Prevalence Of Left Ventricular Hypertrophy Research Articles

Left ventricular hypertrophy in young hypertensives: the possible crosstalk of mTOR and angiotensin-II -a case-control study

BackgroundHypertension is a major cause of cardiac dysfunction. The earliest manifestation is left ventricular remodeling/hypertrophy. The occurrence of adverse cardiac remodeling and outcomes occurs irrespective of age in blacks. This necessitated an estimate of the prevalence of left ventricular hypertrophy (LVH) and an assessment of the roles of the mammalian target organ of rapamycin (mTOR) and angiotensin-II (Ang II) as possible pathogenic markers of LVH among young hypertensives.MethodsThis prospective case-control study involved 110 hypertensive and 60 normotensive (control) participants aged 18–45 across tertiary hospitals in Ekiti state. Ethical approval was obtained from all the various institutions. Participants were recruited consecutively after giving informed consent. Sociodemographic/clinical information, resting electrocardiogram and echocardiography were obtained. Venous blood was obtained to estimate mTOR, Ang II, Chemerin, lipids – triglyceride (TG), high-density lipoprotein (HDL), total cholesterol (TC), troponin-T, NF-Kβ, and Galectin-3 using enzyme-linked immunosorbent assay.ResultsThe prevalence of LVH among the hypertensive group was 20.9%, 39%, 11.01%, and 15.74% using 2D-transthoracic echocardiography, Sokolow-Lyon, Cornell’s and Cornell product ECG criteria. Also, hypertensives with LVH had a significantly increased blood pressure, body mass index, serum level of TG, TG/HDL, TC/HDL, chemerin, troponin T, Galectin-3 and total mTOR compared to normotensive and hypertensives without LVH. At the same time, serum NF-kβ and Ang II were only significant when compared with normotensive but not hypertensives without LVH. The total mTOR moderately correlated positively with ANG-II.ConclusionsThe results suggest an interaction between mTOR and Ang II in the development of LVH. In addition, it shows that LVH is associated with dyslipidemia, inflammation, and fibrosis.

PREVALENCE OF LEFT VENTRICULAR HYPERTROPHY (LVH) IN TYPE 2 DIABETES MELLITUS AT PAF HOSPITAL MUSHAF

Left Ventricular Hypertrophy (LVH) is widely recognized as a predictor of adverse cardiovascular outcomes, including heart failure, arrhythmias, and sudden cardiac death. Objective: The basic aim of the study is to find the prevalence of left ventricular hypertrophy (LVH) in type-II diabetes mellitus at PAF Hospital Mushaf. Methods: This Cross-sectional study was conducted at the Department of Medicine, PAF Hospital Mushaf, Sargodha from January to July 2024. Data were collected through a non-probability, consecutive sampling technique. Data were collected using a self-generated questionnaire and included biodata like age, gender, contact number, and the presence or absence of LVH. Transthoracic 2D Echo was performed in selected individuals on the Toshiba Xario (Echo machine). Results: Data were collected from 154 patients with a mean age of 52.6 ± 7.4 years, with a nearly equal gender distribution, consisting of 48% male and 52% female participants. The average duration of diabetes was 10.3 ± 4.2 years, and the mean BMI was 28.4 ± 3.7 kg/m², indicating a mildly overweight population. Blood pressure was on average 140/90 ± 10/6 mmHg, with a significant proportion (61%) suffering from hypertension. Fasting blood glucose levels were elevated at 175.6 ± 34.8 mg/dL, and the mean HbA1c was 8.5 ± 1.2%, reflecting poor long-term blood sugar control. Conclusion: It is concluded that Left Ventricular Hypertrophy (LVH) is prevalent in a significant proportion of patients with Type 2 Diabetes, particularly those with longer diabetes duration and male gender. The findings highlight the importance of early detection and management of cardiovascular risk factors in diabetic patients and a significant gender difference, with male patients being more likely to develop LVH compared to females in this study were observed.

Elevated concentrations of cardiac troponin T are associated with thoracic aortic calcification in non-dialysis chronic kidney disease patients of stage G3 to G5

Background Vascular calcification (VC), especially coronary artery calcification (CAC), serves as a robust predictor of cardiovascular mortality in chronic kidney disease (CKD) patients. Recent studies have revealed that the presence of extra-coronary calcifications (ECCs) contributes to cardiovascular disease (CVD). Elevated myocardial injury markers predict mortality risk in CKD patients and are associated with CVD. Nevertheless, the relationship between VC, including CAC and ECCs, and myocardial injury markers remain unexplored in non-dialysis CKD patients. Methods In 278 non-dialysis CKD patients of stage G3 to G5, we assessed calcified scores in CAC (Agatston score) and ECCs including thoracic aortic calcification (TAC), abdominal aortic calcification (AAC), carotid artery calcification, and valvular calcification. We analyzed the relationships between VC and myocardial injury markers of cardiac troponin T (cTnT) and creatine kinase-MB (CK-MB). Results A total of 278 non-dialysis CKD patients (median age 52.4 ± 13.2; male 65.1%; diabetes 33.5%) were enrolled. A total of 71.8% (227) of patients had cTnT levels above the upper limit of normal (> 0.014 ng/mL). Moderate to severe (calcified score ≥100 vs. <100), CAC (OR 6.39; 95% CI 1.03–39.61) and TAC (OR 6.16; 95% CI 1.76–21.55) were significantly associated with higher cTnT concentrations after adjustment for confounders. Additionally, male sex and a lower eGFR were also associated with cTnT elevation. However, when we included CAC and TAC in one model, only moderate to severe TAC (OR 4.85; 95% CI 1.38–16.96) was a risk factor for cTnT elevation, but not CAC. Furthermore, patients with severer TAC presented lower diastolic blood pressure (DBP), wider pulse pressure (p < 0.001) and higher prevalence of left ventricular hypertrophy (LVH). Conclusion Moderate to severe thoracic aortic calcification (TAC score ≥ 100) is significantly associated with elevated cTnT concentrations in non-dialysis CKD patients of stage G3 to G5. The linkage may result from decreased coronary perfusion and relative myocardial ischemia.

