Reduction In Left Ventricular Mass Index Research Articles

Do treatment-induced changes in arterial stiffness affect left ventricular structure? A meta-analysis

Vascular research demonstrated that pulse wave velocity (PWV), a measure of arterial stiffness, is inherently blood pressure dependent. Considering the hypothesized pathophysiological chain of increased arterial stiffness leading to increased blood pressure load with consequent left ventricular hypertrophy (LVH) development, we conducted a systematic review of antihypertensive and lifestyle intervention studies to determine the association between, on the one hand, changes in arterial stiffness and blood pressure, and, on the other hand, changes in left ventricular mass (LVM). Using PubMed, EMBASE, Cochrane and Web of Science, we identified 23 studies, containing 2573 patients. Studies reported changes in arterial stiffness (assessed by means of PWV), SBP, DBP and LVM index (LVMI), respectively. Statistically significant reductions in SBP, PWV and LVMI were reported in 16, 14 and 20 studies, respectively. Pooled analysis of studies showed that the proportion in SBP reduction did not correlate significantly to the proportion in reductions of the other two variables. On the contrary, we found a significant positive correlation (r = 0.61, P = 0.003) between arterial stiffness and reduction of LVM, expressed as a relevant reduction in LVMI of 6.9 g/m per 1.0 m/s reduction in PWV. Our findings provide evidence that a decrease in arterial stiffness is associated with reduction of LVM. To investigate whether there exists a causal relation between LVH due to arterial stiffness increases and in turn blood pressure load increases, future studies should strive for a multiple follow-up design and use of blood pressure independent or corrected stiffness indices.

Dietary intervention with a specific micronutrient combination for the treatment of patients with cardiac arrhythmias: the impact on insulin resistance and left ventricular function

BackgroundCardiac arrhythmias (CA) are very common and may occur with or without heart disease. Causes of these disturbances can be components of the metabolic syndrome (MetS) or deficits of micronutrients especially magnesium, potassium, B vitamins and coenzyme Q10. Both causes may also influence each other. Insulin resistance (IR) is a risk factor for diastolic dysfunction. One exploratory outcome of the present pilot study was to assess the impact of a dietary intervention with specific micronutrients on the lowering of IR levels in patients with CA with the goal to improve the left ventricular (LV) function.MethodsThis was a post hoc analysis of the randomized double blind, placebo-controlled pilot study in patients with CA (VPBs, SVPBs, SV tachycardia), which were recruited using data from patients who were 18–75 years of age in an Outpatient Practice of Cardiology. These arrhythmias were assessed by Holter ECG and LV function by standard echocardiography. Glucose metabolism was measured by fasting glucose, fasting insulin level and the Homeostasis Model Assessment of IR (HOMA-IR) at baseline and after 6 weeks of dietary supplementation.ResultsA total of 54 randomized patients with CA received either a specific micronutrient combination or placebo. Dietary intervention led to a significant decrease in fasting insulin ≥58 pmol/l (p = 0.020), and HOMA-IR (p = 0.053) in the verum group after 6 weeks. At the same time, parameters of LV diastolic function were improved after intervention in the verum group: significant reduction of LV mass index (p = 0.003), and in tendency both a decrease of interventricular septal thickness (p = 0.053) as well as an increase of E/A ratio (p = 0.051). On the other hand, the premature beats (PBs) were unchanged under verum.ConclusionsIn this pilot study, dietary intervention with specific micronutrient combination as add-on to concomitant cardiovascular drug treatment seems to improve cardio metabolic health in patients with CA. Further studies are required.Study registrationThe study was approved by the Freiburg Ethics Commission International and was retrospectively registered with the U.S. National Institutes of Health Clinical Trials gov ID NCT 02652338 on 16 December 2015.

