Regression Of Left Ventricular Hypertrophy Research Articles

Changes in Cardiac Structure and Function Before and After Renal Transplantation: A Longitudinal Study

BackgroundEnd-stage renal disease is a major risk factor for cardiovascular disease. Kidney transplantation (KT) may lead to reversal of these cardiac changes. MethodsEchocardiographic changes in cardiac structure and function were recorded in 30 patients with end-stage renal disease before KT, and 3 months and 6 months after KT. Patients with ischemic heart disease and valvular heart disease were not included. ResultsThirty patients with a mean age of 34±12 years were studied, and 28 (93%) were male. Mean duration of hemodialysis (none on peritoneal dialysis) was 9.18±8.39 months. There was significant improvement in echocardiographic parameter of cardiac morphology and the cardiac systolic and diastolic functions after KT. ConclusionsThis longitudinal prospective study found significant regression of left ventricular hypertrophy within 6 months after renal transplant. There was also an improvement in ventricular functions on echocardiography. The improvement in hemoglobin shows linear correlation with reduction in left ventricular dimension and improvement in left ventricular functions.

Dynamics of left ventricle myocardial deformation, soluble ST2 and cardiotrophin-1 in hypertensive women on combined valsartan/hydrochlorothiazide therapy

Abstract Funding Acknowledgements Type of funding sources: None. Background. The treatment-induced regression of left ventricular hypertrophy (LVH) is associated with improved prognosis in patients with arterial hypertension. However, the assessment of LVH by echo is restricted by substantial measurement variability and low sensitivity to changes during follow-up. The alternative approach could be the dynamic evaluation of myocardial deformation parameters and biochemical markers of cardiac remodeling. The purpose of this study was to assess the dynamics of left ventricle (LV) myocardial deformation, soluble ST2 and cardiotrophin-1 levels in hypertensive women treated with combination of valsartan/hydrochlorothiazide. Methods. The study involved 100 postmenopausal women (mean age – 57.7 ± 4.3 years) with uncomplicated arterial hypertension. All patients were treated with combination of valsartan (80-320 mg; average dose 195 mg) and hydrochlorothiazide (12.5 mg). Ambulatory blood pressure monitoring, conventional and 2-dimensional speckle tracking echocardiography were performed before and 6 months after treatment. The concentrations of cardiotrophin-1 and soluble ST2 were determined by ELISA method. The data are presented as median and interquartile range. Results. Treatment with valsartan/hydrochlorothiazide was effective and well tolerated. Target blood pressure level was achieved in 64 % of the patients. The LV global longitudinal strain (GLS) raised significantly after 6 months of treatment (Table). We found the reduction of mechanical dispersion - parameter, which indirectly reflects myocardial tissue homogenicity. The levels of circulating cardiotrophin-1 and soluble ST2 decreased by 37.93% and 19.74%, respectively (p < 0.0001). Conclusions. The 6-month therapy with valsartan/hydrochlorothiazide was associated with improvement of myocardial deformation parameters with concomitant reduction of soluble ST-2 and cardiotrophin-1 levels. These markers could be more sensitive than standard parameters for hypertensive patients" follow-up. However, this approach should be confirmed in future studies. Parameter Baseline 6-month p Office SBP, mm Hg 148 (140; 157) 135 (124; 143) <0.0001 Office DBP, mm Hg 89 (82; 96) 81 (74; 87) <0.0001 LV GLS, % -19.6 (-18.1; -21.1) -20.4 (-18.9; -21.8) 0.01 Mechanical dispersion, ms 43 (37; 51) 41 (37; 48) 0.04 Cardiotrophin-1, pg/ml 12.2 (9.4; 16.81) 8.5 (6.26; 10.82) <0.0001 Soluble ST2, ng/ml 25.3 (17.93; 29.72) 18.2 (13.93; 25.96) <0.0001 Values are given as median and interquartile range

Structural and functional condition of the myocardium and the relationship of metabolic disorders in patients with chronic kidney disease

