowledge regarding CMR techniques and their potential usage in patients with hypertensive heart disease.

Abstract P345: Left Ventricular Hypertrophy Screening via Machine Learning for Young Adults

Background: A use of conventional 12-lead electrocardiographic (ECG) criteria and machine learning for the ECG parameters to identify the presence of left ventricular hypertrophy (LVH) is estimated 20%-30% in the general population. We developed an ECG system with simple anthropometric data using machine learning to increase the sensitivity in screening for LVH. Methods: In a large sample of 2,196 males, aged 17-45 years, the support vector machine (SVM) classifier with linear kernel is used as the machine learning method for 31 characteristics including age, body height, and body weight in addition to 28 ECG parameters such as axes, intervals and voltages to link the output of LVH. The diagnosis of LVH is based on the echocardiographic criteria for young adult males as 116 g/m 2 (left ventricular mass (LVM)/body surface area) or 49 g/m 2.7 (LVM/body height 2.7 ). The samples are divided into a training/validation set and a test set. By applying the synthetic minority over-sampling technique (SMOTE) in pre-processing of training data, the imbalance in sample size between the Non-LVH and LVH cases can be solved. Results: For the test set with 440 cases, average accuracy, specificity, sensitivity, precision and F 1 score are 76.1%, 75.1%, 92.6%, 19.5% and 32.3%, respectively. The AUCs of ROC and PR curves are 0.871 and 0.272, respectively. To compare with the Cornell and Sokolow-Lyon voltage criteria as shown in Fig.1, all data of the 2,196 young males are also tested in the model. With the specificity of 73.3%, our SVM technique provides much better sensitivity 86.7% compared to 3.3% and 52.7% for the Cornell and Sokolow-Lyon voltage criteria, respectively. The body height and body weight are the most important factors among the 31 features in our SVM model. Conclusions: We provide a novel screening tool using simple anthropometrics and several ECG data to identify LVH in young adults and improves much in sensitivity as compared with the conventional ECG criteria or using machine learning for ECG data alone to identify LVH.

Abstract P5-14-14: A validated clinical risk prediction model for cardiac toxicity in patients treated with antiHER2 agents

Abstract Background: Cardiac toxicity (CT) in the form of left ventricular systolic dysfunction is a well-known complication of anti-HER2 therapy. Prior clinical trial data has suggested potential factors associated with increased risk for CT. We sought to develop a clinical risk prediction model from real world patients to better identify patients who may be at higher risk for CT. Methods: Patients treated with anti-HER2 agents at all Mayo Clinic sites from Jan 2008 to July 2015 were reviewed. Patient data including age, race, body mass index, comorbidities, smoking history, baseline ejection fraction (EF), presence of left ventricular hypertrophy (LVH), prior cancer treatments, number of anti-HER2 agents used, and cardiac medication use were recorded. Factors were compared in patients with and without development of CT. Cox regression models were used to identify univariate and multivariate predictors of CT. A risk score was then assigned based on the final multivariable model. Results: 604 patients were included in final analysis. Median follow-up 2.9 yrs; median age: 57 yr; baseline EF: 64%. One yr CT rate was 7%. Independent predictors of CT were age, baseline EF, LVH, and anthracycline use (C index=0.74). Based on model coefficient, scores of 1, 1, 2 and 3 were assigned to age&amp;gt;55, EF &amp;lt;60%, anthracycline exposure and LVH, respectively. Two random samples of 300 patients were created out of the original cohort for internal validation of the risk score model. In each, the risk score was found to be a highly significant predictor for CT with C index of 0.72 {HR 2.13 (95% CI 1.57-2.90), p &amp;lt;0.001} and 0.77 {HR 2.45 (95% CI 1.74-3.44), p &amp;lt;0.001}. Conclusions: Patients with risk factors of older age, lower baseline EF, anthracycline use and LVH are at increased risk for CT when treated with anti-HER2 agents. Using a risk prediction model at therapy initiation may enhance identification of patients who benefit from cardiology referral, closer cardiac monitoring, and/or prophylactic treatment while on anti-HER2 targeted therapy. Table 1. Multivariable Cox regression model predicting cardiac dysfunctionParameterParameter EstimateHR (95%CI)p valueScoreAge &amp;gt;550.909552.48(1.27, 4.84)0.00751EF&amp;lt;600.634361.89(1.01, 3.53)0.04751Anthracycline Exposure1.046132.85(1.48, 5.46)0.00162Baseline LVH1.633565.12(2.04,12.85)&amp;lt;0.0013 Citation Format: Pooja P Advani, Lauren Cornell, Zhuo Li, Jordan Ray, Catalina Sanchez, Armando Villanueva, Taryn Smith, Alvaro Moreno-Aspitia. A validated clinical risk prediction model for cardiac toxicity in patients treated with antiHER2 agents [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-14-14.