Weight loss facilitates reduction of left ventricular mass in obese hypertensive patients: The Campania Salute Network

Background and aimsReduction of left ventricular mass index (LVMi) during antihypertensive treatment is less likely to occur in obese subjects. The aim of the study was to assess whether weight loss influences reduction of LVMi in treated, obese, hypertensive patients. Methods and resultsFrom the Campania Salute Network registry, we identified 1546 obese hypertensive patients (50 ± 9 years, 43% women) with more than 12 months follow-up. Echocardiographic reduction of LVMi was considered as achievement of normal values (<47 g/m2.7 in women or <50 g/m2.7 in men) or a reduction of ≥10% during follow-up. Weight loss was considered as ≥5% reduction in body weight, and occurred in 403 patients (26%) during a median follow-up of 50 months (IQrange:31–93). Median weight loss was 8.6% (IQrange:6.5–12). Patients with weight loss had higher baseline body mass index (p < 0.05), while there was no difference in age, sex, duration of hypertension, prevalence of diabetes, metabolic syndrome and average blood pressure during follow-up. During follow-up, 152 patients (9.8%) exhibited reduction of LVMi. Reduction of LVMi was more frequent (12.9% vs 9.1%, p < 0.030) in patients losing weight than in those who did not. In logistic regression analysis, weight loss was associated with reduction of left ventricular mass index (OR 1.51 [95%CI 1.02–2.23], p = 0.039), independent of significant associations with younger age, lower average systolic blood pressure during follow-up, longer follow-up time and higher LVMi at baseline. ConclusionIn treated obese hypertensive patients, weight loss during follow-up promotes significant reduction of LVMi, independent of baseline characteristics and blood pressure control.

IMPACT OF THE TRIPLED FIXED-DOSE COMBINATION OF ANTIHYPERTENSIVE DRUGS ON CARDIAC ORGAN DAMAGE REGRESSION

Objective: The increase of left ventricular mass index (LVMI), a marker of cardiac end-organ damage, is frequently found in hypertensive patients (HTs) and is associated with high risk of cardiovascular and cerebrovascular events. Therefore, LVMI reduction is an important treatment goal. Few specific studies on LVMI have been reported to date about the effects of tripled fixed-combination (TFC) of antihypertensive drugs. Design and method: The data shown herein are a part of a clinical prospective, open-label study performed in 2016 (see reference below), involving 92 HTs with essential hypertension randomized to 4-month treatment with the TFC of perindopril + indapamide + amlodipine and a comparable sample of HTs taking a free tripled combination therapy (FCT) with ACE-inhibitor + diuretic + calcium channel blocker. The study was aimed to clarify whether TFC treatment was as effective as FCT in reducing echocardiographic LVMI in a 14-month of follow-up. The changes of office systolic (SBP) and diastolic (DBP) blood pressure (BP) at the follow-up (FW) from baseline (BL) were calculated according this formula: ((BP_FW - BP_BL) / (BP_BL)) × 100. Analysis of variance for repeated measures was performed. Ref. Mazza A et al. Adv Ther 2017; 34:975–985. Results: During the follow-up, BP lowering was comparable in the two groups, with a positive but non-significant trend for TFC (Figure 1). Compared to baseline, both treatments reduced LVMI, but the reduction was significantly greater with TFC that with FCT (Figure 2). Conclusions: A TFC of antihypertensive drugs was found to be effective in improving LVMI and could be considered a new important tool in modulating the cardiovascular continuum from cardiac organ damage to events.

Factors associated with reduction of left ventricular mass in children on peritoneal dialysis.

This study aimed to investigate sensitive factors involved in left ventricular mass reduction in children with end-stage renal disease (ESRD) undergoing peritoneal dialysis. Thirty-five subjects on peritoneal dialysis were enrolled. Two successive echocardiographic and clinical data for each subject were obtained. Blood pressure and left ventricular mass index (LVMI) were indexed through a division with the normal 95th percentile value. Differences in numeric data between two datasets were calculated. The mean age was 12.9±4.6years. Predictors of left ventricular hypertrophy and its persistence were systolic blood pressure index (P=0.019 and P=0.046) and E' velocity (P=0.035 and P=0.031) in univariate analysis. However, differences in these predictors between the datasets were not related to the change in indexed LVMI. Reduction in indexed LVMI was correlated to a reduction of indexed left atrial volume (R=0.638, P=0.001), trans-mitral A velocity (R=0.443, P=0.011), and serum blood urea nitrogen level (R=0.372, P=0.028) and an elevation of haemoglobin level (R=-0.374, P=0.027). The extent of circulating volume expansion is potentially the main predictive factor for change of LVMI, because the volume dependent diastolic functional variables correlate to the change of LVMI. Further study with a large number of ESRD children including a group under fluid volume control is needed to investigate the role of volume expansion on the change of LVMI.