Purpose. Study of the structural and functional characteristics of the heart in patients receiving long term hemodialysis (HD) treatment, and the identification of links with bone mineral, lipid disorders and anemia.Material and methods. A total of 160 patients with chronic kidney disease (CKD) of the 5th dialysis (5D) stage (70 men, 90 women) who were treated in the hemodialysis departments of Izhevsk were examined. The average age of patients is 52.9 ± 2.0 years old (31 to 78 years old). The procedures were performed 3 times a week for 4–4.5 hours. The inclusion criteria were the duration of dialysis therapy for at least one year and the availability of informed consent. The adequacy index Kt / V amounted to1.56 ± 0.2. Echocardiographic examination assessed the structural and functional parameters, calculated Left Ventricular Mass, LVM index, relative thickness index, “inner membrane”, fractional-shortening of the middle fibers. A study of general clinical indicators of mineral-bone disorders, Lipemic index, erythrocytes was carried out.Results. Violation of left ventricular (LV) geometry was found in 140 (87.5%) patients with 5D CKD stage. Concentric and eccentric hypertrophy prevailed. No significant dependence on patient’s sex was revealed. Patients with eccentric hypertrophy showed high rates of inter-dialysis weight gain (p < 0.05) and ultrafiltration (p < 0.05). In patients with concentric hypertrophy, high indicators of calcium-phosphorus metabolism (p < 0.05), pre-dialysis systolic pressure (p < 0.05) and pulsatility (p < 0.05) were obtained. They also tended to have higher triglyceride indices and more pronounced anemia. The correlation of the structural and functional state of the myocardium with the level of phosphorus, calcium, calcium-phosphorus ratio and pulsatility was established.Conclusions. In most patients with stage 5D CKD, LV remodeling with the prevalence of concentric and eccentric hypertrophy is observed. No significant gender differences were found. In patients with hypervolemia requiring more intense ultrafiltration during dialysis, eccentric LV hypertrophy was detected. High values of pre-dialysis and pulsatility, as well as levels of calcium and phosphorus, are observed with the concentric remodeling type. Correlations of structural changes in the myocardium with calcium-phosphorus metabolism were revealed. The data obtained may open new ways of influencing the regression of LV hypertrophy and improve the cardiovascular prognosis in patients receiving programmed hemodialysis treatment.

Структурно-функціональний стан лівого шлуночка у хворих з гіпертонічною хворобою та ревматоїдним артритом під впливом різних схем лікування

Hypertensive disease is one of the most common diseases in the world and the leading cause of death and disability from cardiovascular diseases among the population. Recent studies have indicated that patients with hypertension in combination with rheumatoid arthritis have a higher risk of cardiovascular complications and mortality. Ukrainian recommendations for the management of patients with hypertension for 2018 indicated that angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are more effective in regressing left ventricular hypertrophy. The purpose of the study was to compare the effect of long-term therapy with valsartan in combination with indopamide and amlodipine on the structural and functional state of the left ventricular myocardium and the level of blood pressure in patients with arterial hypertension in combination with rheumatoid arthritis. Material and methods. The study included hypertensive patients in combination with rheumatoid arthritis. The patients were divided into 3 groups: the first group consisted of 17 patients with essential hypertension in combination with rheumatoid arthritis who took valsartan at a dose of 80 mg at home. The second group included 17 patients who were transferred to additional administration of the drug indapamide at a dose of 15 mg. The third group consisted of 18 patients whose dose of amlodipine was increased from 5 to 10 mg Results and discussion. In the daily blood pressure profile, the time-averaged values of systolic blood pressure and diastolic blood pressure were calculated for three-time intervals of 24 hours, day and night. Left ventricular remodeling was assessed by the relative left ventricular thickness - the ratio of the sum of the thickness of the interventricular septum and the thickness of the posterior wall to the final diastolic size of the left ventricular. The norms were considered to be an indicator of relative wall thickness <0.45. When studying the analysis of the effect of 4-week monotherapy of valsartan at a dose of 80 mg / day on the level of blood pressure and daily blood pressure profile, we revealed a statistically significant decrease in blood pressure by -14.1±2.2 / -8.2±1.4 mm Hg. Art. (P <0.01), mean daily values of systolic blood pressure (24) by 15.1±2.4 mm Hg. Art. (P <0.001), diastolic blood pressure (24) on September 8±1.7 mm Hg. Art. (P <0.001), day and night mean values and indicators of systolic blood pressure and diastolic blood pressure. Analysis of 24-week monotherapy with amlodipine (the average dose of which was 10 mg / day) in 15 patients revealed a decrease in blood pressure by 24.1±3.6 / 15.2±2.3 mm Hg. Art. (P <0.01) and its normalization in 9 out of 15 patients (60%). According to the ABPM data, a significant decrease in systolic blood pressure and diastolic blood pressure was revealed within 24 hours, both in the daytime and at night. The target level of 24-hour AO was achieved in 6 (40%) patients. Valsartan therapy and their combination with indapamide led to regression of left ventricular hypertrophy in all patients, normalization of left ventricular geometry in 33% of patients. In 24 patients with concentric left ventricular hypertrophy, in (25%) left ventricular myocardial mass index and left ventricular geometry normalized, in 4 (17%) patients, left ventricular hypertrophy became eccentric, in 1 (4%) it turned into concentric remodeling, in 10 (54%) patients it remained without changes. Conclusion. Therefore, valsartan and its combination with indapamide in these patients led to regression of left ventricular hypertrophy, normalization of left ventricular geometry in 33% of patients, improvement of left ventricular diastolic function in 88.2%