Preeclampsia-Induced Cardiovascular Alterations and Their Impact on Left Ventricular Structure during Pregnancy

Preeclampsia is a significant hypertensive disorder in pregnancy, characterized by elevated blood pressure and proteinuria after the 20th week of gestation. It affects 5-8% of pregnancies and poses substantial risks to both maternal and fetal health. This study investigates the association between preeclampsia, left ventricular hypertrophy (LVH), and blood pressure in pregnant women attending Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State. A cohort of 33 preeclampsia women was enrolled, with blood pressure and proteinuria measurements used for diagnosis. Electrocardiograms (ECGs) were analyzed for the presence of LVH based on Sokolow-Lyon criteria. The results revealed a strong correlation between preeclampsia and LVH, with 42.9% of preeclampsia patients showing LVH. Blood pressure exceeding 140/90 mmHg and proteinuria were found to significantly increase the prevalence of LVH, with 60% of preeclampsia women exhibiting LVH. Statistical analysis revealed a significant positive correlation between preeclampsia and LVH (r=0.401, p=0.021) and a strong negative correlation between preeclampsia and blood pressure (r=-0.896, p&lt;0.05). These findings highlight the role of hypertension in cardiac remodeling during preeclampsia and suggest that women with a history of preeclampsia may be at greater risk for long-term cardiovascular complications. Further studies are needed to understand these alterations' mechanisms and develop preventive and therapeutic strategies to improve maternal health outcomes.

Influence of smoking on cardiometabolic profile and surgical outcomes in patients with primary aldosteronism: a cohort study.

To evaluate the influence of smoking on cardiometabolic profile and surgical outcomes in patients with primary aldosteronism (PA). Multicentre retrospective study of patients with PA evaluated in 36 Spanish tertiary hospitals with available information on smoking habits [smokers and non-smokers (never smokers and ex-smokers)]. A total of 881 patients were included, of whom 180 (20.4%) were classified as smokers and 701 as non-smokers. At diagnosis, smokers and non-smokers did not differ in blood pressure or serum potassium levels between. However, smokers had a higher prevalence of left ventricular hypertrophy (LVH) than non-smokers [odds ratio (OR) 2.0, 95% confidence interval (CI) 1.23-3.25], and smokers were more likely to have severe LVH than non-smokers (12.5% vs 6.6%, P = .164). A larger mean tumour size of the adrenal nodule/s was observed in the smoking group (18.6 ± 9.66 vs 15.8 ± 8.66 mm, P = .002). In addition, the odds of mild autonomous cortisol secretion (MACS) was greater in smokers than in non-smokers (OR 2.1, 95% CI 1.14-4.06), but these differences disappeared when adjusted for the size of the adrenal nodule/s (adjusted OR 1.6, 95% CI 0.76-3.37). The rate of biochemical and hypertension cure was similar in both groups; however, hypertension cure tended to be more frequent in the non-smoker group (41.2% vs 29.9%, P = .076). Patients with PA who smoke have a higher prevalence of LVH and MACS and larger adrenal nodule/s than non-smokers. Smoking has no significant effect on the probability of hypertension response after adrenalectomy in patients with PA; however, a tendency to a lower probability of hypertension cure is observed in smokers compared to non-smokers.

Atherosclerotic renal artery stenosis, mediating biomarkers, and risk of cardiac among individuals with hypertension: A real-world study

BackgroundAtherosclerotic renal artery stenosis (ARAS) is commonly associated with cardiovascular diseases(CVD). Patients with ARAS typically present with cardiac structural and functional abnormalities, and the differences in cardiac structure and function compared to hypertensive patients without ARAS remain to be explored. MethodsA total of 499 hypertensive patients were included, of whom 134 had ARAS and 365 had no renal artery stenosis (RAS). Parameters about cardiac function and structure detected by echocardiography and other clinical data are collected. Univariate and multivariate binary logistic regression and mediation analysis were performed on the collected data. ResultsCompared to hypertensive patients without ARAS, those with ARAS had significantly increased left ventricular (LV) internal diameter (LVIDd), posterior wall thickness (PWTd), LV geometric abnormalities, diastolic dysfunction, and a higher prevalence of LV hypertrophy (LVH). After adjustment, ARAS was significantly associated with LV diastolic dysfunction (LVDF) (OR = 1.12, 95 %CI = 1.03–1.3), LVIDd (OR = 1.07, 95 %CI = 1.02–1.13), LV geometry (OR = 1.24, 95 %CI = 1.12–1.36), PWTd (OR = 1.2, 95 %CI = 1.09–1.31), and LV mass index (OR = 1.31, 95 %CI = 1.18–1.47). Mediation analysis identified hypersensitive C-reactive protein (Hs-CRP) and serum creatinine (Scr) as significant mediators, accounting for 10.80 % to 59.54 % of the ARAS impact on LV abnormalities. ConclusionARAS appears to be an independent risk factor for abnormalities in cardiac function and structure, potentially mediated by Hs-CRP and Scr. Hypertensive patients with ARAS demonstrate a higher prevalence of left ventricular hypertrophy (LVH) and diastolic dysfunction, underscoring the importance of vigilant monitoring in this population.

