Proportion Of Left Ventricular Hypertrophy Research Articles

Nighttime mean arterial pressure is associated with left ventricular hypertrophy in white-coat hypertension.

White‐coat hypertension (WCH) is associated with increased cardiovascular risks. To investigate the relationship between WCH and left ventricular hypertrophy (LVH), the authors recruited 706 participants who underwent anthropometric measurements, blood laboratory analysis, 24h ambulatory blood pressure monitoring (ABPM), and echocardiography. The authors defined WCH as elevated office BP but normal ABPM over 24h, daytime, and nighttime periods. The authors compared the proportion of LVH between the true normotension (NT) and the WCH population, and further assessed the associations between BP indexes and LVH in the two groups, respectively. The proportion of LVH was significantly higher in the WCH group than in NT participants (19.70% vs. 13.12%, P = .036). In the NT group, 24h SBP, 24h PP, daytime SBP, daytime PP and SD of nighttime SBP were associated with LVH after adjustment for demographic and blood biochemical data (all P < .05). In the WCH population, LVH was associated with 24h SBP, nighttime SBP, nighttime MAP, and office SBP after adjustment (all P < .05). However, on forward logistic regression analysis with all the BP indexes listed above, only 24h SBP (OR = 1.057, 1.017–1.098, P < .001) in the NT group, and nighttime MAP (OR = 1.114, 1.005–1.235, P < .05) and office SBP (OR = 1.067, 1.019–1.117, P < .001) in the WCH group were still significantly associated with LVH. Our study suggests that the proportion of LVH is higher in WCH patients than in the NT population. Furthermore, elevated nighttime MAP and office SBP may play critical roles in the development of LVH in the WCH population.

Baseline characteristics of 547 new onset heart failure patients in the PREFERS heart failure study.

AimWe present the baseline characteristics of the PREFERS Stockholm epidemiological study on the natural history and course of new onset heart failure (HF) aiming to improve phenotyping focusing on HF with preserved left ventricular ejection fraction (HFpEF) pathophysiology.Methods and results New onset HF patients diagnosed in hospital or at outpatient HF clinics were included at five Stockholm hospitals 2015–2018 and characterized by N‐terminal pro brain natriuretic peptide (NT‐proBNP), biomarkers, echocardiography, and cardiac magnetic resonance imaging (subset). HFpEF [left ventricular ejection fraction (LVEF) ≥ 50%] was compared with HF with mildly reduced LVEF (HFmrEF; LVEF 41–49%) and with HF with reduced LVEF (HFrEF; LVEF ≤ 40%). We included 547 patients whereof HFpEF (n = 137; 25%), HFmrEF (n = 61; 11%), and HFrEF (n = 349; 64%). HFpEF patients were older (76; 70–81 years; median; interquartile range) than HFrEF (67; 58–74; P < 0.001), more often women (49% vs. 30%; P < 0.001), and had significantly higher comorbidity burden. They more often had atrial fibrillation, hypertension, and renal dysfunction. NT‐proBNP was lower in HFpEF (896; 462–1645 ng/L) than in HFrEF (1160; 563–2370; P = 0.005). In HFpEF, left ventricular (LV) diameters and volumes were smaller (P < 0.001) and septal and posterior wall thickness and relative wall thickness higher (P < 0.001). E/é ≥ 14 was present in 26% of HFpEF vs. 32% of HFrEF (P = 0.017) and left atrial volume index > 34 mL/m2 in 57% vs. 61% (P = 0.040). HFmrEF patients were intermediary between HFpEF and HFrEF for LV mass, LV volumes, and RV volumes but had the highest proportion of left ventricular hypertrophy and the lowest proportion of elevated E/é.ConclusionsPhenotype data in new onset HF patients recruited in a broad clinical setting showed that 25% had HFpEF, were older, more often women, and had greater comorbidity burden. PREFERS is well suited to further explore biomarker and imaging components of HFpEF pathophysiology and may contribute to the emerging knowledge of HF epidemiology.Clinical trial registration: Clinicaltrials.gov identifier: NCT03671122.

