Prevalence Of Left Atrial Enlargement Research Articles

Morbidity and mortality of acute heart failure patients stratified by mitral regurgitation in the Arabian Gulf: Observations from the Gulf acute heart failure registry (Gulf CARE)

This study aimed to evaluate the clinical outcomes of patients with acute heart failure (AHF) stratified by mitral regurgitation (MR) in the Arabian Gulf. Patients from the Gulf CARE registry were identified from 47 hospitals in seven Arabian Gulf countries (Yemen, Oman, Kuwait, Qatar, Bahrain, the United Arab Emirates, and Saudi Arabia) from February to November 2012. The cohort was stratified into two groups based on the presence of MR. Univariable and multivariable statistical analyses were performed. The population cohort included 5005 consecutive patients presenting with AHF, of whom 1491 (29.8 %) had concomitant MR. The mean age of patients with AHF and concomitant MR was 59.2 ± 14.9 years, and 63.1 % (n = 2886) were male. A total of 58.6 % (n = 2683) had heart failure (HF) with reduced ejection fraction (EF) (HFrEF), 21.0 % (n = 961) had HF with mildly reduced EF (HFmrEF), and 20.4 % (n = 932) had HF with preserved EF (HFpEF). Patients with MR had a lower haemoglobin (Hb) level (12.4 vs. 12.7 g/dL; p < 0.001), and a higher prevalence of left atrial enlargement (80.2 % vs. 55.1 %; p < 0.001), cardiogenic shock (9.7 % vs. 7.3 %; p = 0.006) and atrial fibrillation (7.6 % vs. 5.6 %; p = 0.006), and HFrEF (71.0 % vs. 52.6 %; P < 0.001). Multivariable analysis demonstrated that MR was independently associated with increased all-cause mortality at 1-year and 3-month HF rehospitalization [1-year all-cause mortality, adjusted odds ratio (aOR), 1.40; 95 % confidence interval (Cl): 1.13–1.74; p = 0.002; 3-month HF rehospitalization, aOR, 1.26; 95 % Cl: 1.06–1.49; p = 0.009]. In an Arabian Gulf cohort with AHF, concomitant MR was associated with an increased risk of 1-year mortality and 3-months HF rehospitalization.

DIFFERENT APPROACHES FOR THE ASSESSMENT OF LEFT ATRIAL VOLUME IN A LARGE SAMPLE OF PATIENTS UNDERGOING AN ECHOCARDIOGRAM FOR CARDIOVASCULAR RISK STRATIFICATION

Objective: Left atrial (LA) enlargement (LAE) is associated to an increased risk of cardiovascular complications, and in particular of atrial fibrillation. When LA size is measured by echocardiography, LA volume measurement is preferred over linear measurements. In fact, the strength of the relationship between cardiovascular diseases is stronger for LA volume than for LA linear dimensions. Recently it has been proposed a new method (LAV_e) to estimate LA volume in order to provide a surrogate of biplane LA volume when direct measurement is not available. The aim of our study was to evaluate the correlation between LA volume assessed by the biplane method(LAV_bip) and LA volume estimated by the linear measurements(LAV_e) and to assess the prevalence of LA enlargement in a large sample of patients undergoing an echocardiogram for cardiovascular risk stratification at an ESH excellence centre in Italy. Design and method: 4941 subjects undergoing a diagnostic work-up for arterial hypertension (known or suspect) were analysed. LAV_bip was assessed as by the area-length method using the apical 4-chamber and 2-chamber views and LAV_e was calculated according to the formula: 2.323*(LA parasternal linear diameter2.071). LAV was indexed to height2. Results: Mean age was 56 ± 16 years, BMI 26 ± 5, 43% of subjects had normal weight, 39% overweight, 18% obese, 54% males, 84 % were hypertensives.Mean LAV_bip was 46.2 ± 18.4 and LAV_e was 35.4 ± 11.6 ml. Mean LAV_bip/h2 was 16.2 ± 6.3 and LAV_e/h2 was 12.4 ± 4.1 ml/h2. The correlation coefficients between the two variables were respectively 0.62 and 0.60 (p &lt; 0.0001). Bland &amp; Altman analysis showed a progressive increase in discrepancy between the two measures with increasing LAV_bip. The prevalence of LA enlargement was 32% with the biplane method and 10 % with the elliptical estimation. Conclusions: In a large sample of subjects undergoing a diagnostic work-up for arterial hypertension we observed a possible underestimation of LAV and a lower prevalence of left atrial enlargement when the elliptical approach is used. These results, if confirmed in other populations, suggest that direct measurement of left atrial volume should be preferred, if available.

