Ratio Of Left Ventricular Mass Research Articles

Comparative Analysis of the Fibrosis Factors Expression in the Heart Tissue of Sprague-Dawley and Wistar Rats during Development of Chronic Renal Failure

The severity of the development of uremic cardiomyopathy (UC) and fibrosis of cardiac tissue at chronic renal failure (CRF) was compared in the model experiments on male Sprague-Dawley and Wistar rats of the SPF category. To induce CRF in rats, subtotal nephrectomy (NE) was performed on the left, and after 2 weeks, total nephrectomy on the right. Sham-operated (Sham) animals served as controls. 4 weeks after the second surgery, blood pressure (BP) was measured in animals, and the expression of fibrotic factors (transcription factor Fli1, pro-collagen-I, collagen-I and collagen-IV) in the tissues of heart left ventricle was evaluated by real-time PCR and immunoblotting. After NE, Sprague-Dawley rats exhibited a significant increase in systolic blood pressure and left ventricular hypertrophy. In Wistar rats, the difference in BP between NE and Sham animals was smaller, and the ratio of left ventricular mass to body weight did not change. Experimental CRF in Sprague-Dawley rats was accompanied by a 1.5–2.5-fold suppression of the Fli1 gene expression and a decrease in the content of Fli1 protein in the cardiac tissue, while no significant differences were observed in Wistar rats. The levels of pro-collagen-I and collagen-I in the heart of rats of both lines did not change either at the levels of transcription or translation. Such difference in development of pathological processes indicates ineffectiveness of applied NE scheme for induction of UC and investigation of pro-fibrotic processes in Wistar rats.

Anatomic and functional discordance among patients with non-obstructive coronary disease

Abstract Background Non-obstructive coronary artery disease (CAD) is associated with increased adverse cardiovascular (CV) events. However, it is unclear if functional stenosis, as assessed by FFRCT <0.80, further stratifies risk among patients with non-obstructive CAD and which factors contribute to this anatomic-functional discordance (stenosis <50% and FFRCT <0.80). Purpose We hypothesized that patients with anatomically non-obstructive CAD by CTA and an abnormal FFRCT value of ≤0.80 have a phenomenon termed anatomic-functional discordance, and this discordance would be associated with increased adverse outcomes. Methods Patients in the ADVANCE (Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Care) Registry who had exclusively non-obstructive CAD (anatomic stenosis <50%) were stratified by FFRCT >0.80 in all coronary vessels (concordant) vs. FFRCT <0.80 in at least one vessel (discordant). Baseline patient demographics, coronary computed tomography angiography findings, downstream testing and clinical outcomes were compared between groups. The primary composite endpoint included revascularization, CV hospitalization, heart failure, arrhythmia, non-fatal myocardial infarction, unplanned hospitalization for an acute coronary syndrome leading to urgent revascularization, and all-cause death. Results Among 1,261 patients with non-obstructive CAD, 543 (43.1%) had functional stenosis with FFRCT <0.80. Patients in the discordant group were older, more likely to have hypertension, hyperlipidemia, and had significantly higher indexed left ventricular (LV) mass and significantly lower coronary volume-to-mass ratios when compared with patients in the concordant group. Downstream non-invasive testing was more common among patients with discordance (35.9% vs 20.2%, p<0.0001) and more frequently resulted in a positive downstream test (10.3% vs. 3.3%, p<0.0001). Invasive angiography was also more common among patients with discordance (25.2% vs. 11.6%, p<0.0001). Anatomic-functional discordance was associated with higher rates of CV hospitalization and percutaneous coronary intervention (both p<0.0001), but no significant difference in all-cause death. After adjustment, anatomic-functional discordance was associated with a significantly higher risk of the composite endpoint (adjusted HR 2.79, 95% CI 1.67–4.65), Figure 1. As shown in Figure 2, the more vessels with anatomic-functional discordance, the higher the rate of adverse cardiac events. Conclusion Anatomic-functional discordance was present in nearly half of patients with exclusively non-obstructive CAD. The lower coronary volume: LV mass ratio may reflect abnormal coronary physiology at lower thresholds of anatomical stenosis among those with discordance. Compared to patients with concordance, patients with discordance had worse clinical outcomes suggesting that anatomic-functional discordance may stratify risk for adverse CV events among patients with non-obstructive CAD. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): The analysis was an investigator-initiated analysis sponsored by Heart Flow.