Three-year dynamics of left ventricular structural parameters in patients with resistant arterial hypertension on four-component therapy

Aim. To study the three-year dynamics of left ventricular (LV) structural parameters with the four-component antihypertensive therapy in patients with resistant arterial hypertension (RAH). Material and methods. A total of 102 patients with true RAH were included. The duration of the treatment was 3.2 ± 0.1 years. Patients received triple single-pill combination of antihypertensive drugs (TSPC), which was alternately added by spironolactone, eplerenone, moxonidine, torasemide, or nebivolol for three-months treatment. Than patients received the TSPC with an addition of the most effective of the four medications listed. Office and ambulatory blood pressure (BP) measurements and echocardiography were performed, clinical characteristics; specifics of neurohumoral and proinflammatory status were assessed. Results. The patients were divided into 2 groups according to the changes in LV mass index (LVMI) within three years. The 1 st group included 68 patients who demonstrated regression of LV hypertrophy (LVH). The 2 nd group included 28 patients who had LVMI unchanged or increased. LVMI was normalized in 38.2 % of patients, and a degree of LVH was reduced from severe to moderate in 61.8 % of patients in achieving the target BP level in 44 % of patients and restoring the physiological 24-hour BP rhythm in 39 % of patients. In the 2 nd group, 28.6 % of patients achieved BP targets; a large proportion of them were patients with concomitant coronary heart disease (42.3 %) and chronic kidney disease (64.3 %). Conclusions. Effective antihypertensive therapy providing 24-hour BP control and restoring the physiological 24-hour BP rhythm contributes to LVH regression in 66.7 % of patients with RAH. Higher baseline LVMI (β = 0.655; P < 0.0001) and plasma active renin (β = 0.442; P = 0.005), lower 24-hour urinary albumin excretion rate (β = -0.475; P < 0.0001) are independent predictors of LVH regression in RAH patients.

Przerost lewej komory mięśnia sercowego u chorych na przewlekłą chorobą nerek

Left ventricular hypertrophy (LVH)left is a common phenomenon among patients with CKD (chronic kidney disease) and is a significant risk factor for death in this group of patients. An important aspect in patients with CKD is the control of risk factors for the development of LVH such as hypertension and anemia. It is worth noting that in patients with CKD and especially ESRD (End Stage Renal Disease) diagnostics of left ventricular hypertrophy is more difficult than in general population. It should also be borne in mind that there are differences in the interpretation of the electrocardiogram record in patients with ESRD, especially the changes in the wave amplitude caused by changes in volemia during hemodialysis, electrolyte and acid-base disturbances. The best method of renal replacement therapy is kidney transplantation, which has a large impact on LVH regression in this group of patients. Due to the fact that left ventricular hypertrophy is a strong risk factor for cardiovascular death in patients with CKD, its prevention, early diagnosis, and adequate and intensive treatment are important.

Regression of Electrocardiographic Left Ventricular Hypertrophy and Strain Pattern Using Pharmacotherapy in a Patient With Dilated Cardiomyopathy

Summary A patient with dilated cardiomyopathy (DCM) was hospitalized for acute decompensated heart failure. His electrocardiogram (ECG) showed left ventricular hypertrophy (LVH) and strain pattern. As heart failure drugs were up-titrated, he experienced LV reverse remodeling. Serial ECG demonstrated regression of LVH and strain pattern. ECG-LVH and its regression can predictor and monitor reverse remodeling in DCM.

Blood pressure response in exercise is associated with future cardiac structural alterations in hypertensive patients