Age Alters Prevalence of Left Atrial Enlargement and Nonstenotic Carotid Plaque in Embolic Stroke of Undetermined Source.

Nonstenotic carotid plaque and undetected atrial fibrillation are potential mechanisms of embolic stroke of undetermined source (ESUS), but it is unclear which is more likely to be the contributing stroke mechanism. We explored the relationship between left atrial enlargement (LAE) and nonstenotic carotid plaque across age ranges in an ESUS population. A retrospective multicenter cohort of consecutive patients with unilateral, anterior circulation ESUS was queried (2015 to 2021). LAE and plaque thickness were determined by transthoracic echocardiography and computed tomography angiography, respectively. Descriptive statistics were used to compare plaque features in relation to age and left atrial dimensions. Among the 4155 patients screened, 273 (7%) met the inclusion criteria. The median age was 65 years (interquartile range [IQR] 54-74), 133 (48.7%) were female, and the median left atrial diameter was 3.5 cm (IQR 3.1-4.1). Patients with any LAE more frequently had hypertension (85.9% versus 67.2%, P<0.01), diabetes (41.0% versus 25.6%, P=0.01), dyslipidemia (56.4% versus 40.0%, P=0.01), and coronary artery disease (22.8% versus 11.3%, P=0.02). Carotid plaque thickness was greater ipsilateral versus contralateral to the stroke hemisphere in the overall cohort (median 1.9 mm [IQR 0-3] versus 1.5 mm [IQR 0-2.6], P<0.01); however, this was largely driven by the subgroup of patients without any LAE (median 1.8 mm [IQR 0-2.9] versus 1.5 mm [IQR 0-2.5], P<0.01). Compared with patients ≥70 years, younger patients had more carotid plaque ipsilateral versus contralateral (mean difference 0.42 mm±1.24 versus 0.08 mm±1.54, P=0.047) and less moderate-to-severe LAE (6.3% versus 15.3%, P=0.02). Younger patients with ESUS had greater prevalence of ipsilateral nonstenotic plaque, while the elderly had more LAE. The differential effect of age on the probability of specific mechanisms underlying ESUS should be considered in future studies.

Cardiovascular outcomes in patients with left atrial enlargement undergoing transcatheter aortic valve implantation.

BackgroundIncreased left ventricular afterload resulting from severe aortic stenosis (AS) leads to progressive cardiac remodeling. Left atrial enlargement (LAE) is an early manifestation in a series of maladaptive changes and may affect clinical outcomes after valvular replacement therapy. The aim of this study is to determine the impact of LAE on clinical outcomes in symptomatic patients with severe AS undergoing transcatheter aortic valve implantation (TAVI).MethodsIn a prospective single‐center TAVI registry, we analyzed LA dimensions measured by echocardiography before intervention. Patients with atrial fibrillation or concomitant mitral valve disease were excluded. LAE was defined as indexed LA volume >34 ml/m2. The primary endpoint was cardiovascular death (CVD) at 1 year.ResultsAmong 1663 patients undergoing TAVI between August 2007 and December 2016, 768 (46.2%) were eligible for the present analysis and 486 patients had LAE. The prevalence of LAE was higher in males (68.3%) as compared to females (58.8%). Patients with LAE were older (82.3 ± 6.7 years vs. 80.0 ± 6.4 years) and had a higher STS‐PROM score (6.1 ± 4.7% vs. 4.7 ± 2.9%). After adjustment, patients with LAE had an increased risk of CVD at 1‐year compared to patients with normal LA dimensions (49 [10.4%] vs. 8 [2.9%]; HRadj, 3.52; 95% CI, 1.66–7.44)]. In multivariable analysis, LAE was independently associated with an increased risk of CVD at 1‐year (HRadj, 3.52; 95% CI, 1.66–7.44).ConclusionsLAE secondary to AS was documented in a significant proportion of patients undergoing TAVI and was associated with a more than threefold increased risk of CVD at 1‐year.