The association of echocardiographic parameters on renal outcomes in chronic kidney disease

Background Patients with chronic kidney disease (CKD) often have structural abnormalities of the heart due to pressure and volume overload. The aim of this study was to evaluate associations between echocardiographic parameters and renal outcomes (estimated glomerular filtration rate [eGFR] slope and progression to dialysis) in patients with stage 3–5 CKD. Methods This longitudinal study enrolled 419 patients. Changes in renal function were assessed using the eGFR slope. Rapid renal progression was defined as an eGFR slope < −3 mL/min/1.73 m2/year, and the renal endpoint was defined as commencing dialysis. Results Increased left atrial diameter (LAD), ratio of left ventricular mass to body surface area (LVM/BSA), ratio of LVM to height2.7 (LVM/ht2.7), and ratio of observed to predicted LVM (o/p LVM) were associated with eGFR slope in an adjusted model, but left ventricular ejection fraction (LVEF) was not. Furthermore, LAD ≥ 4.7 cm, LVM/BSA > 115 g/m2 in males and > 95 g/m2 in females, and LVM/ht2.7 > 48 g/ht2.7 in males and > 44 g/ht2.7 in females were correlated with progression to dialysis, but o/p LVM and LVEF were not. The maximum change in χ2 change to predict renal outcomes was observed for LAD, followed by LVM/BSA and LVM/ht2.7. Conclusions A large LAD and increased LVM, regardless of how it was measured (LVM/BSA, LVM/ht2.7 and o/p LVM), were correlated with adverse renal outcomes in patients with CKD stage 3–5. LAD had superior prognostic value to LVM and LVEF.

Stimulation of soluble guanylyl cyclase (sGC) by riociguat attenuates heart failure and pathological cardiac remodelling

Heart failure is associated with an impaired NO-soluble guanylyl cyclase (sGC)-cGMP pathway and its augmentation is thought to be beneficial for its therapy. We hypothesized that stimulation of sGC by the sGC stimulator riociguat prevents pathological cardiac remodelling and heart failure in response to chronic pressure overload. Transverse aortic constriction or sham surgery was performed in C57BL/6N mice. After 3weeks of transverse aortic constriction when heart failure was established, animals receive either riociguat or its vehicle for 5 additional weeks. Cardiac function was evaluated weekly by echocardiography. Eight weeks after surgery, histological analyses were performed to evaluate remodelling and the transcriptome of the left ventricles (LVs) was analysed by RNA sequencing. Cell culture experiments were used for mechanistically studies. Transverse aortic constriction resulted in a continuous decrease of LV ejection fraction and an increase in LV mass until week 3. Five weeks of riociguat treatment resulted in an improved LV ejection fraction and a decrease in the ratio of left ventricular mass to total body weight (LVM/BW), myocardial fibrosis and myocyte cross-sectional area. RNA sequencing revealed that riociguat reduced the expression of myocardial stress and remodelling genes (e.g. Nppa, Nppb, Myh7 and collagen) and attenuated the activation of biological pathways associated with cardiac hypertrophy and heart failure. Riociguat reversed pathological stress response in cultivated myocytes and fibroblasts. Stimulation of the sGC reverses transverse aortic constriction-induced heart failure and remodelling, which is associated with improved myocardial gene expression. This article is part of a themed issue on cGMP Signalling in Cell Growth and Survival. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v179.11/issuetoc.

Left ventricular mass normalization for body size in children based on an allometrically adjusted ratio is as accurate as normalization based on the centile curves method.