Longitudinal Assessment of Left Ventricular Mass in Autosomal Dominant Polycystic Kidney Disease

IntroductionThe high burden of cardiovascular morbidity and mortality in autosomal dominant polycystic kidney disease (ADPKD) is related to development of hypertension and left ventricular hypertrophy. Blood pressure reduction has been shown to reduce left ventricular mass in ADPKD; however, moderators and predictors of response to lower blood pressure are unknown.MethodsThis was a post hoc cohort analysis of HALT PKD study A, a randomized placebo controlled trial examining the effect of low blood pressure and single versus dual renin−angiotensin blockade in early ADPKD. Participants were hypertensive ADPKD patients 15 to 49 years of age with estimated glomerular filtration rate (eGFR) > 60 ml/min per 1.73 m2 across 7 centers in the United States. Predictors included age, sex, baseline eGFR, systolic blood pressure, total kidney volume, serum potassium, and urine sodium, potassium, albumin, and aldosterone. Outcome was left ventricular mass index (LVMI) measured using 1.5-T magnetic resonance imaging at months 0, 24, 48, and 60.ResultsReduction in LVMI was associated with higher baseline systolic blood pressure and larger kidney volume regardless of blood pressure control group assignment (P < 0.001 for both). Male sex and baseline eGFR were associated with a positive annual slope in LVMI (P < 0.001 and P = 0.07, respectively).ConclusionCharacteristics associated with higher risk of progression in ADPKD, including higher systolic blood pressure, larger kidney volume, and lower eGFR are associated with improvement in LVMI with intensive blood pressure control, whereas male sex is associated with a smaller slope of reduction in LVMI.

Myocardial changes in incident haemodialysis patients over 6-months: an observational cardiac magnetic resonance imaging study

Patients commencing on haemodialysis (HD) have an increased risk of cardiovascular events in the first year after starting HD compared to those patients established on HD longer. Left ventricular (LV) hypertrophy and abnormal myocardial strain predict mortality. There may be changes in the myocardium of incident HD patients over a 6-month period of HD which may explain changes in cardiovascular risk. We used CMR to consider changes in LV mass, myocardial strain and T1 mapping. We examined changes in pre-dialysis highly sensitive troponin T. 33 patients undergoing HD for <12 months were recruited. Participants underwent CMR at baseline and after 6-months of standard care. 6-months of HD was associated with reduction in LV mass index (Baseline: 78.8 g/m2 follow up: 69.9 g/m2, p = <0.001). LV global longitudinal strain also improved (Baseline: −17.9%, follow up: −21.6%, p = <0.001). Change in T1 time was not significant (Baseline septal T1 1277.4 ms, follow up 1271.5 p = 0.504). Highly sensitive troponin T was lower at follow up (Baseline 38.8 pg/L, follow up 30.8 pg/L p = 0.02). In incident HD patients, 6-months of HD was associated with improvements in LV mass, strain and troponin. These findings may reflect improvement in known cardiac tissue abnormalities found in patients over the first year of HD.

Angiographic assessment of aortic regurgitation by video-densitometry in the setting of TAVI: Echocardiographic and clinical correlates.

We sought to investigate a new angiographic method for aortic regurgitation (AR) severity assessment in the setting of transcatheter aortic valve implantation (TAVI). AR after TAVI is common but challenging to quantitate, especially in the cath-lab. In 228 patients, AR was quantitated before and after TAVI by echocardiography and by video-densitometric analysis of aortograms. Contrast time-density curves for the aortic root (the reference region) and the left ventricular outflow tract, LVOT were generated. LVOT-AR was calculated as the area under the curve of the LVOT as a fraction of the area under the curve of the reference region. LVOT-AR was 0.10±0.08, 0.13±0.10 and 0.28±0.14 in none-trace, mild and moderate-severe post-TAVI AR as defined by echocardiography (P<0.001) and a cutpoint of >0.17 corresponded to moderate-severe AR on echocardiography (area under the curve=0.84). At follow-up (median, 496 days), patients with LVOT-AR ≤ 0.17 showed a significant reduction of LV mass index (LVMi; 121 [95-148] vs. 140 [112-169]g/m2 , P=0.009) and the prevalence of LV hypertrophy (LVH; 64 vs. 88%, P=0.001) compared to baseline. In patients with LVOT-AR>0.17, LVMi (149 [121-178] vs. 166 [144-188]g/m2 , P=0.14) and the prevalence of LVH (74 vs. 87%, P=0.23) did not show a significant change. Compared to patients with LVOT-AR ≤ 0.17, those with LVOT-AR>0.17 had an increased 30-day (16.4% vs. 7.1%, P=0.035) and one year mortality (32.9 vs. 14.2%, log rank P value=0.001; HR: 2.690 [1.461-4.953], P=0.001). LVOT-AR>0.17 corresponds to greater than mild AR as defined by echocardiography and predicts impaired LV reverse remodeling and increased early and midterm mortality after TAVI. © 2017 Wiley Periodicals, Inc.