Interatrial block, P terminal force or fragmented QRS do not predict new-onset atrial fibrillation in patients with severe chronic kidney disease

BackgroundThe prevalence of left atrial enlargement (LAE) and fragmented QRS (fQRS) diagnosed using ECG criteria in patients with severe chronic kidney disease (CKD) is unknown. Furthermore, there is limited data on predicting new-onset atrial fibrillation (AF) with LAE or fQRS in this patient group.MethodsWe enrolled 165 consecutive non-dialysis patients with CKD stage 4–5 without prior AF diagnosis between 2013 and 2017 in a prospective follow-up cohort study. LAE was defined as total P-wave duration ≥120 ms in lead II ± > 1 biphasic P-waves in leads II, III or aVF; or duration of terminal negative portion of P-wave > 40 ms or depth of terminal negative portion of P-wave > 1 mm in lead V1 from a baseline ECG, respectively. fQRS was defined as the presence of a notched R or S wave or the presence of ≥1 additional R waves (R’) or; in the presence of a wide QRS complex (> 120 ms), > 2 notches in R or S waves in two contiguous leads corresponding to a myocardial region, respectively.ResultsMean age of the patients was 59 (SD 14) years, 56/165 (33.9%) were female and the mean estimated glomerular filtration rate was 12.8 ml/min/1.73m2. Altogether 29/165 (17.6%) patients were observed with new-onset AF within median follow-up of 3 [IQR 3, range 2–6] years. At baseline, 137/165 (83.0%) and 144/165 (87.3%) patients were observed with LAE and fQRS, respectively. Furthermore, LAE and fQRS co-existed in 121/165 (73.3%) patients. Neither findings were associated with the risk of new-onset AF within follow-up.ConclusionThe prevalence of LAE and fQRS at baseline in this study on CKD stage 4–5 patients not on dialysis was very high. However, LAE or fQRS failed to predict occurrence of new-onset AF in these patients.

The relationship between famine exposure in early life and left atrial enlargement in adulthood.

Increased left atrium diameter (LAD) is associated with an elevated risk of cardiovascular diseases. The relationship between nutrition status and left atrial enlargement (LAE) is still unclear. The present study aimed to investigate the association of famine exposure in early life with LAE in adulthood. Participants were divided into non-exposed, fetal, early, middle and late childhood exposed groups according to birth data. LAE was defined when LAD was ≥3.9cm in women and ≥4.1cm in men, or ≥2.3cmm-2 by a sex-independent cut-off normalised for body surface area. Multivariate logistic regression was performed to calculate the odds ratio (OR) and confidence interval (CI) between famine exposure and LAE. In total, 2522 [905 male, mean (SD) age 59.1(3.65)years] subjects were enrolled, including 392 (15.5%) LAE subjects. The prevalence of LAE in non-exposed, fetal, early, middle and late childhood exposed groups was 55 (10.8%), 38 (11.2%), 88 (18.1%), 102 (16.7%) and 109 (19.0%), respectively. Compared to the non-exposed group, the ORs for LAE were in fetal (OR=0.956, 95% CI=0.605-1.500, P=0.847), late (OR=1.748, 95% CI=1.208-2.555, P=0.003), middle (OR=1.647, 95% CI=1.140-2.403, P=0.008) and early (OR=1.630, 95% CI=1.116-2.399, P=0.012) childhood exposed groups after adjusting potential cofounders. When stratified by gender, smoking, body mass index, hypertension and diabetes, we found that the effect of famine exposure on LAE was only modified by diabetes (Pinteraction =0.007). Famine exposure during childhood stage might increase the risk of LAE in adults, and this effect interacts with diabetes.

The prevalence of left atrial enlargement in Polish patients with atrial fibrillation — a single center study

Background. Atrial fibrillation (AF) remains one of the major causes of cardiovascular morbidity worldwide. Left atrial enlargement (LAE) is a common risk factor of AF. Left atrial enlargement is also connected with a higher prevalence of heart failure in AF patients. The aim of this study was to assess the prevalence of LAE in Polish patients with AF. Material and methods. Transthoracic echocardiography was performed in consecutive AF patients hospitalized in the Department of Heart Diseases. We assessed LAE using a two-dimensional method. Left atrial (LA) size was classified into the 4 categories: normal (LAE values < 39 mm in women and < 41 mm in men), mildly enlarged (39–42 mm in women and 41–46 mm in men), moderately enlarged (43–46 mm in women and 47–51 mm in men), and severely enlarged (≥ 47 mm in women and ≥ 52 mm in men). Results. We analyzed 113 individuals with AF (mean age 77.2 ± 9.8 years; 37.2% men). Of these, 71 (62.8%) patients had LAE (age 77.6 ± 9.9 years; 36.6% men). LA was mildly enlarged (39–42 mm in women and 41–46 mm in men) in 20 (28.2%) patients, moderately enlarged (43–46 mm in women and 47–51 mm in men) was observed in 30 (42.3%), and severely enlarged (≥ 47 mm in women and ≥ 52 mm in men) in 21 (29.6%) patients. The incidence of heart failure was significantly higher in AF patients with LAE [39 (54.9%) compared to the patients without LAE — 12 (28.6%) p = 0.01]. Conclusions. In patients with AF, LAE was highly prevalent. Patients with AF and LAE have more often HF compared to AF patients without LAE.