Left Ventricular Hypertrophy in Women With a History of Preeclampsia.

As a hypertensive disorder of pregnancy, preeclampsia is associated with increased cardiovascular morbidity and mortality later in life. Since early signs of myocardial affection could indicate a higher risk of future cardiovascular disease manifestations, we investigated whether women with prior preeclampsia have a higher prevalence of left ventricular hypertrophy compared with women from the general population and to what extent chronic hypertension affects any potential difference. In a cohort study, women aged 40 to 55 years with prior preeclampsia were compared with age- and parity-matched women from the general population. They underwent a research cardiac computed tomography, and the primary outcome was left ventricular hypertrophy, defined as a left ventricular mass index >30 g/m2.7. In 679 women with prior preeclampsia and 672 controls (median age, 47 years), we found a higher prevalence of left ventricular hypertrophy (14.0% versus 6.4%) in the preeclampsia group with an odds ratio of 1.62, 95% CI (1.07-2.46), P=0.024, median of 15 years (range, 0-28) after pregnancy, after adjustment for cardiovascular risk factors, including chronic hypertension. Left ventricular hypertrophy was more frequent among women with preeclampsia with (26.2% versus 15.6%) and without (5.5% versus 2.4%) chronic hypertension, and a mediation analysis showed that chronic hypertension explained 22% of the association between preeclampsia and left ventricular hypertrophy. Women with prior preeclampsia had a 2-fold higher prevalence of left ventricular hypertrophy compared with women from the general population, and preeclampsia was independently associated with left ventricular hypertrophy, regardless of the presence of cardiovascular risk factors, including chronic hypertension. URL: https://www.clinicalTrials.gov; Unique identifier: NCT03949829.

Abstract 4120929: Silent Myocardial Infarctions in Women with Ischemic Sudden Cardiac Death

Background: Sudden cardiac death (SCD) is a significant mode of death in both sexes, with most cases attributed to coronary artery disease (CAD). In women, ischemic SCD seems to occur more often without previously diagnosed CAD, but the prevalence and characteristics of silent myocardial infarctions (SMI) in women are not known. Aim: This study aimed to investigate the prevalence and characteristics of women with silent myocardial infarction (SMI) and ischemic SCD. Methods: The Fingesture study consists of 5,869 autopsy-verified SCD cases (21.1% women) in Northern Finland 1998-2017. In this study, we investigated women with ischemic SCD without previous CAD diagnosis (N=660). SMI was defined as a myocardial infarction (MI) scar at autopsy in the absence of CAD history in medical records. As a control group, we used women with ischemic SCD without MI scar and previous CAD diagnosis. Coronary artery stenosis, myocardial fibrosis, and MI scars were evaluated through macroscopic assessment during autopsy, with further histological verification for myocardial fibrosis and MI scars. Results: Among 660 ischemic SCD subjects without prior CAD diagnosis, 220 (33.3%) had SMI. Women with SMI were older compared to those without SMI (73.4 vs. 71.4 years in subjects without SMI, p=0.03), and SMIs became more prevalent with advancing age (+4.4% per decade, p&lt;0.01). Women with SMI had higher heart weight (411 vs. 386 g in subjects without SMI, p&lt;0.01) and a higher prevalence of left ventricular hypertrophy (LVH) (73.6% vs. 64.5% in subjects without SMI, p=0.02). The average body mass index was 27.1 kg/m 2 in subjects with SMI and 27.6 kg/m 2 in subjects without SMI (p=0.34). Subjects with SMI were more likely to have severe coronary artery stenosis with &gt;90% occlusion (37.3% vs. 22.5% in subjects without SMI, p&lt;0.01). Severe (15.0% vs. 3.0% in subjects without SMI, p&lt;0.01) and moderate (69.1% vs. 39.4% in subjects without SMI, p&lt;0.01) degrees of myocardial fibrosis were more prominent among subjects with SMI. Conclusions: One-third of ischemic SCD cases without prior CAD diagnosis in women had findings of SMI at autopsy. Women with SMI were slightly older and exhibited more severe coronary disease, LVH and myocardial fibrosis at autopsy. These findings underscore the importance of earlier diagnosis and treatment of CAD in SCD prevention in women.