Effect of exercise on left ventricular mass index by echocardiography in mild and moderate hypertension: A meta-analysis

Background: Left ventricular (LV) hypertrophy is considered to be a significant manifestation of increased blood pressure, which is associated with an increased risk of cardiovascular morbidity and mortality. Exercise training is recommended for reducing blood pressure in mild and moderate hypertensive patients. Methods: We conducted a search for interventional studies evaluating the effect of exercise on LV mass index (LVMI) in hypertensive patients. Studies were searched using different databases from 1990 to 2015. The primary end points were change in LVMI, systolic blood pressure (SBP), and diastolic blood pressure (DBP). Of 122 studies, eight studies were found to be eligible for this meta-analysis. Results: The produced effect size was found to be large for LVMI (3.6, 95% confidence interval [CI]: 1.7–5.5) and DBP (2.8, 95% CI: 1.6–3.9) with significant heterogeneity, while moderate (0.56, 95% CI: 0.35–0.77) for SBP without significant heterogeneity. The estimated predictive intervals for LVMI (95% CI: −3.2–10.3) and DBP (95% CI: −1.3–6.8) showed a positive but not significant difference in the intervention and control groups. Conclusion: The study demonstrated a significant reduction in LVMI and DBP in hypertensive patients after exercise training. A moderate reduction in the SBP of these patients was also depicted after exercise. Our study supports the American College of Cardiology/American Heart Association guidelines for regular exercise in hypertension.

OP.LB03.06] EFFECTS OF SPIRONOLACTONE AND INORGANIC NITRATE AS BEETROOT JUICE ON CARDIAC STRUCTURE AND PERFORMANCE IN PATIENTS AT RISK OF OR WITH TYPE 2 DIABETES

Objective: Patients with type II diabetes (T2DM) are at 2–3 fold excess risk of heart failure. Its prevention and treatment are poor. Here we tested the hypothesis that spironolactone, perhaps by limiting myocardial fibrosis, and inorganic nitrate, which acutely affects myocardial dynamics, would improve cardiac structure and function beyond effects of blood pressure (BP) in these patients. Design and method: 104 patients with or at risk of T2DM participated in a factorial design, double blind, randomised controlled trial (VaSera). Trans-thoracic cardiac ultrasound (echo) was performed at randomisation, 3 and 6 months after intervention of either < 50 mg spironolactone or <16 mg doxazosin (control), and beetroot juice (<11 mmol inorganic nitrate (NO3-)) or placebo (NO3- depleted). Data are ‘intention-to-treat’. Results: Baseline data (mean ± SD) were: age 57 ± 11y, 65% T2DM, BP 142/87 mmHg; left ventricular (LV) mass index (LVMI) 53.5 ± 13.3 g/m2.7, 89% had normal LV filling pressure (E/A 1.02 ± 0.41, E/E′ 7.8 ± 2.3). 82% had echos at 6 months’ follow up. Brachial BP change was similar between drugs (spiro/dox SBP 6.5/6.4 mmHg DBP 5.2/4.8 mmHg) unaffected by juice. Reduction in LVMI with spironolactone tended to be greater than doxazosin's (mean (95% CI): −1.48 (−2.08,−0.88) vs −0.63 (−1.28,0.01) g/m2.7, p = 0.064), but with overtly significant effects on mean differences in LV posterior wall (−0.3 (−0.4,−0.1) mm, p < 0.01) and relative wall thickness (−0.01 (−0.02,−0.0), p < 0.01). E/A ratio on spironolactone decreased by 0.12 (−0.19,−0.04) (p < 0.01) compared with doxazosin while S′ (a tissue Doppler index of systolic function) increased compared with doxazosin by 0.52 (0.05,1) cm/s, p < 0.05. No treatment altered the E/E′ ratio. While NO3- did not affect the above parameters, active juice decreased LV end diastolic (ED) and systolic volume (6.3 (−11.1,−1.6) mL and 3.2 (−5.9,−0.5) mL, p = 0.01 and p = 0.02 respectively) and increased the ED mass/volume (M/V) ratio by 0.04 (0,0.7) g/mL (p < 0.05) compared to placebo. Conclusions: Spironolactone influences myocardial remodelling and LV systo-diastolic function in patients with or at risk of T2DM. Inorganic nitrate decreases LV volumes with no changes in LV mass, which leads to increased M/V ratio suggesting a favourable effect on LV wall stress. The trial was funded by Fukuda Denshi.

Effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on left ventricular mass index and ejection fraction in hemodialysis patients: A meta-analysis with trial sequential analysis of randomized controlled trials

BackgroundAngiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) are effective therapies for left ventricular hypertrophy and heart failure. We aimed to assess the efficacy of ACEI and ARB in hemodialysis patients. MethodsThe MEDLINE, EMBASE, and Cochrane Library databases were searched to identify studies published before December 2015 that investigated the use of ACEI or ARB compared with controls to determine the effect on the left ventricular mass index (LVMI) and ejection fraction (EF) in hemodialysis patients, and trial sequential analysis was also performed for outcomes. ResultsA total of 357 cases of patients involved in 8 clinical trials (nine comparisons) were included. Compared with controls, ACEI/ARB treatment resulted in more effective improvement of LVMI in hemodialysis patients (weighted mean difference (WMD) −14.42, 95% confidence interval (CI) −20.89 to −7.95), and the cumulative z curve crossed the trial sequential monitoring boundary for benefit in trial sequential analysis. Although ACEI/ARB and controls did not show significant differences with regards to EF (WMD: −0.84, 95% CI: −2.91 to 1.24). ConclusionsThe comparison between ACEI/ARB and controls showed that the former type of drug causes a greater reduction in LVMI with hemodialysis patients, although they have no significant impact on the EF. Compared with other antihypertensive drugs or placebo, ACEI/ARB is recommended as a better choice in hemodialysis patients.

Calcium Acetate/Magnesium Carbonate and Cardiovascular Risk Factors in Chronic Hemodialysis Patients

Background/Aim: Calcium acetate/magnesium carbonate (CaMg) is a recent phosphate binder that has been shown to have protective cardiovascular (CV) effects in animal models. The aim of this study was to evaluate the relationship between CaMg therapy and CV risk markers like pulse pressure (PP), left ventricular mass index (LVMI) and valvular calcifications compared to sevelamer or no phosphate binder (NPB) therapy in chronic hemodialysis (HD) patients. Methods: We performed a 48-month prospective study in 138 HD patients under hemodiafiltration with a dialysate Mg concentration of 0.5 mmol/l. Patients underwent treatment with CaMg or sevelamer for at least 36 months or NPB therapy. Demographic, clinical, biochemical and echocardiographic parameters were evaluated at baseline and after a 48-month period. Results: At the end of the study, patients who had taken CaMg showed a significant reduction in PP (p < 0.001), LVMI (p = 0.003), aortic (p = 0.004) and mitral valve calcifications (p = 0.03) compared with NPB patients. Patients under CaMg showed a significant reduction of PP (p < 0.001), LVMI (p = 0.01) and aortic valve calcifications (p = 0.02) compared to sevelamer patients. In a multivariable analysis, CaMg therapy was negatively associated with progression of LVMI (p = 0.02) and aortic valve calcifications (p = 0.01). Patients under CaMg showed higher serum Mg levels (0.93 ± 0.14 mmol/l) compared to patients under sevelamer (0.87 ± 0.13) or NPB patients (0.82 ± 0.12; p < 0.001). Conclusions: In prevalent HD patients, the use of CaMg over 48 months was associated with a reduction of PP and LVMI and with a stabilization of aortic valve calcifications. These protective and promising results of this new phosphate binder need to be confirmed in randomized controlled studies.

Reductions of left ventricular mass and atrial size following renal denervation: a meta-analysis.