Echocardiographic Features of Patients With Heart Failure and Preserved Left Ventricular Ejection Fraction

BackgroundThe PARAGON-HF (Prospective Comparison of ARNI With ARB Global Outcomes in HF With Preserved Ejection Fraction) trial tested the efficacy of sacubitril-valsartan in patients with heart failure with preserved ejection fraction (HFpEF). Existing data on cardiac structure and function in patients with HFpEF suggest significant heterogeneity. ObjectivesThe aim of this study was to characterize cardiac structure and function, quantify their associations with clinical outcomes, and contextualize these findings with other HFpEF studies. MethodsEchocardiography was performed in 1,097 of 4,822 PARAGON-HF patients within 6 months of enrollment. Associations with incident first heart failure hospitalization or cardiovascular death were assessed using Cox proportional hazards models adjusted for age, sex, region of enrollment, randomized treatment, N-terminal pro–brain natriuretic peptide, and clinical risk factors. ResultsAverage age was 74 ± 8 years, 53% of patients were women, median N-terminal pro–brain natriuretic peptide level was 918 pg/ml (interquartile range: 485 to 1,578 pg/ml), 94% had hypertension, and 35% had atrial fibrillation. The mean left ventricular (LV) ejection fraction was 58.6 ± 9.8%, prevalence of LV hypertrophy was 21%, prevalence of left atrial enlargement was 83%, prevalence of elevated E/e′ ratio was 53%, and prevalence of pulmonary hypertension was 31%. Heart failure hospitalization or cardiovascular death occurred in 288 patients at 2.8-year median follow-up. In fully adjusted models, higher LV mass index (hazard ratio [HR]: 1.05 per 10 g/m2; 95% confidence interval [CI]: 1.00 to 1.10; p = 0.03), E/e′ ratio (HR: 1.04 per unit; 95% CI: 1.02 to 1.06; p < 0.001), pulmonary artery systolic pressure (HR: 1.51 per 10 mm Hg; 95% CI: 1.29 to 1.76; p < 0.001), and right ventricular end-diastolic area (HR: 1.04 per cm2; 95% CI: 1.01 to 1.07; p = 0.003) were each associated with this composite, while LV ejection fraction and left atrial size were not (p > 0.05 for all). Appreciable differences were observed in cardiac structure compared with other HFpEF clinical trials, despite similar E/e′ ratio, pulmonary artery systolic pressure, and event rates. ConclusionsDiastolic dysfunction, left atrial enlargement, and pulmonary hypertension were common in PARAGON-HF. LV hypertrophy, elevated left- and right-sided pressures, and right ventricular enlargement were independently predictive of incident heart failure hospitalization or cardiovascular death. Echocardiographic differences among HFpEF trials despite similar clinical event rates highlight the heterogeneity of this syndrome. (Efficacy and Safety of LCZ696 Compared to Valsartan, on Morbidity and Mortality in Heart Failure Patients With Preserved Ejection Fraction [PARAGON-HF]; NCT01920711)

Study on Prevalence of Cardiovascular Diseases in Canines of Jammu

The present study was conducted to screen various cardiovascular diseases in the Sher-e-Kashmir University of Agricultural Sciences and Technology Jammu, between July 2012 and June 2013. The prevalence of Cardiovascular diseases (CVDs) was found to be 1.61 percent with maximum occurrence in month March (16 percent). Males (56 percent) were more affected than female with highest prevalence in Labrador breed (44 percent). Dogs in the age group of old age (>5 year) were found most susceptible (64 percent) to CVDs. Category wise division of Cardiovascular disorders revealed prevalence of Left atrial enlargement (40 percent), DCM (24 percent), CHF (16 percent), Bi atrial enlargement (12 percent) and 2o AV block (8 percent). Grading of CVD based on clinical signs as per New York Heart Association Insufficiency Score revealed prevalence of Class I (8 percent), Class II (16 percent), Class III (20 percent) and Class IV (56 percent).