Normalization for body size is required for reliable left ventricular mass (LVM) evaluation, especially in children due to the large variability of body size. In clinical practice, the allometrically adjusted ratio of LVM to height raised to the power of 2.7 is often used. However, studies presenting normative LVM data for children recommend centile curves as optimal for the development of normative data. This study aimed to assess whether the allometrically adjusted LVM-to-height ratio can reliably reproduce the results of LVM normalization for height based on the centile curves method. Left ventricular mass was computed for 464 boys and 327 girls, 5-18 years old, based on echocardiographic examination. Normalized data representing LVM for height were developed using the centile curves construction method and two variants of the allometrically adjusted ratio method: one variant with the allometric exponents specific to the study groups, and one variant with the universal exponent of 2.7. The agreement between the allometric methods and the centile curves method was analyzed using the concordance correlation coefficient, sensitivity, and specificity. For both the specific allometric variant and the universal variant, the analysis of concordance has indicated high reproducibility compared to the centile curves method. The respective coefficient values were 0.9917 and 0.9916 for girls, and 0.9886 and 0.9869 for boys. The sensitivity and specificity test has also shown high agreement. However, for girls, the sensitivity was higher for the specific variant (100% vs. 90.9%). The results of the study show that allometric scaling of LVM for height can very reliably reproduce the results of LVM normalization for height based on the centile curves method. However, the analysis of sensitivity and specificity indicates greater agreement for the allometric normalization with the group-specific allometric exponents.

Type 2 diabetes mellitus is associated with increased left ventricular mass independent of coronary artery volume

To determine the relationship of left ventricular mass (LVM) and coronary artery volume in diabetic patients and the controls. This work included 448 consecutive patients (206 patients with diabetes and 242 non-diabetic participants) who underwent coronary computed tomography angiography (CTA) for evaluation of coronary artery disease (CAD). The whole coronary artery tree and the LVM were analysed using a cardiac imaging workstation. Multivariable logistic regression analysis was used to determine the independent association with coronary artery lumen volume to LVM ratio (V/M). The total coronary artery cumulative volume and the coronary cumulative length showed no differences between groups (p>0.05); however, the LVM in patients with diabetes was significantly greater than that in controls (132.46±45.04 versus 115.82±29.13, p=0.006), and the total epicardial coronary arterial lumen volume to LVM ratio (V/M) was significantly lower in the diabetic group than in the non-diabetic group (2.02 cm3/100±0.73 g versus 2.31 cm3/100±0.82 g, p=0.024). In multivariate logistic regression analysis, diabetes was associated with V/M (odds ratio [OR] 2.027, 95% confidence interval [CI]: 1.462-2.728, p=0.001), and hypertension was not associated with V/M (OR 1.191, 95% CI: 0.978-1.451, p=0.081). Patients with diabetes demonstrated a significantly lower coronary CTA-derived coronary V/M than controls. V/M may have an important role as a global measure of coronary vasculature in diabetic patients.

Total arterial compliance, estimated by a novel method, is better related to left ventricular mass compared to aortic pulse wave velocity: The SAFAR study

ABSTRACTAim: The investigation of the association between total arterial compliance (CT)—estimated by a novel technique—with left ventricular mass (LVM) and hypertrophy (LVH). Our hypothesis was that CT may be better related to LVM compared to the gold-standard regional aortic stiffness. Within the frame of the ongoing cross-sectional study “SAFAR,” 226 subjects with established hypertension or with suspected hypertension underwent blood pressure (BP) assessment, carotid-to-femoral pulse wave velocity (cf-PWV), and echocardiographic measurement of LVM. LVM index (LVMI) was calculated by the ratio of LVM to body surface area. CT was estimated by a previously proposed and validated formula: CT = 36.7 /cf-PWV2 [ml/mmHg]. LVMI was related to age (r = 0.207, p = 0.002), systolic BP (r = 0.248, p < 0.001), diastolic BP (r = 0.139, p = 0.04), mean BP (r = 0.212, p = 0.002), pulse pressure (r = 0.212, p = 0.002), heart rate (r = −0.172, p = 0.011), cf-PWV (r = 0.268, p < 0.001), and CT (r = −0.317, p < 0.001). The highest correlation was observed for CT that was significantly stronger than the respective correlation of cf-PWV (p < 0.001). In multivariate analysis, CT was a stronger determinant, compared to cf-PWV, of LVMI and LVH. It remains to be further explored whether CT has also a superior prognostic value beyond and above local or regional (segmental) estimates of pulse wave velocity.

Assessment of Left Ventricular Structural Remodelling in Patients with Diabetic Cardiomyopathy by Cardiovascular Magnetic Resonance.