Renal denervation (RDN), a novel therapy for resistant hypertension, has been shown to have an effect on cardiac remodeling in several small studies. We aimed to pool currently available data to assess the effects of RDN on left ventricular hypertrophy (LVH) and left atrial (LA) enlargement. Two investigators independently searched PubMed, EMBASE and Cochrane Library Central Register of Controlled Trials database for studies reporting change in left ventricular mass index (LVMI) or LA size before and after RDN. Twelve publications met our pre-defined inclusion criteria. Echocardiographic data showed that RDN markedly reduced both LVMI [weighted mean difference (WMD)=-15.77g/m(2); 95% confidence interval (CI) -22.51 to -9.02g/m(2)] and LA diameter [WMD=-2.48mm; 95% CI -4.12 to -0.83mm] after 6months. Data from cardiac magnetic resonance also showed a significant reduction in LVMI [WMD=-5.43g/m(2), 95% CI -10.01 to -0.35g/m(2)) at 6months. Changes in LVH and LA size at 12months were more pronounced than those at 6months. Meta-regression analysis failed to demonstrate a significant relationship between RDN-induced LVMI reduction and BP lowering at 6months. RDN led to significant regressions of both LVH and LA enlargement at 6months, which were sustained at least up to 12months.

Associations of residual left ventricular and left atrial remodeling with clinical outcomes in patients after aortic valve replacement for severe aortic stenosis

BackgroundAortic valve replacement (AVR) is currently the standard therapy for severe aortic stenosis (AS), and regression of left ventricular (LV) hypertrophy after AVR has been reported. However, data regarding a temporal relation between LV mass and left atrial (LA) volume are limited, and their prognostic impacts have not been fully elucidated. We aimed to clarify the temporal patterns of LA and LV reverse remodeling and their associations with clinical outcomes. MethodsWe retrospectively reviewed 198 consecutive patients who underwent AVR for severe AS. After excluding patients with prior cardiac surgery, atrial fibrillation, concomitant moderate to severe aortic regurgitation, or concurrent mitral valve surgery, 83 patients with echocardiographic LV mass index (LVMI) and LA volume index (LAVI) data before and 1 year after AVR were eligible for the outcome analysis and 29 patients with these 2 measures before surgery, 1 month, 1 year, and 3 years after surgery were eligible for the analysis of time-dependent change of LVMI and LAVI. ResultsSignificant reductions in LVMI and LAVI (both p<0.001) after surgery were observed over time. LA dilatation improved and reached a plateau 1 month after surgery, whereas LV hypertrophy improved more gradually and reached a plateau at 1 year. The presence of both LV hypertrophy and LA dilatation 1 year after surgery was associated with significantly higher mortality (patients with both conditions vs. patients with neither or one condition=22.6% vs. 7.3% at 3 years; p=0.031) and major adverse cardiac and cerebrovascular events (38.9% vs. 12.6% at 3 years; p=0.021). ConclusionsLA reverse remodeling occurred rapidly after AVR for severe AS, and regression of LV hypertrophy was more gradual. The presence of both residual LV hypertrophy and LA dilatation 1 year after AVR was associated with poor long-term outcomes.

Spironolactone is secure and reduces left ventricular hypertrophy in hemodialysis patients.

There is recent evidence that aldosterone play a role in the pathogenesis of cardiovascular disease in dialysis patients, which leads to the opportunity to block its actions for the benefit of these patients. In nondialytic chronic kidney disease, spironolactone was safe and effective in reducing left ventricular hypertrophy. However, routine use has been precluded in hemodialysis patients due to the risk of hyperkalemia. The aim of this study is to verify the safety and efficacy in regression of left ventricular hypertrophy with spironolactone in hemodialysis patients undergoing pharmacotherapeutic monitoring. We performed a controlled, randomized, double blind study evaluating 17 hemodialysis patients who received spironolactone at a dose of 12.5 mg titrated, in the second week, to 25 mg of spironolactone or placebo. The patients were treated for 6 months. The groups were composed of eight patients (intervention) and nine patients (control). These groups did not differ in their baseline characteristics. The group receiving spironolactone had a left ventricular mass index reduction from 77 ± 14.6 g/m(2.7) to 69 ± 10.5 g/m(2.7), p < 0.04, whereas in placebo group there was an increase from 71 ± 14.2 g/m(2.7) to 74 ± 17.4 g/m(2.7). Systolic or diastolic blood pressure did not change during the study. Potassium did not differ statistically between groups in all instances. Spironolactone treatment in hemodialysis patients was secure and effective in regression of left ventricular hypertrophy, a major risk factor for cardiovascular events in these patients. This effect occurred in spite of blood pressure stability. ClinicalTrials.gov identifier NCT01128101.