Identification and Prevalence of Atrial Fibrillation Associated ECG Markers in Collegiate Cross-Country Skiers

Middle-aged and elderly cross-country skiers have an increased occurrence of atrial fibrillation (AF) than the general population and other endurance athlete populations. The increased AF occurrence in middle-aged and elderly cross-country skiers is thought to be associated with a few characteristic adaptations of the athletic heart syndrome which can be quantified through the use of 12-lead electrocardiography (ECG). The identification and investigation of the prevalence of these AF associated ECG markers among collegiate cross-country skiers (CCCS) may offer insight into the development of AF in the lifespan of the endurance athlete. PURPOSE: This study used 12-lead ECG to identify and investigate the prevalence of these AF associated ECG markers, which include the continuous dependent variables of PR interval (PRI) duration, heart rate (HR), and P-wave height and the categorical dependent variables of bradycardia, left atrial enlargement (LAE), and P-wave peaking, in CCCS as compared with a matched inactive collegiate population (IC). METHODS: Supine resting 12-lead ECGs of ten Division I CCCS and ten IC were taken and subsequently analyzed. Subject height, weight, and blood pressure were recorded. Independent T-tests and Chi-square tests were used respectively to analyze continuous and categorical dependent variables. RESULTS: No significant differences in PRI duration or prevalence of LAE were found between the two groups, but CCCS had a greater prevalence of bradycardia than IC (HR: 52 ± 7 bpm vs. 66 ± 7 bpm) (P<0.05). The CCCS had a 58% taller mean P-wave height and a greater prevalence of P-wave peaking than the IC (60% vs. 0%) (P<0.05). CONCLUSION: The identification and prevalence of AF associated ECG markers in cross-country skiers is difficult to determine in CCCS, suggesting that it is affected by other factors such as cumulative training time or age. However, as the increases in vagal tone and atrial chamber modifications characteristic of the endurance athletic heart syndrome accumulate over a lifetime of endurance training, they may result in a higher prevalence of AF among cross-country skier athletes. Therefore, further research involving the potential progression of these ECG changes in the lifespan of the cross-country skier is warranted.

Prevalence of left atrial enlargement and its risk factors in general Chinese population.

BackgroundLeft atrial enlargement (LAE) has been proven to be significantly related to stroke and cardiovascular diseases. In China, few studies related to LAE have been conducted, especially in the general population. To the best of our knowledge, our study is the first to explore the prevalence of LAE and associated risk factors in the general Chinese population.MethodsThis study included a total of 11,956 subjects aged ≥35 years. All participants completed a questionnaire, and underwent complete physical examination, electrocardiogram (ECG) and echocardiogram. We defined LAE as a LA diameter exceeding 4.0 cm in men and 3.8 cm in women. We conducted a multivariable logistic regression analysis and a linear regression analysis to identify independent factors of LAE.ResultsThe overall prevalence of LAE was 6.43 % for subjects aged over 35 years. The prevalence of LAE was 6.78 % in women and 6.02 % in men. The major risk factors of LAE were female sex (odds ration [OR]: 1.229, β: 0.197), advancing age (OR: 1.015, β: 0.036), high systolic blood pressure (OR: 2.331, β: 0.185), high body mass index (BMI) (OR: 3.956, β: 0.373), diabetes (OR: 1.498, β: 0.030), high left ventricular myocardial index (OR: 1.003, β: 0.073), and low left ventricular ejection fraction, low heart rate, and low estimated glomerular filtration rate. Additionally, the association between BMI and LAE was the most obvious.ConclusionsFemale sex, advancing age, high systolic blood pressure, high BMI, diabetes, high left ventricular myocardial index, low estimated glomerular filtration rate, low left ventricular ejection fraction, and low heart rate were proven to be risk factors of LAE.

GW26-e3862 Prevalence of left atrial enlargement and its independent risk factors in rural Chinese population: An important but ignored condition

GW26-e3862 Prevalence of left atrial enlargement and its independent risk factors in rural Chinese population: An important but ignored condition

Biomarkers of cardiomyocyte injury and stress identify left atrial and left ventricular remodelling and dysfunction: A population-based study

