Relative Wall Thickness Research Articles

Maladaptive remodeling reduces survival in patients with moderate aortic stenosis and preserved ejection fraction

Abstract Background Aortic valve stenosis (AS) is a common cause of left ventricular (LV) pressure overload and subsequent hypertrophy and diastolic dysfunction. The extent of LV hypertrophy does not necessarily correlate with the severity of valve stenosis and excessive LV remodeling can be seen in moderate AS. Therefore aortic stenosis is the disease of valve and myocardium. Left ventricular hypertrophy (LVH) with different geometric patterns is associated with adverse prognosis, The concept of staging AS disease rather than merely classifying AS based on hemodynamic severity seems more appropriate. Current guidelines do not address whether aortic valve replacement should be recommended in patients with moderate aortic valve stenosis regardless of the presence of LV dysfunction. Purpose This study aimed to investigate differences in left ventricular remodeling and its impact on survival in patients with unequivocally moderate aortic stenosis and preserved LV ejection fraction. Methods We retrospectively analyzed 182 unequivocally moderate AS patients (57% were male, age was 70±9), who underwent transthoracic echocardiography from March 2018 to November 2021. AS severity was defined by specific threshold values peak velocity 3-4 m/sec, an MPG 20-40 mmHg and an AVA 1-1.5 cm. All values were concordant and suggested moderate AS. All patients were in sinus rhythm and with LV ejection fraction >50%. We calculated the LV mass index (LVMI) and ventricular geometry was assessed with a relative wall thickness (RWT). Left ventricular hypertrophy (LVH) was defined as LV mass index >95g/m2 in women and >115g/m2 in men and was defined as concentric when associated with a RWT>0.42 and eccentric when RWT was ≤0.42. Concentric remodeling was defined as normal LVM index and increased RWT. The follow-up assessment in December 2023 ascertained vital status and data on aortic valve replacement (AVR). Results LVH was present in 91 patients (50%). Eccentric LVH was present in 49 (27%), concentric LVH in 42 (23%), and concentric remodeling in 27 (15%). During a median 41 months follow-up, 49 (27%) deaths occurred. 32 (18%) patients undervent AVR. As expected, LV hypetrophy was associated with all-cause mortality (HR 2.556; CI: 1.007-6.448; p = 0.048), and if concentric hypertrophy was present mortality was even higher (HR 3.736; CI: 1.553-8.992; p = 0.003) AVR had a non-statistically significant protective effect (HR 0.654; CI: 0.193 -2.220; p = 0.496). Conclusion Maladaptive remodeling is associated with worse outcomes in patients with moderate AS. RWT is important for identification of abnormal geometry. Further studies investigating the adequate timing of AVR in patients with moderate AS with maladaptive LV response are needed.

Left atrial stiffness and its association to left ventricular geometry in resistance trained athletes using anabolic-androgenic steroids

Abstract Background Anabolic-Androgenic Steroids (AAS) are commonly used in resistance trained (RT) individuals despite the negative impact on left ventricular (LV) structure and function. Purpose Due to the inter-dependence of the left atrium (LA) and the LV, alongside the importance of the atria contributing to LV filling and cardiac output, this study aimed to assess the relationship between LV geometry and LA stiffness in young RT users of AAS. Methods Utilising a cross-sectional design, male (n=99) and female (n=19) RT individuals aged 29±6yrs were grouped based on self-reported AAS user status: current (CU; n=70), past (PU; n=22) and non-users (NU; n=27). All participants underwent transthoracic echocardiography with strain imaging. Left ventricular geometry was defined based on LV mass index and relative wall thickness as per European Association of Cardiovascular Imaging guidelines. Left atrial stiffness index (LASi) was calculated as the ratio of E/E’ to LA reservoir strain (LARes) and concentricity as the ratio of LV mass to end-diastolic volume^0.67. Ejection Fraction (EF) was calculated using Simpsons biplane method. All data was presented as mean ± standard deviation with group differences assessed using a one-way ANOVA with post-hoc Bonferroni adjustment and Kruskal-Wallis test for non-normally distributed indices. A Fishers exact test was used to compare geometry between groups. Relationships between LASi and concentricity were assessed using multi linear regression Results Current users presented greater LV remodelling compared to PU and NU (eccentric hypertrophy (45%, 9% and 0%), concentric remodelling (2%, 0% and 0%) and concentric hypertrophy (8%, 0% and 0% respectively; p<0.001). EF was lower in those with concentric (52±9, p=.006) and eccentric (53±5, p<.001) hypertrophy than with normal geometry (58±5), but no difference between concentric and eccentric hypertrophy. LARes was lower in CU (32.0±7.5) compared to PU (39.1±8.3, p=.001) and NU (40.2±7.7, p<.001). E/E’ and LASi were higher in CU than PU (p=.006, p=.001) and NU (p<.001, p<.001; E/E’: 6.7±1.8, 5.9±1.5, and 5.7±1.4; LA stiffness index: 0.21±0.08, 0.16±0.05, and 0.15±0.05). Concentricity was higher in CU than PU (p<.001) and NU (p<.001; 8.3±2.2; 6.4±1.4 and 5.7±2.2 respectively). Controlling for user status, concentricity predicted LASi (R²=0.23, F(2,109)=16.1, p<.001) with a 0.1 increase in LASi for each 10g.ml^-0.667 increase in concentricity. Conclusions Although current users of AAS presented with more eccentric hypertrophy, those with increased concentricity and concentric hypertrophy had higher LA stiffness index. These data highlight 1) the potential greater negative functional impact of concentric compared to eccentric hypertrophy in young RT individuals using AAS, 2) the added value of LASi above conventional indices such as EF and 3) the possible reversible nature of LV and LA remodelling following cessation of AAS use.