0159: Surgical aortic valve replacement in patients with small aortic annulus using a new rapid deployment bioprosthesis: preliminary results

optimal management of patient with small aortic annulus who require aortic valve replacement (AVR) is debated. The adverse prognostic impact of a prosthesis - patient mismatch (PPM) is well established. Hemodynamic performance of new generation of rapid deployment aortic bioprosthesis with LVOT enlargement by the sub-valvular expandable frame must be evaluated. to determine the prelimary results (1month FU) in patients operated on aortic stenosis with Edwards INTUITY bioprosthesis. Inclusion criteria: 1/Severe symptomatic aortic stenosis 2/ Small aortic annulus 3/ tricuspid aortic valve. Endpoints: 1/ Success of procedure and in-hospital mortality 2/ post op evolution of mean gradient and indexed effective orifice area (iEOA) 3/Evolution of LV mass 4/Incidence of peri-prosthetic regurgitation (PPR) 5/incidence of PPM. 38 patients, age = 78.6±6.6, BMI = 25.5± 3.3, Euroscore II= 3.8±3.6, LVEF = 63.4±10.2%, iAVA = 0.5±0.2cm 2 , mean gradient = 56.7±19.3 mmHg, Stroke volume = 49.9±11.6 ml/m 2 , Surgical procedure: full sternotomy in all, 15 patients with INTUITY 19mm and 23 patients with INTUITY 21mm, CABG in 12 patients (31.6%), Cross clamping time = 45.6±21.1min. 1/ Success of procedure: 100%. In-hospital mortality: 2.6%. 2/ Evolution of mean gradient and iEOA at 1 month FU = 17.8±12.7 mmHg and 0.7± 0.1 cm2/m2 (INTUITY19mm); 11.9±4.2mmHg and 1± 0.3cm2/m2 (INTUITY21mm). 3/ Evolution of LV mass: Significant reduction of LV mass index at 1 month FU (124 mg/m 2 vs 167 mg/m 2 , p=0,001) 4/Incidence of PPR: No PPR >grade 1. 5/Incidence of PPM: only six patients (8.3%) with moderate PPM (ELI <0.85cm2/m2). None with severe PPM. These early results suggest potential future applicability of the Edwards INTUITY in addressing some of the challenges in patients with a small aortic annulus. Mid-term results in a large population should be evaluated.

Associations of Hemodynamic Load and Ventricular Repolarization in Patients With Newly Diagnosed Essential Hypertension: A Long‐Term Follow‐Up Study

The evolution of QT interval and its dispersion (QTd) were studied in 135 newly diagnosed nondiabetic patients, as well as the relationship between changes of these left ventricular (LV) repolarization parameters with blood pressure (BP) and LV mass changes, which were prospectively studied for a median period of 3.8 years. At baseline and at last follow-up visit, all patients underwent ambulatory BP monitoring, echocardiographic assessment, and 12-lead electrocardiography. At the end of follow-up, responders of antihypertensive treatment based on a reduced 24-hour systolic BP (n=122) exhibited a reduction in LV mass index (by 7.6 g/m2, P<.001) and corrected QT (by 4.3, P=.038), while corrected QTd was unchanged. In nonresponders (n=13), although no difference in LV mass index was observed, corrected QT increased by 12.4 ms (P=.048) and corrected QTd by 8.2 ms (P=.027). Changes in parameters of LV repolarization were related to BP changes but not to changes of myocardial size.

Biomarkers of Cardiovascular Remodeling in Patients on Peritoneal Dialysis

Objectives: The purpose of this study was to determine endothelin (ET)-1 and nitric oxide (NO) serum concentration levels at baseline and after 1 year of peritoneal dialysis (PD) treatment. A further aim was to evaluate the association between ET-1 and NO with parameters of echocardiography and the common carotid artery (CCA) ultrasound, and to assess their impact on cardiovascular remodeling. We also aimed to evaluate the influence of dialysis adequacy and residual renal function (RRF) on cardiovascular remodeling. Methods: This study included 40 PD patients in whom we measured serum ET-1 and NO concentrations, echocardiography and CCA ultrasound parameters. Results: ET-1 decreased and NO serum concentration levels increased (p < 0.01) after 12 months of PD treatment compared to baseline values. Left ventricular (LV) hypertrophy was observed in 77.5% of patients at baseline with significant reduction in LV mass index (LVMI), CCA intima media thickness (IMT) and plaque score after 12 months of PD treatment (p < 0.001). The dialysis adequacy and RRF were significantly associated with LVMI and CCA IMT after 12 months on PD. Conclusion: In our study, ET-1 significantly decreased while NO increased during PD treatment and both were independently related to the cardiovascular remodeling parameters in PD patients.