Background. Diabetic cardiomyopathy (DCM) is always accompanied with alteration of left ventricular structure and function. The aims of this study were to assess the structural remodelling in patients with DCM by cardiovascular magnetic resonance (CMR) and correlation of structural remodelling with severity of DCM. Methods. Twenty-five patients (53.8 ± 8.8 years, 52.0% males) with DCM and thirty-one normal healthy controls (51.9 ± 13.6 years, 45.2% males) were scanned by CMR cine to assess function and structure of left ventricular. Length of diabetic history and results of cardiac echocardiography (E′, A′, and E′/A′) were also measured. Results. Compared with normal controls group, DCM group was associated with significantly increased ratio of left ventricular mass at end diastole to end-diastolic volume (MVR) (P < 0.05) and no significant difference was in mass at end diastole (P > 0.05). The ratio correlated with both length of diabetic history and echocardiographic Doppler tissue imaging E′ (all P < 0.05). Conclusions. CMR can be a powerful technique to assess LV remodelling, and MVR may be considered as an imaging marker to evaluate the severity of LV remodelling in patients with DCM.

Cardiac magnetic resonance imaging to assess the impact of maternal habitus on cardiac remodeling during pregnancy

It is well known that the maternal cardiovascular system undergoes profound alterations throughout pregnancy. Interest in understanding these changes has led investigators to use evolving and increasingly sophisticated techniques to study these changes, most recently with 2-dimensional echocardiography. Despite its clinical utility, echocardiography has limitations, and cardiac magnetic resonance imaging (CMRI) has become increasingly used for evaluation of cardiac structure and function. We used CMRI to evaluate cardiac remodeling according to maternal habitus throughout pregnancy and postpartum. This was a prospective, observational study ofnulliparous women aged 18-30 years, without preexisting medical conditions, conducted from October 2012 through December 2014. Women were classified according to prepregnancy body mass index (BMI) as either normal (BMI 18.5-24.9 kg/m(2)) or overweight (BMI 25-35 kg/m(2)). All women underwent CMRI during 5 epochs throughout gestation: 12-16 weeks, 26-30 weeks, 32-36 weeks, at delivery, and 3 months' postpartum. Using left ventricular mass (LVM) as a marker of cardiac remodeling, the 2 cohorts were compared. There were 14 normal-weight (BMI 22.2 ± 1.3) and 9 overweight (BMI 29.1 ± 2.0) women who participated in the study. Beginning at 26-30 weeks and continuing to delivery, LVM of both normal-weight and overweight women was significantly increased compared with the respective first-trimester studies for each cohort (P < .001). LVM of both cohorts returned to their index values by 3 months' postpartum. The geometric ratio of LVM to left ventricular end-diastolic volume was calculated, and both normal-weight and overweight women demonstrated concentric remodeling throughout gestation, however this resolved by 12weeks' postpartum. There is substantial cardiac remodeling during pregnancy with significant increases in LVM that are proportional to maternal size. Left ventricular geometric remodeling was concentric in both normal-weight and overweight women. All changes in cardiac remodeling resolved by 3 months' postpartum.

Abstract 12359: Clinical Impact of Left Ventricular Trabeculae in Hypertrophic Cardiomyopathy: Insights From Cardiac Magnetic Resonance Analysis