Assessment of the Sokolow Lyons Criteria of Left Ventricular Hypertrophy in Comparison with Echocardiography in Hypertensive Patients

Around 65.4% of people over the age of 60 have hypertension, and it's the underlying cause of 6% of all fatalities globally. The left ventricle enlarges, or hypertrophies, in people with hypertension. If the left ventricle of the heart thickens its walls or the chamber of the left ventricle expands, or if both happen at once, the condition is called left ventricular hypertrophy (LVH) [1]. This condition impacts approximately 15 -20% of the general population and has similar rates in men and women. Serious health complications such as cardiovascular diseases, stroke, congestive heart failure, irregular heart rhythms (ventricular arrhythmias), and sudden cardiac death are linked to it.Rationale of the study: In people with slightly hypertensive conditions, the prevalence of LVH is 20%; in those with severe or complex hypertension, it approaches 100%. LVH is also a result of valve disorders, which cause pressure and/or volume overload. Furthermore, "physiological" LVH—which occurs in well-trained athletes in reaction to job overload—can arise. About 0.2% of the general population has hypertrophic cardiomyopathy, a hereditary condition caused by mutations in the sarcomere protein genes. It is characterized by severe cardiac tissue disarray, fibrotic scarring, and aberrant internal coronary arteries.Background and statement of the problem: Hypertension is a leading cause of many cardiovascular problems and cerebrovascular accidents Aim: Assessment of the Sokolowlyon’s Criteria of Left Ventricular Hypertrophy in comparison with Echocardiography Inhypertensives PatientsObjective: To determine whether the ECHO of left ventricular hypertrophy significantly coincides with the Sokolow Lyon criterion of the ECG.Methodology: This cross-sectional study was carried out at the Shree Balaji Medical College and Hospital's general medicine department in Chromepet, Tamil Nadu, India. The study ran from June 2022 to December 2023, a duration of eighteen months.Results: The study focused on assessing the correlation between Sokolow-Lyon criteria on (ECG) and (LVH) as determined by echocardiography (ECHO). The results revealed that among the 125 participants, 88 cases (70.40%) were identified as having LVH based on Sokolow-Lyon criteria, while 37 cases (29.60%) showed no signs of LVH. These findings provide a quantitative breakdown of the prevalence of LVH according to ECG criteria within the study population.Conclusion: Our investigation's findings showed that the ECG LVH Sokolow Lyon criteria had a satisfactory level of specificity and sensitivity in the diagnosis of left ventricular hypertrophy (LVH). The most sensitive diagnostic criteria turned out to be the ECG LVH Sokolow Lyon criteria, especially when it came to patients with co-morbidities. We found that the Sokolow Lyon criteria had a 36% sensitivity in the current investigation. As such, we suggest applying these criteria to assist in verifying the diagnosis of LVH, particularly in low-complexity healthcare environments without image-based diagnostic techniques like MRI and ECHO.

Prevalence and prognostic implication of left ventricular hypertrophy defined by different echocardiographic criteria

Abstract Objective Echocardiographic criteria of left ventricular hypertrophy (LVH) recommended in the international guidelines are derived from Caucasian population, which could be less accurate in estimating the LVH burden in other ethnic groups. LVH is a well-known prognostic factor and assessing the LVH burden based on ethnic-specific criteria have important implications. To evaluate the prevalence and prognostic implications of LVH in general Chinese population according to the criteria of the Echocardiographic Measurements in Normal Chinese Adults (EMINCA) study and the international guidelines. Methods Nationally representative populations aged ≥ 35 years (n=20210, mean age 56.0 years, women 53.3%) were enrolled from the China Hypertension Survey. LVH criteria of the EMINCA study was left ventricular mass index (LVMI) &amp;gt; 109 g/m2 for men and &amp;gt; 105 g/m2 for women; and the international guidelines was LVMI &amp;gt; 115 g/m2 for men and &amp;gt; 95 g/m2 for women. Results The prevalence of LVH defined by the EMINCA study and international guidelines was 8.3% (≈ 56.8 million) and 11.7% (≈ 80.1 million) respectively. LVH defined by the EMINCA study was associated with adjusted hazard ratio (HR) of 1.58 (95% CI 1.18-2.12; P-value=0.002) for cardiovascular death and 1.21 (95% CI 0.98-1.49; P-value=0.07) for all-cause death; while defined by the international guidelines, LVH was associated with adjusted HR of 1.33 (95% CI 0.98-1.80; P-value=0.07) for CV death and 1.22 (95% CI 1.00-1.50; P-value=0.054) for all-cause death. Conclusions Prevalence and prognostic implications of LVH in general Chinese population differ by different echocardiographic criteria, supporting the application of ethnic-specific criteria.Cumulative rate of outcomes at follow-upLVH and CV death and all-cause death

Antihypertensive treatment of masked hypertension guided by ambulatory blood pressure monitoring: a double-blind, placebo-controlled trial