The burden, correlates and outcomes of left ventricular hypertrophy among young Africans with first ever stroke in Tanzania

BackgroundLeft ventricular hypertrophy is a pathophysiological response often due to chronic uncontrolled hypertension. Our primary aim was to investigate the magnitude, correlates and outcomes of left ventricular hypertrophy as a surrogate maker for chronic uncontrolled hypertension in young adults ≤ 45 years with stroke. Our secondary aim was to determine the accuracy of electrocardiography using Sokolow-Lyon and Cornell criteria in detecting left ventricular hypertrophy compared to echocardiography.MethodsThis cohort study recruited young strokes who had undergone brain imaging, electrocardiography and transthoracic echocardiography at baseline. The modified Poisson regression model examined baseline correlates for left ventricular hypertrophy. The National Institute of Health Stroke Scale assessed stroke severity and the modified Rankin Scale assessed outcomes to 30-days. Performance of electrical voltage criterions was estimated using receiver operator characteristics.ResultsWe enrolled 101 stroke participants. Brain imaging revealed ischemic strokes in 60 (59.4%) and those with intracerebral hemorrhage, 33 (86.8%) were localized to the basal ganglia. Left ventricular hypertrophy was present in 76 (75.3%:95%CI 65.7%–83.3%), and 30 (39.5%) and 28 (36.8%) had moderate or severe hypertrophy respectively. Young adults with premorbid or a new diagnosis of hypertension were more likely to have left ventricular hypertrophy, 47 (61.8%), and 26 (34.2%). On multivariable analysis, left ventricular hypertrophy was independently associated with not being on anti-hypertensive medications among hypertensives participants {adjusted risk ratio 1.4 (95%CI:1.04–1.94). The mean National Institute of Health Stroke score was 18 and 30-day mortality was 42 (43.3%). The sensitivity and specificity for Sokolow-Lyon in detecting left ventricular hypertrophy was 27% and 78%, and for Cornell was 32% and 52% respectively.ConclusionsWe identified a high proportion of left ventricular hypertrophy in young adults with stroke associated with chronic undertreated hypertension. While the study methodology does not allow us to determine causation, this association and knowledge of pathophysiological processes supports the notion that chronic hypertension is a major risk factor for young strokes associated with high mortality. Our findings did not support the use of the electrical voltage criteria for detecting left ventricular hypertrophy. We recommend low cost interventions like blood pressure screening and treatment to reduce this burden.

Racial Differences in Left Ventricular Mass and Wave Reflection Intensity in Children.

The burden of heart failure is disproportionately higher in African Americans, with a higher prevalence seen at an early age. Examination of racial differences in left ventricular mass (LVM) in childhood may offer insight into risk for cardiac target organ damage (cTOD) in adulthood. Central hemodynamic load, a harbinger of cTOD in adults, is higher in African Americans. The purpose of this study was to examine racial differences in central hemodynamic load and LVM in African American and non-Hispanic white (NHW) children. Two hundred sixty-nine children participated in this study (age, 10 ± 1 years; n = 149 female, n = 154 African American). Carotid pulse wave velocity (PWV), forward wave intensity (W1) and reflected wave intensity (negative area, NA) was assessed from simultaneously acquired distension and flow velocity waveforms using wave intensity analysis (WIA). Wave reflection magnitude was calculated as NA/W1. LVM was assessed using standard 2D echocardiography and indexed to height as LVM/[height (2.16) + 0.09]. A cutoff of 45 g/m (2.16) was used to define left ventricular hypertrophy (LVH). LVM was higher in African American vs. NHW children (39.2 ± 8.0 vs. 37.2 ± 6.7 g/m (2.16), adjusted for age, sex, carotid systolic pressure and socioeconomic status; p < 0.05). The proportion of LVH was higher in African American vs. NHW children (25 vs. 12 %, p < 0.05). African American and NHW children did not differ in carotid PWV (3.5 ± 4.9 vs. 3.3 ± 1.3 m/s; p > 0.05). NA/W1 was higher in African American vs. NHW children (8.5 ± 5.3 vs. 6.7 ± 2.9; p < 0.05). Adjusting for NA/W1 attenuated racial differences in LVM (38.8 ± 8.0 vs. 37.6 ± 7.0 g/m (2.16); p = 0.19). In conclusion, racial differences in central hemodynamic load and cTOD are present in childhood. African American children have greater wave intensity from reflected waves and higher LVMI compared to NHW children. WIA offers novel insight into early life origins of racial differences in central hemodynamic load and cTOD.