Effectiveness of liver function tests in screening for cardiovascular risk in rheumatoid and psoriatic arthritis patients

Abstract Background Liver tests are used to evaluate liver damage due to medication and have gained attention for their potential role in assessing cardiovascular risk (CVR) in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA). In the general population, studies suggest that serum gamma-glutamyl transpeptidase (GGT) levels correlate with endothelial dysfunction and left ventricular (LV) alterations, leading to a higher risk of cardiovascular events. In contrast, serum bilirubin (SB), a byproduct of heme metabolism known for its antioxidant and anti-inflammatory properties, shows potential protective effects. Purpose To associate SB levels with carotid plaque prevalence and GGT levels with LV alterations in RA and PsA patients. Methods We conducted a cross-sectional study involving RA and PsA patients aged 40 to 75 who met the 2010 ACR/EULAR and 2006 CASPAR criteria, respectively. Patients with previous cardiovascular disease, pregnancy, overlap syndrome, renal or hepatic dysfunction were excluded. A carotid ultrasound and transthoracic echocardiograms were performed on all participants. CP was defined as a diffuse carotid intima-media thickness (cIMT) ≥1.2 mm or focal thickness ≥0.5 mm. The echocardiographic evaluation included left ventricle mass index (LVMI), relative wall thickness (RWT), mitral deceleration time (MDT), E/E mitral ratio, E/A mitral ratio, tricuspid annular plane systolic excursion (TAPSE), and left ventricular ejection fraction (LVEF). Subclinical LV systolic dysfunction was defined as a global longitudinal strain (GLS) greater than -18%. The Kolmogorov–Smirnov test was employed to determine normality. Comparisons with Chi-square, T-, or U-Mann Whitney test, accordingly. A p-value of ≤0.05 was considered statistically significant. Results A total of 51 patients were included 25 with RA and 26 with PsA. Patients were divided into two groups based on the presence of carotid plaque and according to GGT levels, with ≥28 U/L considered high. Most were women (n= 40, 78.4%) and had similar CVR factors (Tables 1 and 2). CP was found in 52.9% (n=27) of the patients and these had more prevalence of dyslipidemia (66.6% vs 50%, p=0.227), as well as higher SB levels. Conversely, patients with lower GGT levels exhibited greater remodeling characteristics, although there was no statistically significant difference in either case. A slightly higher prevalence of subclinical systolic dysfunction was observed in the high GGT group (66.6% vs 60%, p=0.25). Conclusion Our study found that SB levels are neither a protective factor against subclinical atherosclerosis nor an association between GGT levels and LV alterations in RA or PsA patients. Therefore, larger sample sizes are necessary to evaluate the effectiveness of the liver profile as a predictor of CVR and the detection of echocardiographic alterations. Carotid ultrasound and echocardiographic assessments should be included in a comprehensive cardiovascular evaluation.