Abstract Background/Introduction Exaggerated blood pressure response (EBPR) during the exercise treadmill test (ETT) is often observed in individuals without known cardiovascular disease. Although it is generally considered as an abnormal response and a risk factor for hypertension development, its clinical significance remains controversial. On the other hand, regression of left ventricular hypertrophy (LVH) is independently associated with improved cardiovascular outcome. Purpose In this study we aimed to investigate the role of EBPR during exercise in LVH regression in hypertensive subjects over time. Methods 1413 hypertensive subjects, (mean age 57±11 years), 51% males, with baseline office blood pressure (BP) 144/89mmHg were followed for a mean period of 6.4±3.0 years. At baseline and last follow-up visit all patients underwent office BP, laboratory tests and echocardiographical determination of left ventricular mass index (LVMI). At baseline, all subjects underwent treadmill exercise testing (Bruce protocol) in order to identify the presence of EBPR based on the systolic BP elevation at peak exercise (&amp;gt; or =210 mmHg for men and &amp;gt; or =190 mmHg for women). Main outcome variable was LVH Regression/prevention (LVH Regr/prev), defined as: LVH at baseline visit with normal LVMI values at last visit or absence of LVH at baseline and last visit. BP control was considered optimal when the mean of office BP measurements during follow-up was &amp;lt;140/90mmHg. Results 46% of study population presented LVH Regr/prev during follow-up period. Cox-regression analysis, after adjustment for clinical and biochemical variables, revealed that low levels of baseline LVMI (HR=0.98, 95% CI 0.97–0.99, p&amp;lt;0.0001), absence of EBPR (HR=0.81, 95% CI 0.67–0.98, p=0.02) and optimal BP control during follow-up (HR=1.19, 95% CI 1.01–1.56, p=0.03) were independent predictors of LVH Regr/prev during follow-up. Conclusions Beyond optimal BP control, EBPR is a significant predictor of left ventricular mass changes overtime. Hence, ETT can provide clinical relevant information, including EBPR, which may help in the improvement of risk stratification of hypertensive subjects. Funding Acknowledgement Type of funding source: None

Structural valve deterioration and mode of failure of stentless bioprosthetic valves

BackgroundAortic stentless bioprosthetic valve (SLBPV), either porcine or pericardial, minimizes transvalvular gradient and favors regression of left ventricular hypertrophy. The drawback consists of longer time for suturing. While structural valve deterioration (SVD) in stented porcine and pericardial BPVs has been extensively investigated, less information is available on SLBPVs. Material and MethodsWe studied 82 SLBPVs explants, either porcine (Toronto SPV, [St. Jude Medical, MN, USA], CryolifeO'Brien Model 300 and CryoLife-O'Brien [Cryolife International, GA, USA], BioCor PVS [St. Jude Medical, MN, USA] Prima and Prima Plus [Edwards Lifesciences Corp. One Edwards Way, CA, formerly Baxter Inc, CA, USA]) or pericardial ([Pericarbon Freedom and Freedom Solo [Sorin-Biomedica, S.p.A., Saluggia, Italy]). ResultsBy excluding cases with leak and endocarditis, we focused the investigation on 46 SLBPVs, which failed because of SVD.Gender was male in 29 (63%).Mean age of patients at time of implant was 59.8 years. Postoperative time of SVD was 115.0 months for porcine and 79.0 months for pericardial SLBPVs. Dysfunction requiring reoperation was mainly incompetence for porcine and stenosis for pericardial SLBPVs.Even pinpoint mineralization at the commissures resulted in sudden cusp tearing and incompetence. Cuspal atheromasia accounted for cusp tearing even in the absence of calcification.Mineralization showed progression with time in pericardial but not in porcine SLBPVs. ConclusionsTissue mineralization remains the nightmare also of SLBPVs, with the peculiar features of pinpoint calcific deposits at commissures, tearing and abrupt incompetence in porcine SLBPVs and of massive cuspal mineralization and stenosis in pericardial SLBPVs.

Regression of left ventricular hypertrophy in primary aldosteronism after adrenalectomy: a meta-analysis of echocardiographic studies.

Available evidence on regression of left ventricular (LV) hypertrophy in patients with primary aldosteronism after unilateral adrenalectomy is scanty. We performed a systematic meta-analysis of echocardiographic studies to provide an updated and comprehensive information on this issue. The PubMed, OVID-MEDLINE and Cochrane library databases were analyzed to search English-language articles published from 1 January 1990 up to 30 June 2020. Studies were identified by using MeSH terms and crossing the following search items: 'primary aldosteronism' 'Conn's syndrome' 'adrenalectomy', with 'cardiac damage', 'hypertensive heart disease' 'left ventricular mass', 'left ventricular hypertrophy', 'left ventricular hypertrophy regression', 'echocardiography'. A total of 629 hypertensive patients with primary aldosteronism (mean age 49 years, 45% men) were included in 14 studies. Baseline and postintervention pooled mean LV mass/BSA values were 134 ± 4 and 108 ± 3 g/m2 [standard means difference (SMD) -0.42 ± 0.05, confidence interval (CI) -0.52/-0.32, P < 0.0001]; corresponding values for LV mass/h2.7 were 56 ± 2 and 49 ± 1 g/h2.7 (SMD -0.45 ± 0.06, CI -0.52/-0.36, P < 0.0001). Adrenalectomy, followed by a marked decrease in blood pressure, was associated with a decrease in relative wall thickness (SMD -0.17 ± 0.06, CI -0.31/-0.03, P < 0.01) as well as in the number of antihypertensive drugs (SMD -0.45 ± 0.04, CI -0.50-0.32, P < 0.0001). The present meta-analysis suggests that adrenalectomy in patients with primary aldosteronism exerts a beneficial effect on LV structure and geometry by reducing the burden of LV hypertrophy and LV concentric geometry.