Impact of Gender on the Association between Low Serum Prolactin and Left Ventricular Mass in Subjects with Prediabetes.

BackgroundLow circulating prolactin hormone was associated with increased risk for type 2 diabetes mellitus. An inverse association of serum prolactin with cardiac remodeling was also previously suggested. Thus, the first question arises whether low serum prolactin is associated with adverse cardiac remodeling in subjects with prediabetes and if so what the impact of gender is? Second, could serum prolactin be considered a predictor of cardiac morbidity in those subjects? This study was conducted to assess prolactin level variations in relation to echocardiographic indices of cardiac remodeling among adult men and women with prediabetes.MethodsThis cross sectional study enrolled 80 subjects with prediabetic; 40 men and 40 women. Anthropometric measurements, plasma glucose, lipid profile, homeostasis model assessment of insulin resistance, white blood cells count, prolactin and echocardiography were assessed.ResultsProlactin was significantly lower in men than in women with prediabetes. Left ventricular mass (LVM) was significantly higher in men than in women with prediabetes. The proportion of left ventricular hypertrophy (LVH) in men with prediabetes was 45% compared with 22.5% in women (P=0.03). We also found inverse independent associations of serum prolactin with LVM and LVH in men, but not in women.ConclusionIn prediabetes, physiologically low serum prolactin is an independent predictor of increased LVM and LVH in adult men, but not in women. Prolactin may be a potential diagnostic biomarker for cardiac remodeling in adult men with prediabetes.

Influence of Left Ventricular Mass Indexation Criteria in the Diagnosis of Left Ventricular Hypertrophy by Echocardiogram. Study in Children with Chronic Renal Disease

Background: the echocardiographic diagnosis of left ventricular hypertrophy (LVH) in children is based on the indexed left ventricle mass calculation. However, the indexation criterion is still not defined. Objective: to compare different criteria used for the diagnosis of LVH by echocardiography in children. Method: The study included children with chronic renal disease (CRD) in dialysis (DI) or in conservative treatment (CT). Measures for left ventricle mass calculation were obtained as recommended. The criteria used for LVH were: 1) mass (g) – LVH according to gender and body surface area (BSA, m2) – based on large study of normal Brazilian children; 2) mass indexed to body surface area (g/m2) – LVH according to gender and body surface area (BSA, m2) – based on large study of normal Brazilian children; 3) g/altura2,7 but diagnosis of LVH by a nomogram of age, gender and height; 4) z score (http://parameterz.blogspot.com/2008/09/lv-mass-z-scores) – LVH if > 2 standard-deviation. The proportion of LVH among the groups were compared by X2; significant if p < 0.05. Results: 60 children with CKD were included; 34 in DI (17 boys; median of age= 109 months) and 26 in CT (15 boys; median of age= 80 months). According to each criteria, in the hole group, the proportions of LVH were, respectively, 31/60, 33/60, 41/60 e 31/60 (p=0.049), lower for criterion 2 compared to 3 (p=0.026); in DI group were 23/34; 23/34; 31/34 e 29/34 (p=0.006), higher with criterion 3 compared to criteria 1 (p=0.033) and 2 (p=0.004), and with 4 compared to 2 (p=0.029); in TC group were 8/26; 10/26; 10/26 e 2/26 (p=0.038), lower for criterion 4 compared to criteria 2 (p=0.038) and 3 (p=0.009). Conclusion: in children with CKD the proportion of LVH by echocardiography was different according to the criterion used. (Arq Bras Cardiol: Imagem cardiovasc. 2016;29(2):42-46)

SURVEY OF CARDIOVASCULAR RISK FACTORS AND ELECTROCARDIGRAPHIC, ECHOCARDIOGRAPHIC ABNORMALITIES IN PATIENTS ON WAITING LIST FOR RENAL TRANSPLANTATION