Diagnostic utility of the electrocardiographic left ventricular hypertrophy criteria in specific populations

Background Several electrocardiographic (ECG) criteria have been validated for the diagnosis of left ventricular hypertrophy (LVH); the majority in Caucasian subjects from Europe and North America. Diagnostic utility of ECG criteria to detect LVH has never been established in our population; nonetheless they are frequently used. Objective To evaluate the diagnostic utility of different LVH ECG criteria in a Northern Mexican population and to determine the effect of gender, age, body mass index (BMI), hypertension and ischaemic heart disease (IHD) on their performance. Methods We conducted an observational, case-control study in patients divided according to the presence of LVH in an echocardiogram (Echo). We calculated the accuracy, sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of 22 ECG criteria. Results Four hundred thirty-two patients were studied (202 had LVH). The Dalfó criterion (ECG18. SV3 + RaVL) had the best diagnostic performance with a Se of 56%, Sp of 71.3%, PPV 62.9%, NPV 65% and a diagnostic accuracy (95%CI) of 64.1% (59.5–68.6). This criterion had the highest accuracy in both genders, in all BMI, in older patients (>60 years) and in those with positive Echo ischaemic heart disease (IHD); it also performed well in patients with history of IHD and in hypertensive patients. VDP Cornell had the best accuracy in patients less than 60 years old, and in patients with non-ischaemic findings by Echo. Conclusions The Dalfó criteria had the overall best accuracy in the detection of LVH, and specific populations.

P774 Utility of global longitudinal strain to predict post-operative outcomes in non-cardiac surgery

Abstract Background Pre-operative echocardiography is performed in selected groups of patients for cardiac risk stratification prior to surgery. Many parameters, including Left Ventricular Ejection Fraction (LVEF), are assessed during echocardiography. While many studies have cited association between low LVEF and poor operative outcomes such as perioperative myocardial infarction or cardiogenic pulmonary edema, LVEF has limitations such as left ventricular (LV) cavity border tracing, geometric assumptions and inter-observer variability. LVEF may also appear normal in the presence of LV hypertrophy and a small LV cavity size. Studies have described the routine use of global longitudinal strain (GLS) as an alternative measure of ventricular function, with GLS having been reported to be a reliable marker in detecting subclinical LV dysfunction. This adds incremental value in predicting myocardial function and in risk stratification. In fact, some studies have documented GLS being a useful preoperative parameter in predicting postoperative LV dysfunction after cardiac valve surgery. Purpose The aim of this study is to determine the value of GLS in predicting post-operative outcomes in patients undergoing non-cardiac surgeries. Methods This was a retrospective study of all patients who had echocardiography performed for a pre-operative indication from February 2017 to October 2017. These patients were screened for those who had normal LVEF, had undergone subsequent non-cardiac surgery, and had post-operative troponins measured. Medical records were traced for baseline demographics, past medical history and echocardiographic features. GLS evaluation was prospectively performed using TOMTEC-ARENA (TOMTEC Imaging Systems GmbH) by assessors blinded to patient outcomes. Outcomes for major adverse cardiovascular events and mortality up to 1 year post surgery were collected. Post-op myocardial injury was defined as a peak Troponin T value of &amp;gt;30 ng/L or a &amp;gt;20% increment from baseline. Results A total of 42 patients were included. 61.9% (n = 26) were male and mean age was 72.3 years. Only 75.6% of patients were fully independent with activities of daily living and mean creatinine was 153.4μmol/L. Mortality at 1 year was 16.7% (n = 7) and 28.6% (n = 12) were deemed to have post-operative myocardial injury. 1-year mortality was associated with a lower GLS (-23.8% vs -19.2%, p = 0.001). However, GLS was not correlated with post-operative myocardial injury or hospital readmissions. In our study population, only a history of past myocardial infarction predicted post-op myocardial injury (58.3% vs 16.7%, p = 0.019). Conclusion Our study did not demonstrate the utility of GLS in predicting post-operative events, but this is likely because of the small sample size with low event rates. Nevertheless, GLS values did correlate with 1-year mortality and could be a marker of frailty and an increased mortality risk.