Moderate aortic stenosis and preserved ejection fraction are not benign combination

Abstract Background Degenerative aortic stenosis (AS) is the most common progressive valvular disease and it is followed by adaptive left ventricular (LV) hypertrophy. LV hypertrophy is a compensatory mechanism aimed at reducing wall stress it also alters myocardial perfusion and impairs function and is tightly associated with heart failure with perserved ejection fraction (HFpEF). The outcome in patients with AS depends on the condition of the left ventricle and the presence of symptoms as well as the degree of the stenosis. Current guidelines do not address whether aortic valve replacement should be recommended in patients with moderate aortic valve stenosis regardless of the presence of symptoms and LV dysfunction. Purpose This study aimed to evaluate the association between moderate AS, symptoms, and myocardial structure and function after adjustment for comorbidities. Methods We conducted a matched cohort analysis. 61 patients with moderate aortic stenosis (MAS), LV ejection fraction <50% and sinus rhytm were matched with 1 comparator by age, gender and presence of arterial hypertension, diabetes, coronary artery disease, chronic obstructive pulmonary disease and renal failure. Echocardiographic parameters and presence of any of three symptoms (dyspnoea, chest pain and syncope) were recorded at and compared between two groups. Results No significant difference was found between the two groups concerning the left ventricle (LV) and right ventricle (RV) size, LV ejection fraction RV systolic function, and, pulmonary artery pressure, although patients with MAS tend to have greater end systolic diameter (ESD) but not statistically significant (35.20±8.28mm vs 32.86±6.08; P=0.083), LV global longitudinal strain was less in the MAS patients (-14.29 ±5.37 % vs. -17.95±2.44 %; P = 0.003). The LV mass index (LVMi) was greater, (122.30±31.16g/m2 vs 103.81±27.07; P=0.001), The relative wall thickness (RWT) was greater in MAS patients but not statistically significant (0.43 ± 0.09 vs. 0.41 ± 0.07 cm; P = 0.079). Left atrial volume index (LAVi) was greater in MAS (44±15ml/m2 vs 39±15; P=0.047), E/E′ ratio was greater in MAS (14±6 vs 11±3; P<0.001). Symptoms occurred more frequently in patients with MAS (24.6 %; 15/61 patients) than in the control group (8.2%; 5/61 patients, P=0.013). Conclusions LVEF as a means of assessing systolic function is insufficient. Ventricular hypertrophy and dysfunction were more common in patients with MAS than in the matched control group as well as the presence of symptoms. Timing of valve intervention in patients with symptomatic moderate aortic stenosis should be optimized.

Prognosis and clinical features according to types of hypertrophic cardiomyopathy

Abstract Introduction Hypertrophic cardiomyopathy (HCMP) is a condition characterized by hypertrophy of the myocardium, which can be classified into types based on the location of the hypertrophy. Among these, the most common type is the group with septal hypertrophy. However, prognosis and clinical features according to the type are not well known. Method This study was conducted on 137 patients with HCMP from March 2016 to August 2023. Their echocardiographic findings and demographic features were retrospectively collected, and Single photon emission computed tomography(SPECT) and clinical outcomes were also analyzed. The types of HCMP were classified based on Helmy's classification: basal septal hypertrophy alone (Type I), hypertrophy of the septum and adjacent segments sparing the apex (Type II), apical hypertrophy with hypertrophy of other segments (Type III), and apical hypertrophy alone (Type IV). Additionally, the clinical outcomes, including mortality and cardiovascular hospitalization rates, were analyzed by dividing them into Type I and other types (II~IV). Results The prevalence of type I, II, III, and IV was 23.3% (n = 32), 0% (n = 0), 30.6% (n = 42) and 46% (n = 63). The patients were divided into two groups as septal HCMP (Group I) and non septal HCMP (Group II), with more patients in Group II (n=105, 76.6%) than in Group I (n=35, 23.3%). Mean age, systolic blood pressure, heart rate and body mass index were similar between two groups. In the subgroup analysis of echocardiographic parameter, left ventricular mass (LVM) and relative wall thickness (RWT) were significantly lower in Type IV compared to the other types. In contrast, there was no significant difference between Type I and Type III. In the strain analysis, the global strain values of Type III were significantly lower. (Type I vs. Type III vs. Type IV; -14.7 ± 3.7 vs. -11.1 ± 3.0 vs. -14.2 ± 4.0; p<0.01). Analysis of LV perfusion scores using SPECT showed that cardiac perfusion during stress compared to rest was significantly more impaired in Type III than Type I (p=0.03). In terms of clinical outcomes, mortality was higher in the order of Type I, III, and IV. However, there was no significant difference between Type I and Type III compared to Type IV. Regarding hospitalization, there were no significant differences between the types. Conclusion Patients with non-septal type HCMP accounted for a significant proportion of all HCMP cases. Non-septal types showed differences in echocardiographic parameters and perfusion compared to the septal type. Although the septal type is known to have a worse prognosis, this study did not find a significant difference in hospitalization rates. Further research is warranted.