Abstract Background Masked hypertension, office normotension combined with out-of-office hypertension, is associated with target organ damage (TOD), but whether antihypertensive treatment guided by out-of-office blood pressure (BP) would reduce TOD is unproven. Purpose To assess TOD change on antihypertensive treatment guided by ambulatory BP monitoring. Methods We conducted a double-blind, placebo-controlled randomized trial at 15 Chinese hospitals. Enrolment started on February 14, 2017 and follow-up ended on October 31, 2021. Patients of either sex, aged 30-70 years, not on antihypertensive drugs were eligible, if at two screening visits 1-week apart office BP was &amp;lt;140/&amp;lt;90 mm Hg and the 24 hour, daytime or nighttime ambulatory BP was ≥130/≥80, ≥135/≥85, or ≥120/≥70 mm Hg, respectively. Patients had ≥1 sign of TOD: ECG left ventricular hypertrophy (LVH), brachial-ankle pulse wave velocity (baPWV) ≥1400 cm/s, or urinary albumin-to-creatinine ratio (ACR) ≥3.5 mg/mmol in women and ≥2.5 mg/mmol in men. Active antihypertensive treatment consisted of allisartan starting at 80 mg/day to be increased to 160 mg/day at month 2 and to be combined with amlodipine 2.5 mg/day at month 4, if the ambulatory BP remained uncontrolled. Matching placebos were used likewise in the control group. The primary endpoint included normalization of baPWV, ACR or LVH or ≥20% reduction in baPWV or ACR. Results Of 320 patients (43.1% women; mean age 54 years), 153 were randomized to active antihypertensive treatment and 167 to placebo. At baseline, office BP averaged 130/81 mm Hg and the 24 hour BP 136/84 mm Hg. The prevalence of elevated baPWV, ACR and LVH was 97.5%, 12.5%, and 7.8%. The 24-hour systolic/diastolic decreased by 9.0/5.6 mm Hg (95% CI: 7.5-10.5/4.8-6.5 mm Hg) on active treatment and by 1.4/1.0 mm Hg (-0.1-2.8/0.2-1.8 mm Hg) on placebo. Regression of TOD, the primary outcome, occurred more frequently in patients randomized to active treatment than in those assigned to placebo with 1 year rate of 45.8% (95% CI: 37.9-53.7%) and 25.8% (19.1-32.4%), respectively (P&amp;lt;.001 for between-group differences in BP and TOD). Per-protocol and subgroup analyses were confirmatory. Conclusions Masked hypertensive patients require antihypertensive treatment guided by out-of-office BP monitoring before subclinical TOD progresses to major cardiovascular complications.

Sex-related differences in left ventricular geometry patterns in patients with arterial hypertension

Abstract Background Sex-specific differences in left ventricular (LV) geometry is key for tailoring management strategies for arterial hypertension. Purpose To evaluate sex-related differences in LV geometry patterns at baseline and their evolution over time in hypertension. Methods From a prospective registry, we included hypertensive patients with at least 1 year follow-up, without prevalent cardiovascular disease or incident myocardial infarction, with normal LV ejection fraction and no chronic kidney disease of stage III or more. Four LV geometry patterns were assessed: normal geometry, concentric remodeling, eccentric and concentric LV hypertrophy (LVH). Results A total of 6427 patients (age 53±11 years, 43% females) were included. At baseline, a normal geometric pattern was less common in female than in male patients (50% vs. 72%, p&amp;lt;0.001). LVH was more prevalent among female than male patients (47% vs. 23%, p&amp;lt;0.001), with a higher prevalence of eccentric LVH (40% vs. 18%, p&amp;lt;0.001). Female sex was independently associated with LV remodeling (odds ratio, 2.36, 95% confidence intervals, 2.12-2.62, p&amp;lt;0.001). At long-term follow-up (mean 6.1 years, IQR 2.8-8.6 years), the proportion of patients with LV remodeling increased in both sexes, although a normal LV geometry remained less frequent in female than male patients (43% vs. 67%, p&amp;lt;0.001), with differences persisting in eccentric (41% vs. 21%, p&amp;lt;0.001) and concentric LVH (11% vs. 5%, p&amp;lt;0.001). Conclusions We found relevant sex-related differences in LV geometry among patients with hypertension. Females have a higher risk of LV remodeling at baseline compared with men, with differences persisting at long-term follow-up.

Finerenone and left ventricular hypertrophy in chronic kidney disease and type 2 diabetes.

Left ventricular hypertrophy (LVH) has been associated with an increased risk of cardiovascular (CV) disease and linked to increased morbidity and mortality. In patients with chronic kidney disease (CKD) and type 2 diabetes (T2D), hypertension is common, and patients with these co-morbidities additionally have a high prevalence of LVH. This analysis of the prespecified pooled FIDELITY analysis comprising the randomized, double-blind, placebo-controlled, multicentre FIDELIO-DKD and FIGARO-DKD phase III studies aimed to explore the CV and kidney effects of finerenone, a nonsteroidal mineralocorticoid receptor antagonist, in patients with CKD and T2D stratified by a diagnosis of LVH at baseline. A diagnosis of LVH in the FIDELITY patient population was determined at baseline using investigator-reported electrocardiogram (ECG) findings. The two efficacy outcomes, assessed by baseline LVH, were the composite CV outcome of time to CV death, non-fatal myocardial infarction, non-fatal stroke, or hospitalization for heart failure (HHF), and a composite kidney outcome of time to onset of kidney failure, a sustained decrease in estimated glomerular filtration rate (eGFR)≥57% from baseline over ≥4weeks, or kidney-related death. Safety outcomes by baseline LVH were reported as treatment-emergent adverse events. At baseline out of 13026 patients in FIDELITY, 96.5% had hypertension and 9.6% had investigator-reported LVH. The relative risk reduction for the composite CV and kidney outcomes with finerenone versus placebo was lower in the LVH subgroup; however, the treatment effect of finerenone was not modified by baseline LVH for either outcome (Pinteraction=0.1075 for composite CV outcome and Pinteraction=0.1782 for composite kidney outcome). Analysis of the composite CV outcome components showed a greater reduction in the risk of HHF versus placebo for patients with baseline LVH compared with those without (Pinteraction=0.0024). Overall safety events were comparable between the LVH subgroups and treatment arms. Treatment-emergent hyperkalaemia was observed more frequently with finerenone versus placebo, but discontinuation rates were low in both treatment arms and between LVH subgroups. In conclusion, the overall CV and kidney benefits of finerenone versus placebo were not modified by the presence of LVH at baseline, with overall safety findings being similar between LVH subgroups. A greater benefit was observed for HHF in patients with versus without LVH, suggesting that LVH may be a predictor of the treatment effect of finerenone on HHF.