Порівняння ефективності різних фіксованих комбінацій антигіпертензивних препаратів у хворих з артеріальною гіпертензією та гіпотиреозом

Мета роботи – оцінити ефективність різних фіксованих подвійних комбінацій антигіпертензивних препаратів та проаналізувати їх вплив на ремоделювання серця у хворих з артеріальною гіпертензією (АГ) та гіпотиреозом.Матеріали і методи. У дослідження увійшло 50 хворих з АГ та гіпотиреозом, яких розділили на дві групи методом сліпих конвертів по 25 осіб у кожній. Хворим 1-ї групи була призначена фіксована комбінація периндоприлу з індапамідом, хворим 2-ї групи – фіксована комбінація периндоприлу з амлодипіном. Групи статистично значуще не відрізнялися за віком хворих, тривалістю замісної гормональної терапії, тривалістю АГ, рівнем офісного систолічного і діастолічного артеріального тиску (АТ) при залученні в дослідження. За індексом маси тіла досліджувані групи були порівнянні, проте кількість пацієнтів з ожирінням була більшою у 2-й групі (p=0,05). Спостереження за хворими тривало 12 міс.Результати та обговорення. Отримані дані показали, що у хворих з АГ та гіпотиреозом досягнення еутиреоїдного стану сприяє зниженню рівня АТ, проте вимагає подальшого призначення антигіпертензивної терапії. Вивчені фіксовані комбінації антигіпертензивних препаратів, а саме периндоприлу з індапамідом та периндоприлу з амлодипіном, у хворих із АГ та супутнім гіпотиреозом забезпечують статистично значуще зниження АТ за результатами амбулаторного моніторування (р&lt;0,05). При порівнянні ефективності комбінацій у хворих з АГ та гіпотиреозом залежно від індексу маси тіла встановлено, що комбінація периндоприлу з амлодипіном має більш виразний вплив на АТ у хворих з ожирінням.Висновки. Фіксована комбінація периндоприлу з амлодипіном порівняно з фіксованою комбінацією периндоприлу з індапамідом забезпечує статистично значуще більший вплив на регрес гіпертрофії міокарда лівого шлуночка, а саме зменшення індексу маси міокарда за зростом у степені 2,7 у хворих з ожирінням (р&lt;0,01).

Regression of the Left Ventricular Hypertrophy in Patients with Essential Hypertension on Standard Drug Therapy.

PURPOSE: The American College of Cardiology/ American Heart Association 2017 and European Society of Cardiology/European Society of Hypertension 2018 guidelines were a paradigm shift in hypertension management in contemporary medicine. Lowering of blood pressure to less than 130 (systolic) and 80 (diastolic) mm of Hg irrespective of cardiovascular risk is recommended. While intensive blood pressure control is commonly achievable with rational pharmacotherapy, the magnitude of left ventricular hypertrophy regression is an independent factor in improvement in cardiovascular health. The regression of left ventricular hypertrophy has been adjudged as a clinically useful surrogate marker that reflects the efficacy of hypertension treatment. Though angiotensin converting enzyme inhibitors/ angiotensin receptor blockers (ACEI/ARB) are the preferred initial drug for greater regression of left ventricular mass, the choice of add-on therapy, if required, is still debatable. Therefore, in our observational study, we sought to compare the reduction in left ventricular mass index in hypertensives with left ventricular hypertrophy on standard ACEI/ARB based drug therapy. MATERIALS AND METHODS: The cohort (n=217) comprised of patients with uncontrolled hypertension (blood pressure>140/90 mm of Hg) and left ventricular hypertrophy (left ventricular mass index>115 and 95 gram/square meter in males and females respectively). The add-on drug in ACEI/ARB therapy was either thiazide diuretics (TD) or calcium channel blockers (CCB). Four sub-cohorts were constituted: mono-therapy - group A (n=70, ACEI/ARB), dual-therapy - group B (n=48, ACEI/ARB+TD) and group C (n=51, ACEI/ ARB+CCB), triple therapy - group D (n=48, ACEI/ ARB+TD+CCB). Left ventricular mass index was determined using echocardiography at baseline and after 24 weeks of therapy. RESULTS: There was no significant difference in baseline clinical or demographic variables between group B and group C. Baseline blood pressure and duration of hypertension was greater in group D compared to group A (P<0.001). The reduction in left ventricular mass index (mean ±SD) in the four groups (A to D) was 16.7±18.7, 21.0±20.8, 20.5±15.5 and 29.1±21.5 g/m2 respectively (D>A, P=0.011, B versus C, P=1.00). The corresponding change in blood pressure (systolic/diastolic) was 18.5±13.6/8.9±11.2, 27.5±19.2/12.2±9.3, 23.4±16.7/ 5.4±10.1, 26.6±19.5/10.7±12.8 mm of Hg respectively (systolic, B>A, P=0.027, D>A, P=0.048) (diastolic, B>C, P=0.013). CONCLUSION: Anti-hypertensive treatment with angiotensin converting enzyme inhibitors/angiotensin receptor blockers-based therapy produced graded regression of left ventricular hypertrophy with monotherapy, dual therapy and triple therapy. In dual therapy, add-on of either thiazide diuretics or calcium channel blockers to angiotensin converting enzyme inhibitors/angiotensin receptor blockers showed equal efficacy in regression of left ventricular hypertrophy independent of blood pressure reduction.