Introduction: Hypertrabeculation has been associated with adverse events in patients with left ventricular (LV) non-compaction. However, the clinical significance remains unclear in patients with other cardiomyopathies. Hypothesis: LV trabeculae analyzed by cardiac magnetic resonance (CMR) may have a pathophysiological significance and clinical impact in patients with HCM. Methods: 102 HCM patients receiving regular outpatient treatment underwent CMR. LV volume and mass were analyzed from short-axis cine images using a steady-state free precession sequence and LV fibrosis mass were obtained from late gadolinium enhancement imaging. Individual trabeculae and papillary muscles (TPM) and papillary muscles (PM) were manually planimetered separately on each end-diastolic frame in every slice. Trabeculae (T) was calculated by subtraction of PM from TPM. The data were compared with those of 22 normal control subjects (Cont). Results: In total HCM patients, LV mass index (compacted muscle excluding TPM) was 83.5 ± 23.6 g/m2. TPM mass index were greater in patients with HCM compared with Cont (21.7 ± 7.3 vs 12.4 ± 2.5 g/m2, p &lt; 0.001), and T mass index were also greater (16.8 ± 6.6 vs 9.2 ± 2.2 g/m2, p &lt;0.001). Greater TPM and T masses were associated with more substantial LV mass (r = 0.662 and 0.572, both p &lt;0.001). By multivariate analysis, increased T mass index was independently associated with LV outflow-tract obstruction, increased LV end-diastolic volume index, and LV fibrosis mass index. Kaplan-Meier analysis showed that baseline TPM or T mass index was not associated with cardiovascular outcomes during 14.7 months follow-up. However, baseline T mass / LV mass ratio was significantly associated with the clinical outcomes (p = 0.0124). Conclusions: Alterations of LV trabeculae in HCM may be associated with LV hemodynamic stress and LV remodeling. Furthermore, trabeculae mass to LV compacted mass ratio may be a useful marker for the prognosis in patients with HCM.

Left ventricular remodeling and fibrosis: Sex differences and relationship with diastolic function in hypertrophic cardiomyopathy

ObjectivesWe investigated sex differences in left ventricular (LV) remodeling and fibrosis and their relationship with LV diastolic dysfunction by cardiovascular magnetic resonance (CMR). MethodsCMR imaging was performed simultaneously in 152 age-matched patients (76 men, 76 women; mean age: 49±9 years) without LV systolic dysfunction. LV remodeling index (LVRI) was calculated as the ratio of LV mass and end-diastolic volume. Diastolic function indexes including peak filling rate (PFR) and time to PFR (tPFR) were evaluated. Extent of late gadolinium enhancement (LGE) was measured. ResultsLVRI and extent of LGE were greater in women compared with men (1.48±0.22 vs. 1.36±0.28g/ml; 13.15±2.48 vs. 11.35±2.34g, respectively, both P<0.001). Women had lower PFR and higher tPFR (both P<0.001) than men. LVRI and the extent of LGE showed significant relationships with parameters of diastolic function in both sex. In a multivariate analysis, LVRI remained a strong independent predictor of PFR and TPFR in women (β=−0.272, P=0.032; β=0.348, P=0.016, respectively), and in men (β=−0.374, P<0.001; β=0.660, P<0.001, respectively). Furthermore, the extent of LGE also remained an independent predictor of PFR in women (β=−0.283, P=0.033) and men (β=−0.492, P<0.001). ConclusionsThere are prominent sex differences in LV remodeling and myocardial fibrosis. We suggest that the effects of LV remodeling and fibrosis may lead to diastolic dysfunction with greater susceptibility to worse clinical outcome in women.

Administration of Chromium(III) and Manganese(II) as a Potential Protective Approach Against Daunorubicin-Induced Cardiotoxicity: in vitro and in vivo Experimental Evidence

Daunorubicin (DNR) is a widely used antitumor drug, but its application is limited because of its cardiotoxic side effects. The present study was designed to investigate the interaction between DNR and cardiac myosin (CM) in the presence of chromium(III) (Cr(3+)) and manganese(II) (Mn(2+)) using fluorescence spectrometry under simulative physiological conditions with the aim of exploring the influence of metal ion on DNR-CM complex and finding out an aggressive approach to abrogate of DNR-induced cardiotoxicity. In detail, the quenching and binding constant of ternary system, including metal ion, DNR, and CM, were measured and compared with the DNR-CM. The data from in vitro experiments indicate that the presence of Cr(3+) or Mn(2+) distinctly decreased the binding force between DNR and CM, and alleviated the cardiac toxicity caused by DNR. In addition, the variations in mice body weight and myocardial enzyme level were examined by in vivo experiments. Animals receiving Cr(3+) or Mn(2+) supplementation of DNR showed preservation of the normal pattern of the heart, especially 2.0 mg Cr(3+)/kg body wt or 50.0 mg Mn(2+)/kg body wt exhibited an obviously protective effect accompanied with body weight raise when compared with the mice treated with DNR alone, decreased the ratio of heart to body weight (BW) and the ratio of left ventricular mass to BW to the normal levels, and inhibited the leak of myocardial enzyme caused by DNR. As a result, this study suggests that pretreatment of lower dose of Cr(3+) (2 mg/kg wt) and moderate dose of Mn(2+) (50 mg/kg wt) might be useful and play an important role in ameliorating the cardiotoxicity of DNR treatment in cancer patients.