Background/objectivesThe validation of effective screening tools for the identification of patients with subclinical myocardial remodelling is a major clinical need. Thus, we explored the associations of circulating biomarkers of cardiomyocyte injury and stress with subclinical cardiac remodelling and dysfunction, and with biomarkers reflecting collagen turnover. MethodsWe randomly recruited 727 subjects from a general population (51.2% women; mean age 51.3years). Measurements included echocardiographic left atrial (LA) and left ventricular (LV) structure and function, quantification of high sensitivity cardiac Troponin T (hs-cTnT), NT-proBNP, and biomarkers of collagen types I and III turnover. ResultsIn unadjusted and adjusted analyses, the prevalence of LA enlargement (LAE), LV hypertrophy (LVH) and LV diastolic dysfunction (LVDD) increased with higher hs-cTnT (P≤0.031). NT-proBNP was independently associated with LVDD (P=0.009). Both biomarkers combined yielded significant integrated discrimination and net reclassification improvements (P≤0.014 and P≤0.009, respectively) for LAE, LVH and LVDD, over the conventional risk factors, and were independently and positively associated with biomarkers of collagen type I turnover. In a sensitivity analysis, after excluding participants with previous cardiac diseases, our findings remained consistent. ConclusionsOur population-based study suggested that subclinical LV and LA remodelling were associated with hs-cTnT, and that, in combination with NT-proBNP, hs-cTnT showed incremental diagnostic utility over the conventional risk factors. Both biomarkers were associated with biomarkers of collagen type I turnover. Thus, biomarkers of cardiomyocyte microinjury and hemodynamic stress may stimulate fibrosis-related mechanisms and facilitate the diagnosis of subclinical LA and LV remodelling and dysfunction in the general population.

Left Atrial Enlargement in the Early Stage of Hypertensive Heart Disease: A Common But Ignored Condition

How to identify the early signs of hypertensive heart disease is the key to block or reverse the process of heart failure. The aim of this study was to evaluate the predictive value of left atrial (LA) enlargement in the early stage of hypertensive heart disease and to explore the correlations between LA enlargement and heart failure with normal ejection fraction (HFnEF), as well as the metabolic syndrome (MetS). Baseline clinical characteristics, biochemical indices, electrocardiographic and echocardiographic data were collected from 341 consecutive patients with essential hypertension. Among those patients, LA enlargement was more frequently presented than LV enlargement (57.2% vs 17.9%). Compared with patients without HFnEF, the prevalence of LA enlargement was higher in patients with HFnEF (82.9% vs 49.0%, P<.0001). From grade 2 to grade 3 hypertension, LA size was significantly larger in patients with MetS (P<.01) than those without. Multivariate linear regression analyses showed that age, body mass index, waist circumference, triglyceride level, and left ventricular diameter were independent predictors of LA enlargement. The simple measurement for identification of LA enlargement potentially allows early recognition of those patients at risk for heart failure, particularly among patients with MetS.

Cardiac structure and function in heart failure with preserved ejection fraction: baseline findings from the echocardiographic study of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial.

Heart failure with preserved ejection fraction (HFpEF) is associated with substantial morbidity and mortality. Existing data on cardiac structure and function in HFpEF suggest significant heterogeneity in this population. Echocardiograms were obtained from 935 patients with HFpEF (left ventricular ejection fraction ≥45%) enrolled in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial before initiation of randomized therapy. Average age was 70±10 years, 49% were women, 14% were of African descent, and comorbidities were highly prevalent. Centralized quantitative analysis in a blinded core laboratory demonstrated a mean left ventricular ejection fraction of 59.3±7.9%, with prevalent concentric left ventricular remodeling (34%) and hypertrophy (43%), and left atrial enlargement (53%). Diastolic dysfunction was present in 66% of gradable participants and was significantly associated with greater left ventricular hypertrophy and a higher prevalence of left atrial enlargement. Doppler evidence of pulmonary hypertension was present in 36%. At least 1 measure of structural heart disease was present in 93% of patients. Patients enrolled in TOPCAT demonstrated heterogeneous patterns of ventricular remodeling, with high prevalence of structural heart disease, including left ventricular hypertrophy and left atrial enlargement, in addition to pulmonary hypertension, each of which has been associated with adverse outcomes in HFpEF. Diastolic function was normal in approximately one third of gradable participants, highlighting the heterogeneity of the cardiac phenotype in this syndrome. These findings deepen our understanding of the TOPCAT trial population and expand our knowledge of the diversity of the cardiac phenotype in HFpEF. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00094302.

Common echocardiography findings in pretransplant dialysis patients and their associations