O95 HYPERTENSIVE RESPONSE TO EXERCISE RELATIVE-TO-FITNESS AND LEFT VENTRICULAR HYPERTROPHY ARE ASSOCIATED WITH INCREASED RISK OF CARDIOVASCULAR EVENTS: EVIDENCE FROM THE EXERCISE STRESS TEST COLLABORATION (EXERTION) STUDY

Background. A hypertensive response to exercise (HRE) is associated with a high prevalence of left ventricular hypertrophy (LVH), both being related to an increased risk of cardiovascular disease (CVD). However, these associations may be influenced by aerobic capacity (fitness). This study aimed to determine if an HRE considered relative-to-fitness and LVH are associated with increased risk for CVD events. Methods. Records for 4,307 individuals (aged 58.6±12.7 years, 52.0% male) who underwent exercise stress echocardiography were linked to administrative health datasets (hospital and emergency admissions) to ascertain CVD events (n=458, mean follow-up, 44.8±25.9 months). LVH presence/absence (LVH+/LVH-) was defined as LV mass index adjusted for body surface area around a cut point of ≥115 g/m2 for men and ≥95 g/m2 for women. HRE presence/absence (HRE+/HRE-) relative-to-fitness was defined as peak systolic blood pressure (SBP) divided by peak metabolic equivalents around a cut point of ≥90th percentile. Survival analysis using Cox-proportional hazard regression was used to compare CVD event rates across the four groups defined by the combinations of HRE+/HRE- with LVH+/LVH-, adjusted for age, sex, pre-exercise SBP, and CVD history. Results. Compared to the reference group (HRE-/LVH-), there was a stepwise increase in CVD event rate (Figure 1) across the following groups: HRE+/LVH- [Adjusted HR(95%CI), 1.34(1.02-1.76)], HRE-/LVH+ [Adjusted HR(95%CI), 2.1(1.6-3.76)], HRE+/LVH+ [Adjusted HR(95%CI), 2.55(1.64-3.97)]. Conclusion. Individuals with both HRE considered relative-to-fitness and LVH are at the highest risk of CVD events, greater than either clinical presentation alone. These results emphasise the need to address an HRE and low fitness in people with LVH to improve CVD risk management.

O105 ISOLATED NOCTURNAL HYPERTENSION AND TARGET ORGAN INJURY IN YOUTH

Background and Objective: New American Heart Association (AHA) recommendations in 2022 for pediatric ambulatory blood pressure monitoring (ABPM) established static blood pressure (BP) cutoffs to define hypertension with an optimal sensitivity-specificity balance to best capture target organ injury (TOI). This increased the prevalence of ABPM hypertension, specifically isolated nocturnal hypertension. We utilized ABPM data from the SHIP-AHOY cohort to describe the epidemiology of INH in youth and to evaluate associations between INH and TOI. Methods: We defined INH as wake BP &lt;130/80 mmHg and sleep BP &gt;110/65 mmHg. INH was also evaluated by the 2014 AHA definition: wake BP &lt;95th percentile with sleep BP &gt;95th percentile. Primary outcome was left ventricular hypertrophy (LVH), defined as left ventricular mass index &gt;38.6 g/m2.7. Cardiovascular risk factor (CVRF) scores described the number of risk factors for cardiovascular disease (dyslipidemia, obesity, hypertension by clinic systolic BP, insulin resistance) fro each participant. Logistic regression models assessed the association of INH with LVH, adjusted for age, sex, CVRF score, and ABPM tolerability. Results: Of 397 participants, 77 had INH, mostly (62%) due to elevated systolic BPs only. Median age and height were higher in INH than normotension (16.1 v 15.1 years, P=0.022) (height z-score 1.13 v 0.23, P=0.039). Other characteristics did not differ significantly between groups (Table 1). Estimated glomerular filtration rate was lower in INH. Among those with INH, 27% (N=19/71) had LVH, a greater proportion than found with 2014 definitions (21%, N=7/33). Children with INH had 2.61-fold adjusted odds of LVH compared to normotension (95%CI [1.20,5.69], P=0.016). Conclusions: Over 20% of the SHIP-AHOY cohort had INH, accounting for &gt;1/3 of hypertension overall. INH was associated with older age and taller height, mostly due to systolic BP. Compared to 2014 guidelines, the 2022 definition of INH captured a higher prevalence of LVH. INH was independently associated with increased odds of LVH. Future studies should follow children with INH longitudinally for potential development of daytime hypertension. Table 1: Demographic, Anthropomorphic, and Clinical Characteristics of Isolated Nocturnal Hypertension vs Normotension

Soluble ST2 Is a Biomarker Associated With Left Ventricular Hypertrophy and Concentric Hypertrophy in Patients With Essential Hypertension.