Background: Cardiovascular disease is the major cause of death in dialysis patients, as well as in kidney transplant patients. Assessment of cardiovascular risks of renal transplant candidates to prevent or slow the progression of cardiovascular abệnh nhânormalities. Aim: 1) Evaluating cardiovascular risk factors, electrocardiographic and echocardiographic abnormalities in renal transplant candidates. 2) Identifying the correlation between cardiac morphological parameters with a number of factors involved. Subjects and Methods: We assessed 57 patients (73.7% male, mean age 32.4±8.8) with end-stage renal disease waiting for renal transplantation at Cho Ray Hospital between Jan 2012 and Jan 2013. All patients received a physical examination, blood pressure measurement, Hb, blood glucose test, lipid profile, ECG, echocardiography. Results: The percentage of hypertension was 98.2%, smoking (69.2%), dyslipidemia 40.4% and diabetes 12.3%. All patients had sinus rhythm, left ventricular hypertrophy 61.4% in ECG. Pericardial effusion 5.3%, mitral valve insufficiency 56.1%, aortic valve insufficiency 12.3%, left ventricular hypertrophy 94.7% in echocardiography. IVSd, LVPWd, LVMI positively correlated with kidney failure time (p &lt;0.01, p&lt;0.001), with DBP and SBP (p &lt;0.05) and the degree of anemia (p &lt;0.05). Percentage the degree of hypertension associated with proportion of left ventricular hypertrophy (p &lt;0.05). Conclusions: Identification of cardiovascular risk factors for the prevention or intervention to reduce mortality in renal transplantation. Keywords: Cardiovascular risk factors, end-stage chronic renal failure, renal transplantation.

Small left atrial volume is an independent predictor for fainting during head-up tilt test: The impact of intracardiac volume reserve in vasovagal syncope

BackgroundVigorous left ventricular (LV) contraction with progressive ventricular emptying during orthostatic stress may induce hyper-responsiveness of cardiac mechanoreceptor and vasovagal syncope (VVS). We hypothesized that intracardiac volume reserve estimated by the left atrial (LA) volume index (LAVI) plays an important role in the mechanism of VVS. MethodsA total of 234 patients (115 male, 44±18years) who underwent head-up tilt test (HTT) and transthoracic echocardiography for unexplained syncope were consecutively enrolled. Patients with a positive HTT result (HTT+; n=152) were compared with those with negative HTT response (HTT−; n=82). Results1. Compared to HTT− patients, HTT+ patients were younger (41±17 vs. 48±17years, p=0.005), included a higher number of females (56% vs. 50%, p=0.009) and showed higher basal heart rate (67±12 vs. 63±11bpm, p=0.047). 2. LAVI (20±5 vs. 26±13ml/m2, p<0.001), LV end-diastolic dimension (47.4±3.7 vs. 49.0±4.1mm, p=0.015), and the proportion of LV hypertrophy (13% vs. 24%, p=0.027) were smaller and early diastolic mitral annulus velocity was higher (9.7±3.0 vs. 8.5±2.6cm/s, p=0.004) in HTT+ patients than those in HTT− group. 3. LAVI (OR 0.917 (0.860–0.977), p=0.007) was the only independent predictor of HTT induced VVS, and LAVI had a linear correlation with time to syncope during HTT (r=0.39, p=0.034). In addition, patients with LAVI≥36ml/m2 did not faint during HTT. ConclusionSmall LA volume is an independent predictor of HTT-induced VVS. Limited intracardiac volume reserve might play an important role in the mechanism of VVS.

Cardiovascular and electrocardiographic changes in Nigerians with a normal pregnancy

Pregnancy is associated with major haemodynamic and cardiac changes, which can mimic or precipitate cardiac diseases. There is a paucity of this kind of data among pregnant Nigerian women. This study was aimed at describing the cardiovascular and electrocardiographic changes found among healthy pregnant Nigerian women. This was an age-matched control study of 69 consecutive normal pregnant and 70 healthy non-pregnant controls. The study protocol included history, physical examination and 12-lead electrocardiography. Diastolic blood pressure < 60 mmHg was significantly commoner among pregnant subjects than controls (64.7 vs 24.3%, respectively, p < 0.005). Mean heart rate was higher among pregnant women (88.34 ± 11.46 bpm) than the controls (75.16 ± 12.22 bpm, p = 0.020). Pregnant subjects also had a higher proportion of left ventricular hypertrophy (LVH) (10.2 vs 0%, p < 0.05) than non-pregnant controls. Abnormal cardiac findings included a loud second heart sound (P(2)), missed beats and systolic murmurs (41.2% in pregnant subjects vs 12.9% in non-pregnant controls, p < 0.05). Negroid-pattern ST-segment elevation was commoner among controls (24.3%) than pregnant subjects (2.9%, p < 0.005). Arrhythmias were rare among the study participants. Significant findings on examination were low diastolic blood pressure and a systolic ejection murmur. However, ECG changes showed a normal frontal-plane QRS axis, normal PR interval, significantly rare normal Negroidpattern ST elevation, significant LVH based on Araoye RI > 12 mm and a rarity of all forms of arrhythmias. These data may help resolve some cardiac diagnostic difficulties during pregnancy.