Abnormality in cardiac structure and function is common in chronic kidney disease (CKD) patients. We aimed to evaluate the prevalence of different abnormal echocardiographic findings in CKD patients and find their associated factors. This retrospective cross-sectional study was conducted in the Nephrology and Dialysis Department of the Shiraz University of Medical Sciences. A total number of 1354 kidney transplant candidates between the years 2000 and 2010 were included. Association between variables was assessed by Chi-square test and Student t test. We analyzed our data using multivariate logistic and linear regression when appropriate. Left ventricular hypertrophy (LVH; 47.5%) was the most common finding in this study, followed by left atrial enlargement (43.7%), diastolic dysfunction (25.4%), left ventricular end diastolic dilation (23.1%), and systolic dysfunction (18.5%), in order of frequency. Older age was associated with abnormality in all echocardiographic indexes. Male gender was associated with LVH and systolic dysfunction. We found an association between a longer duration since CKD diagnosis and LVH. Left ventricular end diastolic dilation, left atrial enlargement, and diastolic dysfunction were associated with a longer duration of dialysis. Anemia was associated with all echocardiographic abnormalities except diastolic dysfunction. Hypoalbuminemia and hypocalcemia were associated with only left atrial enlargement and left ventricular end diastolic dilation, respectively. Patients on peritoneal dialysis had a lower prevalence of left atrial enlargement and left ventricular end diastolic dilation. Different echocardiographic abnormalities, especially LVH, are prevalent among CKD patients. Traditional risk factors, such as age, diabetes mellitus, and hypertension, and uremia-related risk factors, such as anemia and hypoalbuminemia, are associated with an increase in the prevalence of these abnormalities. 背景：心臟結構及功能異常在慢性腎病患者 (CKD) 間相當常見，本研究旨在調查 CKD 患者間心臟超音波異常表現的盛行狀況及其中的相關因子。 方法：這是伊朗設拉子醫學大學腎臟醫學與透析部的一項回溯性橫斷研究，納入 2000 至 2010 年間共 1354 位移植候選者，並採用卡方檢定及 Student's t test 以檢定各變項間的關聯性。 結果：最常見的發現依序有：左心室肥大 (LVH) (47.5%)、左心房擴大 (43.7%)、舒張功能障礙 (25.4%)、左心室舒張末擴張 (23.1%)、及收縮功能障礙 (18.5%)。所有心臟超音波指標的異常均與年老有關，其中 LVH 及收縮功能障礙與男性性別有關。我們亦發現 LVH 與 CKD 診斷後的較長時間有關；左心室舒張末擴張、左心房擴大、及舒張功能障礙則與較長的透析時間有關。除了舒張功能障礙之外，貧血與所有的心臟超音波異常均有關。低白蛋白血症及低鈣血症，則分別僅與左心房擴大及左心室舒張末擴張有關。在正接受腹膜透析的病人間，左心房擴大及左心室舒張末擴張的盛行率均較低。 結論：心臟超音波指標異常特別是 LVH 在 CKD 患者間相當常見，它們的出現與傳統的危險因子有關，例如年齡、糖尿病、及高血壓；及尿毒症的相關危險因子如貧血及低白蛋白血症。

Atrial Remodeling in Newly Diagnosed Drug‐Naive Hypertensive Subjects

Systemic hypertension is a major risk factor for heart disease and stroke. Data regarding temporal relationship of left atrial (LA) remodeling to onset of hypertension are sparse. We aimed to quantitate LA structural and functional remodeling in newly diagnosed hypertensive patients. We prospectively identified 380 patients with newly diagnosed systemic hypertension naive to drug therapy, and 380 age-matched control subjects without any history or evidence of hypertension. History or evidence of prior cardiovascular events, congenital or valvular heart disease, and renal dysfunction were exclusion criteria. Prevalence of LA enlargement, LA mechanical dysfunction expressed in total emptying fraction, left ventricular (LV) diastolic dysfunction, LV hypertrophy, and their interrelationships were assessed. Of the 380 newly diagnosed hypertensive patients, 285 (75%) had LA enlargement, 308 (81%) had LA mechanical dysfunction, and 19 (5%) had LVH. Diastolic dysfunction was present in 334 (88%) of the patients. Compared to the controls, the hypertensive group had larger maximal, minimal, and pre-A LA volumes (all P<0.001). Total and active LA emptying fraction were significantly reduced (both P<0.001). Total LA emptying fraction was strongly associated with systolic blood pressure [per 10mmHg, HR 0.94 (0.89-0.98); P<0.001], with stepwise decrease in LA emptying fraction of 6%, 10%, and 16% from the lowest (141-150mmHg) to the top tertile of systolic blood pressure (>160mmHg). In this drug-naive cohort with newly diagnosed hypertension, LA structural and functional remodeling, and LV diastolic dysfunction were common findings prior to initiation of drug treatment. LVH was uncommon. Impairment of LA mechanical function was evident even in the mildly hypertensive subgroup.