Aortic Distensibility in Type 1 Diabetes

OBJECTIVETo evaluate the relationship between long-term glycemia, traditional cardiovascular disease (CVD) risk factors, and ascending aortic stiffness in type 1 diabetes.RESEARCH DESIGN AND METHODSEight hundred seventy-nine subjects in the Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) study were evaluated. The stiffness/distensibility of the ascending thoracic aorta (AA) was measured with magnetic resonance imaging. Associations of AA distensibility and CVD risk factors, mean HbA1c, and cardiovascular complications including macroalbuminuria were assessed using multivariate linear regression models.RESULTSThe mean age of the subjects was 50 ± 7 years (47% women, mean diabetes duration of 28 years). Over 22 years of follow-up, 27% of participants had cardiovascular complications. After adjusting for gender and cohort, AA distensibility was lower with increasing age, mean systolic blood pressure, LDL, and HbA1c measured over an average of 22 years (−26.3% per 10 years, −11.0% per 10 mmHg SBP, −1.8% per 10 mg/dL of LDL, and −9.3% per unit mean HbA1c [%], respectively). Patients with macroalbuminuria had 25% lower AA distensibility compared with those without (P < 0.0001). Lower AA distensibility also was associated with greater ratio of left ventricular mass to volume (−3.4% per 0.1 g/mL; P < 0.0001).CONCLUSIONSOur findings indicate strong adverse effects of hypertension, chronic hyperglycemia and macroalbuminuria on AA stiffness in type 1 diabetes in the DCCT/EDIC cohort.

Prognostic Stratification by Conventional Echocardiography of Patients with Aortic Stenosis: The “CAIMAN-ECHO Score”

Surgery is not recommended in asymptomatic patients with aortic stenosis (AS). However, prognosis of these patients is worse than retained. We built a simple score (named by the acronym "CAIMAN") for stratifying asymptomatic patients with AS according to the different risk for cardiovascular events. Data from 141 patients with moderate-to-severe AS followed up for 36 months were analyzed. The end point "outcome" was defined as death of all causes or aortic valve replacement imposed by symptoms or hospital admission for myocardial infarction and/or heart failure. The score was validated in 143 patients prospectively recruited in 2 different centers. The 40 events occurred in the original cohort were associated with higher aortic transvalvular peak jet velocity, calcium score, and observed/predicted left ventricular (LV) mass ratio. Based on the hazard ratios of Cox analysis, the score was calculated as follows: calcium score 1-3 = 1 point, 4 = 6 points; transvalvular peak jet velocity ≤3.6 m/sec = 1 point, 3.6 m/sec = 3 points, observed/predicted LV mass ratio ≤110% = 1 point, >110% = 3 points. After a mean period of 28 ± 18 months, event-free survival was 18%, 42%, 91%, and 96% in the 4 quartiles of echo score. The accuracy of the score in predicting events was 84% and 77% (P = 0.09) in the original and validation cohort, respectively. The CAIMAN-ECHO score is a simple and feasible tool useful for an accurate prognostic stratification of patients with asymptomatic moderate-to-severe AS.

Circulation : Clinical Summaries

<i>Circulation</i> : Clinical Summaries

The ratio of observed to predicted left ventricular mass is independently associated with increased cardiovascular events in patients with chronic kidney disease