Hypertensive smokers have a worse cardiovascular risk profile than non‐smokers in spite of treatment – A national study in Sweden

Smoking is a well‐established risk factor for cardiovascular disease. Studies have indicated that smoking may outweigh the benefit of blood pressure (BP) control. Our aim was to compare cardiovascular risk factors in smokers vs non‐smokers from a national sample of treated hypertensives. Data were collected on smoking habits, BP control, total and low‐density lipoprotein (LDL) cholesterol, diabetes, left ventricular hypertrophy (LVH), and microalbuminuria (MA), from records of 4424 consecutive patients by 189 physicians. All technical methods were local. Treated hypertensives who smoked had microalbuminuria significantly more often than non‐smokers, 26.2% vs 20.5% (p<0.05), and a higher proportion of smokers were suboptimally controlled (DBP⩾90 mmHg), 32.7% vs 25.0% (p<0.01). Smoking males had a higher prevalence of LVH (25.7% vs 20.1; p<0.05), microalbuminuria (29.7% vs 24.7%; p<0.01), and a higher proportion of subjects with uncontrolled systolic BP (⩾140 mmHg) (72.8% vs 68.9%; p<0.01). Both DBP and total cholesterol were higher in smoking vs non‐smoking females. An increased prevalence of LVH and microalbuminuria was independently associated with smoking. In summary, smokers with treated hypertension show a higher proportion of LVH (men), microalbuminuria and worse diastolic BP control than non‐smokers. This may hypothetically reflect either less compliance with drug treatment in smokers or that smoking impairs the pharmacological effects of antihypertensive drugs.

Characteristics of patients with abnormal stress technetium Tc 99m sestamibi SPECT studies without significant coronary artery diameter stenoses.

Single-photon emission computed tomography (SPECT) sestamibi (MIBI) is an excellent tool for detection of coronary artery disease (CAD), preoperative risk assessment, and follow-up management after coronary revascularization. While the sensitivity of MIBI SPECT for detecting CAD has been reported to exceed 90%, the specificity ranges between 53-100%. The study was undertaken to assess characteristics of patients with abnormal stress technetium Tc99m sestamibi SPECT (MIBI) studies without significant coronary artery diameter stenoses (< 50%). Between January 1999 and November 2000, 270 consecutive patients were referred for coronary angiography due to reversible MIBI uptake defects during exercise. In 41 patients (15%; 39% women, mean age 59 +/- 9 years), reversible MIBI uptake defects were assessed although coronary angiography showed no significant CAD. These patients were compared with age- and gender-matched patients with perfusion abnormalities (39% women, mean age 60 +/- 9 years), due to significant CAD (coronary artery stenosis > 50%). There were no significant differences between the two groups regarding body mass index, left bundle-branch block (LBBB), or method of stress test (dipyridamole in patients with LBBB or physical inactivity [n = 11] and exercise in all the others [n = 30]). Left ventricular hypertrophy (44 vs. 23%, p = 0.05) and left anterior fascicular block (LAFB) (17 vs. 0%, p = 0.005) were more common in patients with perfusion abnormalities with no significant CAD, whereas ST-segment depression during exercise (17 vs. 37% p = 0.05) and angina during exercise (15 vs. 29%, p = 0.02) were significantly less common than in patients with abnormal MIBI perfusion studies and angiographically significant CAD. Sestamibi uptake defects during exercise were significantly smaller in patients without significant CAD than in matched controls with significant CAD (p < 0.0004). Of 270 consecutive patients, 41 (15%) referred to coronary angiography due to reversible MIBI uptake defects showed coronary artery stenoses < 50%. Twenty-six (10%) of these presented angiographically normal coronary arteries. The significantly higher proportion of left ventricular hypertrophy and LAFB in patients with reversible MIBI uptake defects without significant CAD suggest microvascular disease, angiographically underestimated CAD, and conduction abnormalities as underlying mechanisms.