A Contemporary Approach to Hypertensive Cardiomyopathy: Reversing Left Ventricular Hypertrophy.

To highlight pharmacological and non-pharmacological approaches to reversing hypertensive left ventricular hypertrophy (LVH). We identify high-risk phenotypes that may benefit from aggressive blood pressure (BP) management to prevent incident outcomes such as the development of atherosclerotic cardiovascular disease, stroke, and heart failure. LVH is a modifiable risk factor. Intensive BP lowering (systolic BP < 120mmHg) induces greater regression of electrocardiographic LVH than standard BP targets. The optimal agents for inducing LVH regression include renin-angiotensinogen-aldosterone system inhibitors and calcium channel blockers, although recent meta-analyses have demonstrated superior efficacy of non-hydrochlorothiazide diuretics. Novel agents (such as sacubitril/valsartan) and non-pharmacological approaches (like bariatric surgery) hold promise but longitudinal studies assessing their impact on clinical outcomes are needed. LVH regression is achievable with appropriate therapy with first-line antihypertensive agents. Additional studies are warranted to assess if intensive BP lowering in high-risk groups (such as blacks, women, and malignant LVH) improves outcomes.

The role of renin–angiotensin–aldosterone system inhibition in the regression of hypertensive left ventricular hypertrophy: the evidence of the last three decades

Hypertension is a leading cause of cardiovascular mortality and morbidity. The development of left ventricular hypertrophy (LVH) in hypertension is an independent predictor of adverse cardiovascular outcomes. Conversely, regression of LVH is associated with better prognosis. Lowering of blood pressure in patients with hypertension is the unequivocal determinant of regression of LVH. Unless otherwise contraindicated, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) are drugs of first choice in patients with essential hypertension with LVH. In this article, we summarise the preclinical and clinical evidence of the last 3 decades that established the preferential use of ACEIs/ARBs in hypertensive heart disease.

Inhibition of the NFATc4/ERK/AKT Pathway and Improvement of Thiol-Specific Oxidative Stress by Dronedarone Possibly Secondary to the Reduction of Blood Pressure in an Animal Model of Ventricular Hypertrophy.

Untreated chronic hypertension causes left ventricular hypertrophy, which is related to the occurrence of atrial fibrillation. Dronedarone is an antiarrhythmic agent recently approved for atrial fibrillation. Our group previously demonstrated that dronedarone produced an early regression of left ventricular hypertrophy after 14 days of treatment in an experimental study. In this study, we analyze the possible mechanisms responsible for this effect. Ten-month-old male spontaneously hypertensive rats (SHRs, n = 16) were randomly divided into therapy groups: SHR-D, which received dronedarone, and hypertensive controls, SHR, which received saline. Ten-month-old male Wistar Kyoto rats (WKY, n = 8), which also received a saline solution, were selected as normotensive controls. After 14 days of treatment, echocardiographic measurements of the left ventricle were performed, blood samples were collected for thiol-specific oxidative stress analysis, and the left ventricles were processed for western blot analysis. Dronedarone significantly lowered the left ventricular mass index and relative wall thickness compared with the SHR control group, and no differences were observed between the SHR-D group and the WKY rats. Interestingly, the SHR-D group showed significantly decreased levels of nuclear factor of activated T cells 4 (p-NFATc4), extracellular-signal-regulated kinase 1/2 (p-ERK1/2), and protein kinase B (p-AKT) compared with the hypertensive controls without statistical differences when compared with the WKY rats. Moreover, the SHR control group showed elevated thiolated protein levels and protein thiolation index (PTI) compared with the WKY rats. After treatment with dronedarone, both parameters decreased with respect to the SHR control group until reaching similar levels to the WKY rats. Our study suggests that dronedarone produces inhibition of the NFATc4/ERK/AKT pathway and improvement of thiol-specific oxidative stress possibly secondary to the reduction of blood pressure in an animal model of ventricular hypertrophy.