A condition involving the growth of the myocardium that exceeds hemodynamic needs has been reported and called as inappropriate left ventricular mass (LVM). The appropriateness of LVM can be estimated by the ratio of observed LVM to predicted LVM. The excessive growth of LVM is frequently noted in patients with chronic kidney disease (CKD). This study is designed to assess whether the ratio of observed to predicted LVM is a useful prognostic indicator of cardiovascular events in patients with moderate to advanced CKD. We consecutively enrolled 485 patients with CKD stages 3-5 from our Outpatient Department of Internal Medicine. Inappropriate LVM was defined as observed LVM more than 28% greater than the predicted value. The relative risk of cardiovascular events was analyzed by Cox-regression methods. There was a significant trend for a stepwise increase in the observed/predicted LVM ratio (P<0.001) and the prevalence of inappropriate LVM (P=0.003) corresponding to advances in CKD stages. In the multivariate analysis, old age, a history of coronary artery disease, congestive heart failure, atrial fibrillation, wide pulse pressure, decreased serum albumin and hemoglobin levels, left atrial diameter >4.7 cm and increased observed/predicted LVM were independently associated with increased cardiovascular events. Our findings show that increased observed/predicted LVM is independently associated with adverse cardiovascular outcomes in patients with CKD stages 3-5.

Myocardial Structure, Function, and Scar in Patients With Type 1 Diabetes Mellitus

We report relationships between cardiovascular disease risk factors and myocardial structure, function, and scar in patients with type 1 diabetes mellitus in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. Cardiac magnetic resonance was obtained in 1017 patients with type 1 diabetes mellitus. Gadolinium cardiac magnetic resonance was also obtained in 741 patients. The mean age was 49±7 years; 52% were men; and mean duration of diabetes mellitus was 28±5 years. Associations of cardiovascular disease risk factors with cardiac magnetic resonance parameters were examined with linear and logistic regression models. History of macroalbuminuria was positively associated with left ventricular mass (by 14.8 g), leading to a significantly higher ratio of left ventricular mass to end-diastolic volume (by 8%). Mean hemoglobin A(1c) levels over the preceding 22 years were inversely associated with end-diastolic volume (-3.0 mL per unit mean hemoglobin A(1c) percent) and stroke volume (-2.3 mL per unit mean hemoglobin A(1c) percent) and positively related to the ratio of elevated left ventricular mass to end-diastolic volume (0.02 g/mL per unit). The overall prevalence of myocardial scar was 4.3% by cardiac magnetic resonance and 1.4% by clinical adjudication of myocardial infarction. Both mean hemoglobin A(1c) (odds ratio, 1.5 [95% confidence interval, 1.0-2.2] per unit) and macroalbuminuria (odds ratio, 3.5 [95% confidence interval, 1.2-9.9]) were significantly associated with myocardial scar and traditional cardiovascular disease risk factors. In addition to traditional cardiovascular disease risk factors, elevated mean hemoglobin A(1c) and macroalbuminuria were significantly associated with alterations in left ventricular structure and function. The prevalence of myocardial scar was 4.3% in this subcohort of DCCT/EDIC participants with relatively preserved renal function. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00360893 and NCT00360815.

Non-Dipper Pattern is a Determinant of the Inappropriateness of Left Ventricular Mass in Essential Hypertensive Patients

Background and ObjectivesInappropriately high left ventricular mass (iLVM) is known to be related to cardiovascular prognosis. A non-dipper pattern has a greater mean left ventricular (LV) mass than the dipper pattern in hypertensive patients. However, the appropriateness of LV mass in dipper or non-dipper patterns has not been adequately investigated. The aim of this study was to define the relationship between nocturnal dipping and the appropriateness of LV mass.Subjects and MethodsUsing the ambulatory blood pressure monitoring (ABPM) database, the data of 361 patients who underwent ABPM and echocardiography was analyzed retrospectively. Appropriateness of LV mass was calculated as observed/predicted ratio of LV mass (OPR) using a Korean-specified equation. Nocturnal dipping was expressed as percent fall in systolic blood pressure (BP) during the night compared to the day.ResultsDaytime, nighttime and 24 hours BP in hypertensive patients was 140.4±14.8 mmHg, 143.7±15.2 mmHg and 129.4±20.0 mmHg, respectively. OPR was 106.3±19.9% and nocturnal dipping was 10.2±10.9 mmHg. In a multiple linear regression model, 24 hours systolic BP (β=0.097, p=0.043) and nocturnal dipping (β=-0.098, p=0.046) were independent determinants of OPR as well as age (β=0.130, p=0.025) and body mass index (BMI) (β=0.363, p<0.001). Odds ratio of the non-dipper pattern was 2.134 for iLVM (p=0.021) and 3.694 for obesity (p<0.001; BMI >25 kg/m2).ConclusionThe non-dipper pattern is independently associated with iLVM in hypertensive patients as well as obesity.