Cardiac structure and function in relation to cardiovascular risk factors in Chinese

BackgroundCardiac structure and function are well-studied in Western countries. However, epidemiological data is still scarce in China.MethodsOur study was conducted in the framework of cardiovascular health examinations for the current and retired employees of a factory and their family members. According to the American Society of Echocardiography recommendations, we performed echocardiography to evaluate cardiac structure and function, including left atrial volume, left ventricular hypertrophy and diastolic dysfunction.ResultsThe 843 participants (43.0 years) included 288 (34.2%) women, and 191 (22.7%) hypertensive patients, of whom 82 (42.9%) took antihypertensive drugs. The prevalence of left atrial enlargement, left ventricular hypertrophy and concentric remodeling was 2.4%, 5.0% and 12.7%, respectively. The prevalence of mild and moderate-to-severe left ventricular diastolic dysfunction was 14.2% and 3.3%, respectively. The prevalence of these cardiac abnormalities significantly (P ≤ 0.002) increased with age, except for the moderate-to-severe left ventricular diastolic dysfunction. After adjustment for age, gender, body height and body weight, left atrial enlargement was associated with plasma glucose (P = 0.009), and left ventricular hypertrophy and diastolic dysfunction were significantly associated with systolic and diastolic blood pressure (P ≤ 0.03), respectively.ConclusionsThe prevalence of cardiac structural and functional abnormalities increased with age in this Chinese population. Current drinking and plasma glucose had an impact on left atrial enlargement, whereas systolic and diastolic blood pressures were major correlates for left ventricular hypertrophy and diastolic dysfunction, respectively.

Left ventricular geometry and diastolic function in the hypertensive heart: Impact of age

Background and aim. The impact of aging on the relationship between left ventricular (LV) mass/geometry and diastolic function as assessed by updated echocardiographic methods, such as tissue Doppler, is poorly defined. We investigated this issue in a cohort of hypertensive patients. Methods. A total of 660 hypertensives (mean age 65 ± 13 years, 48% men) with preserved LV systolic function underwent a comprehensive echo-Doppler examination for routine clinical indications. For the present analysis, the subjects have been divided in two age groups (<65 or ≥65 years). Results. Overall, 61% of subjects fulfilled the criteria for LVH, 18% for left atrial (LA) enlargement and 11% for altered LV filling index. Concentric LV geometry was 1.4-fold higher in older hypertensives than in younger counterparts; also the prevalence of LA enlargement and altered LV filling was 2.0- and 1.9-fold higher in the former group, respectively. In older hypertensives, at variance from younger ones, neither LV mass nor relative wall thickness (RWT), a continuous index of LV geometry, were independently correlated to conventional as well as tissue Doppler LV diastolic indexes. Conclusions. Our findings suggest the relationship between cardiac hypertrophy and diastolic function in hypertensive subjects is affected by aging-associated factors unrelated to the amount of LV mass as assessed by standard echocardiography.

Association of left atrial enlargement with left ventricular hypertrophy and diastolic dysfunction: A tissue Doppler study in echocardiographic practice

Background. Left atrial (LA) enlargement is a powerful risk factor for cardiovascular diseases; little information is available about its prevalence and correlates in subjects free of overt cardiac disease seen in echocardiographic practice. Aim. We evaluated the prevalence of LA enlargement (LAE) and the relationship with left ventricular (LV) mass and diastolic function in subjects with preserved LV systolic function referred to an echocardiographic study for routine clinical indications. Methods. 1104 subjects (mean age 58 ± 16 years, 46% men, 57% hypertensives) underwent a comprehensive echo-Doppler examination. LAE and LV hypertrophy (LVH) were defined as LA volume index (LAVI) >29 ml/m2 and LV mass index (LVMI) >50 g/h2.7, respectively. Abnormalities of LV relaxation and LV filling were diagnosed by age-related thresholds of lateral annular velocity (Ei) and by early mitral flow velocity to Ei ratio (E/Ei) ≥16, respectively. Results. Overall, 10% of echocardiographic examinations fulfilled the criteria for LAE, 46% for LVH, 45% for altered LV relaxation and 5% for altered LV filling index. LVH progressively increased from 25% to 75% across LAVI quartiles. More patients in the highest quartile exhibited abnormal indexes of LV relaxation and LV filling compared with lower quartiles. In multivariate analysis, LV mass index (β = 0.408), age (β = 0.188), E/Ei ratio (β = 0.140) and Ei (β = 0.140) emerged as major correlates of LAE (p at least <0.01 for all). Conclusions. LAE is a frequent finding in patients with preserved systolic function seen in current practice; this abnormality is strongly related to LVH and to diastolic dysfunction. Early detection of LAE may identify patients at higher cardiovascular risk and promote appropriate prevention strategies.