Influence of endothelin-1 and nitric oxide on left ventricular remodelling in patients on peritoneal dialysis

Background: Left ventricular hypertrophy is the most common structural cardiac alteration in chronic dialysis patients. The aim of this study was to determine the possible association of endotelin-1 (ET-1) and nitric oxide (NO) with parameters of echocardiography in order to assess their participation in left ventricular (LV) remodeling in patients on peritoneal dialysis (PD). Methods: This prospective longitudinal study included 40 PD patients. Serum levels of ET-1 and NO baseline and after 12 months of PD treatment were measured and compared with echocardiography parameters done at the same time of PD treatment. Linear regression analysis was used to detect independent correlations of variables. Results: Mean ET-1 serum concentration decreased significantly after 12 months of PD treatment compared to baseline values (p < 0.01). NO serum concentration increased significantly 12 months after treatment compared to baseline values (p < 0.01). Left ventricular hypertrophy (LVH) was observed in 72.5% of patients at baseline with significant reduction in LV mass index after 12 months of PD treatment (p < 0.001). On linear regression analysis serum concentration of ET-1 was independent predictors of LV mass index, as well as NO at the end of observed period. Conclusions: According to our data ET-1 and NO are independently related to the process of left ventricular remodeling in PD patients

Impact of dialysis modality on left ventricular geometry assessed by echocardiography in patients with end stage renal disease

Purpose: Left ventricular hypertrophy (LVH) is an independent risk factor for morbidity and mortality in patients with end stage renal disease. This study aimed to evaluate pattern of LV remodeling according to dialysis modality in patients with end stage renal disease. Methods: We retrospectively evaluated change in LV mass index (LVMI), relative wall thickness (RWT) and LV geometry, assessed by 2D transthoracic echocardiography, in patients starting dialysis while hospitalized from 2000 to 2012. Patients were classified into hemodialysis (HD) group and peritoneal dialysis (PD) group. Follow-up duration of performing echocardiogram was 11.6±4.5 months. LV geometry was divided into 4 groups as normal LV geometry, concentric remodeling, concentric LVH and eccentric LVH according to LVMI and RWT using cutoff values of 131 (men) or 100 (women) g/m2 for LVMI and 0.45 for RWT, both men and women. The multivariate analysis was performed to evaluate the independent predictors of change in LV geometry among the patients who showed the change of LV geometry. Results: 74 patients with HD (age 54.9±13.0 years, 50.0% male) and 34 patients with PD (age 48±15.1 years, 58.8% male) were enrolled. Before initiation of dialysis, there were no significant difference of ejection fraction, LVMI, RWT (56.1±14.0% vs. 55.8±14.2%, p=0.898; 169.0±47.9g/m2 vs. 168.5±57.3g/m2, p=0.964; 0.46±0.1 vs. 0.46±0.1, p=0.937, respectively). There was no difference of geometry distribution between two groups (4.1% vs. 5.9% concentric remodeling, 51.4% vs. 50.0% concentric LVH, 37.8% vs. 32.4% eccentric LVH, respectively). Follow-up echocardiogram revealed that LVMI and RWT in both groups were not significantly different (166.4±44.4g/m2 vs. 154.5±49.0g/m2, p=0.221; 0.47±0.10 vs. 0.48±0.12, p=0.287). LVMI and RWT showed no significant difference over time in both groups (p=0.63 vs. p=0.22; p=0.31 vs. 0.93, respectively). However, the geometric change of LV was significantly different between two groups. Change to eccentric LVH from the other LV geometries was significantly higher in PD group (37.8% vs. 87.5%, p=0.001, Odds ratio [OR] 11.5, 95% Confidence interval [CI] 2.3-58.3). Change to concentric LVH from the other geometries was not significantly different. PD was associated with increase of LVMI (OR 2.88 95% CI 0.86-9.96). HD was associated with reduction of LVMI (OR 1.89 95% CI 0.94-3.97). Conclusion: Otherwise there was no difference in prevalence of LV geometry pattern at the time of initiating dialysis, PD was an independent predictor for LVMI increment and HD was an independent predictor for LVMI reduction.