INAPPROPRIATE LEFT VENTRICULAR MASS IN YOUNG HYPERTENSIVE MEN: PP.22.368

Objective: Evaluation of the proportionality of left ventricular mass (LVM) with the systolic blood pressure (BP) level, height and sex has high perspective for the evaluation of LV remodeling. Aim of the study is to evaluate the frequency of inappropriate LV mass in young hypertensive men. Methods: Echocardiography (VIVID 7, GE) was performed in three groups of men of 18–25 years old (average age 20,9 ± 2,0 years): 74 with sustained AH, 45 with non-sustained AH, and 26 normotensive subjects. The groups were matched on age, height, weight. Lipids and glucose levels were similar also. BP status was assessed with repeated clinic measurement and ambulatory BP monitoring. Observed LVM was calculated in 2D-mode by modified ASE-cube formula and indexed to the body surface area. Predicted LVM was calculated using de Simone et al. formula. The observed/ predicted LVM ratio >128% was considered as inappropriate high LVM, and < 73% - as inappropriate low LVM. The data are shown as M ± SD. Results: In subjects with sustained AH LVM was 201,2 ± 18,0 g, LVMI 97,6 ± 17,1 g/m2, in subjects with non-sustained AH 172,2 ± 35,1 g and 85,1 ± 15,2 g/m2, respectively, in normotensives 152,0 ± 17,0 g and 73,7 ± 8,5 g/m2, respectively. Observed/ predicted LVM ratio in sustained AH was 118,4 ± 8,2, non-sustained AH 103,0 ± 10,1, in normotensives 98,8 ± 11,2. LVM, LVMI and observed/ predicted LVM ratio were significantly higher in those with sustained AH than in normotensive subjects (p < 0,01). No inappropriately low LVM was revealed in all three groups. LV hypertrophy by ESH 2007 criteria and inappropriately high LVM were revealed only in subjects with sustained AH in 6,7% and 18,9%, respectively. Conclusion: The phenomenon of inappropriately high LVM may be the early sign of the heart remodeling in young men with sustained arterial hypertension.

Incidence of left ventricular hypertrophy in children with kidney disease: impact of method of indexation of left ventricular mass

Patients with chronic kidney disease are at high risk of cardiovascular morbidity and mortality. Increased left ventricular mass (LVM) has been shown to be an adverse prognostic factor. LVM may be indexed for body size by different methods related to height, weight, or body surface area (BSA). Our Null hypothesis was that different methods of indexation would not influence categorization as to whether LVM was within normal limits or increased. Prospective study in children with renal disease. M-mode echocardiography assessed by single investigator blinded to medical therapy. Three different partition values and two different published z-scores were used: Method 1: indexation of LVM to the allometric height in metres raised to the power of 2.7 (m(2.7)), value of 38.6 g/m(2.7) denotes 95th percentile. Method 2: indexation of LVM by body weight, ratio of LVM in gm/kg of >3.0 indicating LVH. Method 3: indexation by BSA, 88.9 g/m(2) represents 95th percentile. Z-score based methods from recent studies with z-score >1.65 denoting LVH, Method 4: z-score indexed either for BSA or Method 5, z-score indexed for height(2.7). One hundred and twenty-three echocardiograms were performed in 80 patients with a mean +/- SD age of 13.1 +/- 3.1 years, height 147.2 +/- 15.3 cm, weight 46.4 +/- 15.8 kg, and body mass index 20.8 +/- 4.1 kg/m(2). Method 1, LVH was observed in 68 (55.3%) studies. Method 2, 32 (26%) studies had LVM/kg >3.0. Method 3, 51 studies (41.5%) demonstrated LVH. Method 4, 22 (17.9%) studies demonstrated LVH and Method 5, 25 studies (20%) demonstrated LVH (chi(2) test, P < 0.001). Different methods of indexation have a profound influence on the categorization of children with respect to LVH. This will have a major impact on the number of patients who are treated as per current guidelines especially in high-risk groups.