Elevated soluble stimulating factor 2 (sST2) level is observed in cardiovascular diseases, such as heart failure and acute coronary syndrome, which reflects myocardial fibrosis and hypertrophy, indicating adverse clinical outcomes. However, the association between sST2 and hypertensive heart disease are less understood. This study aimed to determine the relationship of sST2 with left ventricular hypertrophy (LVH) and geometric remodeling in essential hypertension (EH). We enrolled 483 patients (aged 18-80 years; 51.35% female). sST2 measurements and echocardiographic analyses were performed. Stepwise multiple linear regression analysis showed significant associations among sST2, left ventricular (LV) mass, and LV mass index. The prevalence of LVH and concentric hypertrophy (CH) increased with higher sST2 grade levels (P for trend < 0.05). Logistic regression analysis suggested that the highest tertile of sST2 was significantly associated with increased LVH risk, compared with the lowest tertile (multivariate-adjusted odds ratio [OR] of highest group: 6.61; P < 0.001). Similar results were observed in the left ventricular geometric remodeling; the highest tertile of sST2 was significantly associated with increased CH risk (multivariate-adjusted OR of highest group: 5.80; P < 0.001). The receiver operating characteristic analysis results revealed that sST2 had potential predictive value for LVH (area under the curve [AUC]: 0.752, 95% confidence interval [CI]: 0.704-0.800) and CH (AUC: 0.750, 95% CI: 0.699-0.802) in patients with EH. High sST2 level is strongly related to LVH and CH in patients with EH and can be used as a biomarker for the diagnosis and risk assessment of hypertensive heart disease. Trial Number ChiCTR2400082764.

Prevalence and prognostic relevance of electrocardiographic abnormalities among patients with ANCA-associated vasculitis.

Current guidelines provide limited evidence for cardiovascular screening in ANCA-associated vasculitis (AAV). This study aimed to investigate the prevalence of electrocardiogram (ECG) abnormalities and associations between no, minor or major ECG abnormalities with cardiovascular mortality in AAV patients compared with matched controls. Using a risk-set matched cohort design, patients diagnosed with granulomatosis with polyangiitis or microscopic polyangiitis with digital ECGs were identified from Danish registers from 2000-2021. Patients were matched 1:3 to controls without AAV on age, sex, and year of ECG measurement. Associated hazards of cardiovascular mortality according to ECG abnormalities were assessed in Cox regression models adjusted for age, sex, and comorbidities, with subsequent computation of 5-year risk of cardiovascular mortality standardized to the age- and sex-distribution of the sample. A total of 1431 AAV patients were included (median age: 69 years, 52.3% male). Median follow-up was 4.8 years. AAV was associated with higher prevalence of left ventricular hypertrophy (17.5% vs 12.5%), ST-T deviations (10.1% vs 7.1%), atrial fibrillation (9.6% vs 7.5%), and QTc prolongation (5.9% vs 3.6%). Only AAV patients with major ECG abnormalities demonstrated significantly elevated risk of cardiovascular mortality [HR 1.99 (1.49-2.65)] compared with controls. This corresponded to a 5-year risk of cardiovascular mortality of 19.14% (16-22%) vs 9.41% (8-11%). Patients with AAV demonstrated a higher prevalence of major ECG abnormalities than controls. Notably, major ECG abnormalities were associated with a significantly increased risk of cardiovascular mortality. These results advocate for the inclusion of ECG assessment into routine clinical care for AAV patients.

Association between serum β2-microglobulin and left ventricular hypertrophy in patients with type 2 diabetes mellitus: A cross-sectional study.

Beta 2-microglobulin (β2-MG) is a component of the class I major histocompatibility complex (MHCI) and has recently been reported to be involved in type 2 diabetes mellitus (T2DM) and cardiovascular disease. However, the association of β2-MG with left ventricular hypertrophy (LVH) in T2DM patients remains unknown. This study aims to investigate the correlation between serum β2-MG and LVH in T2DM patients. The retrospective analysis included 4602 eligible T2DM patients, divided into LVH and non-LVH groups based on echocardiography results. Serum β2-MG levels were measured, and participants were categorized into four groups (Q1-Q4) by their serum β2-MG quartile. The relationship of serum β2-MG level with LVH was evaluated using logistic regression, restricted cubic spline (RCS), subgroup analysis, and machine learning. The prevalence of LVH in T2DM patients was 31.12%. Each standard deviation increase in serum β2-MG level corresponded to a 1.17-fold increase in the prevalence of LVH [OR = 1.17, (95% CI: 1.05-1.31); p = 0.006]. When considering β2-MG as a categorical variable (quartile), Q3 [OR = 1.36, (95% CI: 1.09-1.69); p = 0.007] and Q4 [OR = 1.77, (95% CI: 1.36-2.31); p < 0.001] had a significantly higher prevalence of LVH than Q1. RCS analysis found a nonlinear association between β2-MG and LVH prevalence (p for nonlinearity <0.05). Additionally, machine learning results confirmed the importance of β2-MG for LVH in T2DM patients. Elevated serum β2-MG levels were likely to be associated with an increased prevalence of LVH in T2DM patients, suggesting its potential role in LVH development.