Assessment of blood pressure response to physical activity: influence on the results of five-step stress echocardiography

Abstract Introduction Due to the high prevalence of hypertensive blood pressure response to exercise (HER) during stress echocardiography (SE), the unclear prognostic significance, and the possible impact on SE results, it seems appropriate to analyze the prevalence of HER in outpatients and inpatients. Additionally, it is essential to identify the influence of HER on the results of the modern SE protocol. Aim To evaluate the incidence of HER during SE with physical activity on a treadmill or horizontal bicycle ergometer in patients and the impact of HER on the results of five-step SE. Materials and methods This single-center study included 193 patients who underwent five-step SE according to clinical indications. The steps in the protocol are as follows: Step A: Evaluates local contractility abnormalities; Step B: Assesses B-lines/diastolic function; Step C: Measures the contractile reserve of the left ventricle; Step D: Assesses the reserve coronary blood flow velocity in the anterior interventricular branch; Step E: Evaluates heart rate reserve. The blood pressure (BP) response to exercise was assessed as hypertensive with a systolic blood pressure (SBP) ≥190 mm Hg on the treadmill and 200 mm Hg on a bicycle ergometer in women, and ≥210 mm Hg and 220 mm Hg, respectively, in men. Alternatively, HER was defined as an increase in SBP ≥180 mm Hg from the second stage of the test or when SBP rises relative to the baseline by ≥60 mm Hg in men and ≥50 mm Hg in women. The incidence of HER during the SE study and the relationship of HER with positive outcomes of the study protocol steps were examined. Results The prevalence of HER in patients undergoing SE was 36.3% (70 patients). Patients with HER were significantly more likely to have low exercise tolerance (p=0.013). Blood flow velocity in the coronary artery, both at rest and under load, and the amount of contractile reserve were significantly higher in patients with HER (p=0.009, p=0.008, and p=0.002, respectively). There was a trend towards a greater value of relative LV wall thickness in patients with HER (p=0.070). Among patients with HER, a decrease in contractile reserve was less common than among patients with an adequate blood pressure response: 45 (64.3%) versus 99 (80.5%) (p=0.013). Conclusion An excessive increase in blood pressure may be a limiting factor, leading to premature termination of testing. Patients with HER are significantly more likely to have poorer exercise tolerance and require more careful monitoring and control of risk factors. There is a relationship between the response of blood pressure to exercise and the results of SE, particularly the effect of peak blood pressure on contractile reserve. The relationship between BP response to exercise and SE steps, as well as its prognostic significance, requires further study.

Cross-Sectional Association Between Left Ventricular Geometric Patterns, Cortical Cerebral Microinfarcts, and Cognition.

Left ventricular (LV) geometric patterns are associated with cognitive impairment and cerebral small vessel disease. As a novel magnetic resonance imaging marker of cerebral small vessel disease and a risk factor for cognitive dysfunction, cortical cerebral microinfarcts (CMIs) have been associated with heart disease through mechanisms including cardioembolism and cerebral hypoperfusion. Further investigation is required to determine whether cortical CMIs could arise from hemodynamic changes related to LV geometry, thus elucidating the connection between LV geometry and cognitive function. This study aims to investigate the cross-sectional relationship between LV geometric patterns, cortical CMIs, and cognition. A total of 261 patients, aged 75.3±6.8 years, were enrolled from a memory clinic study. LV dimensions were obtained using 2-dimensional echocardiography. LV mass index and relative wall thickness were determined to categorize LV geometric patterns. Cortical CMIs were graded on 3T magnetic resonance imaging. Cognition was assessed using neuropsychological tests and clinical diagnosis. Linear, zero-inflated Poisson, and logistic regression were employed for continuous, count, and binary outcomes, respectively. Mediation analysis was conducted to examine the mediation effect of cortical CMIs. A significant association was observed between concentric LV hypertrophy and cortical CMI counts (rate ratio, 3.85 [95% CI, 1.85-8.01]), as well as the odds of having dementia (odds ratio, 2.86 [95% CI, 1.07-7.89]), in the fully adjusted model. Cortical CMIs may partly explain the relationship between concentric LV hypertrophy and cognitive function. Concentric LV hypertrophy was associated with cortical CMIs and dementia. Further verification is warranted to determine the role of cortical CMIs in the association between LV geometry and cognition.