Left ventricular mass reduction and hypertrophy regression following renal artery revascularization: a meta-analysis.

Few echocardiographic studies have focused on regression of left ventricular hypertrophy (LVH) in patients with renal artery stenosis after revascularization, with inconsistent results. We performed a systematic meta-analysis of these studies in order to offer a comprehensive information on this topic. The PubMed, OVID-MEDLINE, and Cochrane library databases were analyzed to search English-language articles published from 1 January 1990 up to 31 March 2020. Studies were identified by crossing the following terms: 'renal artery stenosis', 'renovascular hypertension', 'fibromuscular dysplasia', 'renal artery stenting', 'renal artery surgery' with 'cardiac damage', 'hypertensive heart disease' 'left ventricular mass', 'left ventricular hypertrophy', 'echocardiography'. A total of 726 hypertensive patients with renal artery stenosis (mean age 61 years, 64% men, 98% treated, 10% with fibromuscular dysplasia) were included in 13 studies. Baseline and postintervention pooled mean LVM values were 220 ± 15 and 203 ± 19 g, respectively (SMD -0.24 ± 0.06, CI -0.37 to -0.21, P<0.0001); corresponding values for LV mass index were 129.0 ± 6 and 115 ± 7 g/m, respectively (SMD -0.28 ± 0.04, CI -0.36 to 0.21, P < 0.0001). Renal revascularization was associated with a 40% lower risk of LVH. This trend was accompanied by a reduction in the number of antihypertensive drugs (SMD -0.27 ± 0.04, CI -0.37 to 0.17, P < 0.0001). The present meta-analysis suggests that renal artery revascularization added to antihypertensive therapy promotes a favourable effect on LV structure, as reflected by a significant decrease in absolute and indexed LV mass index as well by a lower risk of LVH. Limitations include: high prevalence of modest renal artery stenosis (≥50%); small sample of fibromuscular dysplasia; lack of randomized design of most studies.

Regression of left ventricular hypertrophy with SGLT2 inhibitors.

Regression of left ventricular hypertrophy with SGLT2 inhibitors.

The Possibilities of Single-Pill Combinations of Antihypertensive Drugs in Cerebroprotection: Focus on the Combination of Amlodipine with Ramipril

Stroke remains one of the leading causes of death and disability both worldwide and in Russia. Acute cerebrovascular events have many risk factors, among them the most important is arterial hypertension (AH), which predisposes to the stroke development through the direct effect of increased hydrostatic blood pressure on the brain vascular system, followed by arterial remodeling and an increase in their stiffness. In addition, excessive blood pressure variability, activation of the tissue renin-angiotensin-aldosterone system, as well as target-organ damage - primarily the heart in the form of left ventricular hypertrophy, kidneys in the form of microalbuminuria and decrease in glomerular filtration rates. An additional risk factor for stroke is hyperuricemia, which is included in the current European and Russian guidelines for the management of AH as one of the new risk factors in patients with this disease. The state-of-the-art approach to antihypertensive therapy is the using of antihypertensive single-pill combinations, one of the frontline combinations in the absence of special clinical conditions is a combination of an angiotensin converting enzyme inhibitor and a calcium channel blocker. The reference drugs in both classes due to large body of evidence are ramipril and amlodipine, respectively. These drugs provide a high level of brain protection, not only due to the ultra-long and powerful antihypertensive action, but also through a unique potential in target-organ protection via left ventricular hypertrophy regression, antiatherosclerotic effects and improved endothelial function, renal protection, as well as the ability to decrease uric acid in the blood.