Efficacy of antihypertensive treatment for target organ protection in patients with masked hypertension (ANTI-MASK): a multicentre, double-blind, placebo-controlled trial

Masked hypertension is associated with target organ damage (TOD) and adverse health outcomes, but whether antihypertensive treatment improves TOD in patients with masked hypertension is unproven. In this multicentre, randomised, double-blind, placebo-controlled trial at 15 Chinese hospitals, untreated outpatients aged 30-70 years with an office blood pressure (BP) of <140/<90mm Hg and 24-h, daytime or nighttime ambulatory BP of ≥130/≥80, ≥135/≥85, or ≥120/≥70mm Hg were enrolled. Patients had ≥1 sign of TOD: electrocardiographic left ventricular hypertrophy (LVH), brachial-ankle pulse wave velocity (baPWV) ≥1400cm/s, or urinary albumin-to-creatinine ratio (ACR) ≥3.5mg/mmol in women and ≥2.5mg/mmol in men. Exclusion criteria included secondary hypertension, diabetic nephropathy, serum creatinine ≥176.8μmol/L, and cardiovascular disease within 6 months of screening. After stratification for centre, sex and the presence of nighttime hypertension, eligible patients were randomly assigned (1:1) to receive antihypertensive treatment or placebo. Patients and investigators were masked to group assignment. Active treatment consisted of allisartan starting at 80mg/day, to be increased to 160mg/day at month 2, and to be combined with amlodipine 2.5mg/day at month 4, if the ambulatory BP remained uncontrolled. Matching placebos were used likewise in the control group. The primary endpoint was the improvement of TOD, defined as normalisation of baPWV, ACR or LVH or a ≥20% reduction in baPWV or ACR over the 48-week follow-up. The intention-to-treat analysis included all randomised patients, the per-protocol analysis patients who fully adhered to the protocol, and the safety analysis all patients who received at least one dose of the study medication. This study is registered with ClinicalTrials.gov, NCT02893358. Between February 14, 2017, and October 31, 2020, 320 patients (43.1% women; mean age±SD 53.7±9.7 years) were enrolled. Baseline office and 24-h BP averaged 130±6.0/81±5.9mm Hg and 136±8.6/84±6.1mm Hg, and the prevalence of elevated baPWV, ACR and LVH were 97.5%, 12.5%, and 7.8%, respectively. The 24-h BP decreased on average (±SE) by 10.1±0.9/6.4±0.5mm Hg in 153 patients on active treatment and by 1.3±0.9/1.0±0.5mm Hg in 167 patients on placebo. Improvement of TOD occurred in 79 patients randomised to active treatment and in 49 patients on placebo: 51.6% (95% CI 43.7%, 59.5%) versus 29.3% (22.1, 36.5%; p<0.0001). Per-protocol and subgroup analyses were confirmatory. Adverse events were generally mild and occurred in 38 (25.3%) and 43 (26.4%) patients randomised to active treatment and placebo, respectively (p=0.83). Our results suggest that antihypertensive treatment improves TOD in patients with masked hypertension, highlighting the need of treatment. However, the long-term benefit in preventing cardiovascular complications still needs to be established. Salubris China.

Racial Disparities in Sports Cardiology

ImportanceRacial disparities in cardiovascular health, including sudden cardiac death (SCD), exist among both the general and athlete populations. Among competitive athletes, disparities in health outcomes potentially influenced by social determinants of health (SDOH) and structural racism remain inadequately understood. This narrative review centers on race in sports cardiology, addressing racial disparities in SCD risk, false-positive cardiac screening rates among athletes, and the prevalence of left ventricular hypertrophy, and encourages a reexamination of race-based practices in sports cardiology, such as the interpretation of screening 12-lead electrocardiogram findings.ObservationsDrawing from an array of sources, including epidemiological data and broader medical literature, this narrative review discusses racial disparities in sports cardiology and calls for a paradigm shift in approach that encompasses 3 key principles: race-conscious awareness, clinical inclusivity, and research-driven refinement of clinical practice. These proposed principles call for a shift away from race-based assumptions towards individualized, health-focused care in sports cardiology. This shift would include fostering awareness of sociopolitical constructs, diversifying the medical team workforce, and conducting diverse, evidence-based research to better understand disparities and address inequities in sports cardiology care.Conclusions and RelevanceIn sports cardiology, inadequate consideration of the impact of structural racism and SDOH on racial disparities in health outcomes among athletes has resulted in potential biases in current normative standards and in the clinical approach to the cardiovascular care of athletes. An evidence-based approach to successfully address disparities requires pivoting from outdated race-based practices to a race-conscious framework to better understand and improve health care outcomes for diverse athletic populations.