Effects of Renal Transplantation on Cardiac Morphology and Function Luis Vernaza Hospital, Guayaquil, Ecuador: Kidney Transplant and Morphology and Cardiac Function

Introduction: Structural heart disease is a frequent complication of advanced chronic kidney disease and the leading cause of death in patients with renal replacement therapy, mainly in those on dialysis. There is sufficient evidence to demonstrate a regression of left ventricular hypertrophy and improvement of ventricular function after a successful renal transplant. The objective of this study is to describe the experience regarding the effects of renal transplantation on cardiac remodeling and function and thus corroborate with local data the benefits of renal transplantation on the left ventricular mass index (LVMI grs), Left Ventricle Ejection Fraction (LVEF %), Left Atrium Diameter (LAD mm), Left Ventricle Diastolic Diameter (LVDD mm), Left Ventricle Systolic Diameter (LVSD mm), Posterior Wall (PW mm) and Interventricular Septum (IVS mm). Materials and Methods: This is a quantitative, observational, descriptive and retrospective study. A database was constructed whose information was tabulated and subsequently analysed by the statistical program SPSS 13 to perform the statistical analysis. The results of the nominal variables were expressed in percentages and of the numerical variables in average ± standard deviation (SD) and confidence interval. The study included all adults over18 years with a diagnosis of chronic renal failure who underwent renal transplantation at Luis Vernaza Hospital between January 2009 to December 2016 and who had pre and post-transplant transthoracic echocardiography. Results: Of the 132 adults undergoing renal transplantation, 74 patients who met the inclusion criteria were identified, their average age was 35.2 years DS (+/- 11.7 years), forty-eight patients (64%) were male. All patients were dependent on dialysis, whose average time was 5 years and 88% of the population underwent intermittent hemodialysis weekly. The pre-transplant and post-transplant echocardiographic measurements were: LVEF (%) 60.89 ± 1,175 vs. 66.81 ± 0.685 (&lt;0.0001); LVMI (grs) 242.54 ± 11.92 vs. 184.62 ± 7,591 (&lt;0.0001); LAD (mm) 35.9 ± 0.772 vs. 34.8 ± 0.602 (0.215); LVDD (mm) 47.97 ± 0.756 vs. 44.98 ± 0.927 (0.003); LVDS (mm) 29.85 ± 0.897 vs. 26.68 ± 0.681 (0.004); PW (mm) 11.86 ± 0.270 vs. 10.92 ± 0.208 (0.002); IVS (mm) 12.12 ± 0.348 vs. 10.95 ± 0.253 (0.002) respectively. Conclusion: In this study, was observed a favorable overall impact of renal transplantation on the structure and function of the heart, with a significant reduction in LVH and LVMI and systolic and diastolic function of the left ventricle, thus reducing the risk of associated death to cardiovascular events.

Electrocardiographic QRS voltage amplitude improvement by intramyocardial radiofrequency ablation in patients with hypertrophic obstructive cardiomyopathy and one year follow up

ObjectivesThis study aimed to determine whether the serial changes of the electrocardiogram is associated with regression of left ventricular hypertrophy (LVH) after Liwen procedure. BackgroundClinical application of the echocardiography-guided percutaneous intramyocardial septal radiofrequency ablation (PIMSRA, Liwen procedure) is an innovative approach to treat hypertrophic obstructive cardiomyopathy (HOCM). MethodsWe enrolled 30 consecutive patients with HOCM who had undergone Liwen procedure in our Hypertrophic Cardiomyopathy Center, from June 2016 to January 2018. Electrocardiography (ECG) and echocardiogram were performed before and after Liwen procedure, and at each follow-up (1-week, 1, 3, 6 months and 1 year). The Sokolow–Lyon index (SLi), Q wave, R wave, S wave amplitude of 12-lead ECG and interventricular septal (IVS) thickness, left ventricular mass index (LVMI) by echocardiograms were measured in each patient. The sum of the ECG QRS amplitude on each lead was calculated. The reduction of SLi and QRS amplitude were used as improvement index. ResultsThe ECG leads with most improvement rate of the QRS wave amplitude of all cases were V1 and V2, both at 90%. The QRS wave amplitude in V1 leads and SLi were positively correlated with IVS thickness and LVMI at baseline and 1 year after Liwen procedure, respectively. The reduction of IVS thickness, LVMI and QRS wave amplitude in leads V1 and V2 were significant at one month after ablation and the follow-up period. SLi was significantly decreased at 3 months during the observation period. Similarly, the improvement of ECG QRS wave amplitude after the Liwen procedure tracked the gradual thinning of the IVS and the changes of SLi reflected the regression of LVH. ConclusionThe QRS wave amplitude reductions in lead V1 and SLi may be good indicators for evaluating the postoperative interventricular septal remodeling of the Liwen procedure.