Effect of obesity on cardiovascular remodeling, and aerobic capacity in adults with coarctation of aorta.

We hypothesized that patients with coarctation of aorta (COA) and obesity would have more advanced cardiovascular remodeling and impaired aerobic capacity compared to COA patients without obesity. The purpose of this study was to assess the relationship between obesity, cardiovascular remodeling, and aerobic capacity in adults with repaired COA. The study comprised of 3 groups: (1) Obese COA group (n=177) (COA patients with body mass index [BMI] >30 kg/m2); (2) Non-obese COA group (n=572) (COA patients with BMI ≤30 kg/m2); (3) Control group (n=59) (subjects without structural heart disease and BMI ≤30 kg/m2). Cardiovascular remodeling was assessed using the following indices: (1) Arterial stiffness - total arterial compliance index (TACI). (2) Left ventricular hypertrophy - LV mass (LVM) and relative wall thickness (RWT). (3) LV diastolic function - Doppler-derived estimated LV end-diastolic pressure (LVEDP) and Tau. (4) Right ventricular (RV)-pulmonary artery coupling - RV free wall strain and RV systolic pressure (RVFW/RVSP). Aerobic capacity was assessed using predicted peak oxygen consumption (VO2). The obese COA group had higher LVM, RWT, LVEDP, and Tau, as well as lower RVFWS/RVSP, TACI and peak VO2 compared to non-obese COA group and controls. There was a correlation between BMI and LVM (r=0.39, p<0.001), RWT (r=0.47, p<0.001), LVEDP (r=0.43, p<0.001), tau (r=0.22, p=0.008), RVFWS/RVSP (r=- 0.24, p<0.001), and predicted peak VO2 (r=-0.48, p<0.001). These findings underscore the cardiovascular implications of obesity in the setting of COA, and provide opportunities for interventions to address obesity, and improve outcomes in this population.

Left Atrial Mechanics and Atrioventricular Coupling in Hypertension With Supra-Normal Left Ventricular Ejection Fraction.

Supra-normal left ventricular ejection fraction (snLVEF) represents a heterogeneous group with distinct prognoses. Left atrial (LA) strain, measured by speckle tracking echocardiography (STE), is a validated prognostic indicator. This study aimed to evaluate LA and left ventricular (LV) mechanical strains in hypertensive patients with snLVEF. This retrospective study included 101 patients (mean age 59.7 ± 8.4 years; 61.4% men) with primary arterial hypertension and preserved LVEF (≥50%). Patients were categorized into low-normal LVEF (lnLVEF; 50%-59%), mid-normal LVEF (mnLVEF; 60%-69%), and snLVEF (≥70%). LV global longitudinal strain (LVGLS) and LA strains during reservoir (LASr), conduit (LAScd), and contraction (LASct) phases were measured using STE. Relative wall thickness was significantly higher in snLVEF patients compared to mnLVEF (p < 0.01), with no difference in LVGLS (p = 0.933). Compared to mnLVEF, snLVEF patients had reduced LASr and LAScd (both p<0.01) but preserved LASct (p=0.057). In contrast, lnLVEF patients showed greater reductions in all phasic LA strains (all p<0.01). Loess regression revealed an inverted U-shaped relationship between LASr and LVEF, peaking at LVEF 65%-70%. The mitral E/e'mean ratio and LVGLS correlated moderately to strongly with LASr (r = -0.39 and r = -0.65, respectively; both p < 0.001). Hypertensive patients with snLVEF exhibit impaired LA reservoir and conduit functions while maintaining pump function, suggesting snLVEF may be an intermediate stage between mnLVEF and lnLVEF as hypertension progresses. Further studies are needed to explore the prognostic potential of LA strain in this population.

Association between allostatic load and cardiac structural and functional abnormalities in young adults with serious mental disorders.

Allostatic load refers to the pathophysiological consequences of uncompensated adaptation to chronic stress. Few studies have investigated the effect of allostatic load on cardiac health in patients with serious mental disorders (SMDs), a population at high risk of cardiac mortality. Herein we evaluated associations between allostatic load and cardiac structure and function in young adults with SMDs. A total of 106 participants aged younger than 45years underwent echocardiographic study, blood biochemistry examination, and blood cell count analysis. Echocardiographic imaging was conducted in accordance with recommendations of the American Society of Echocardiography and European Association of Cardiovascular Imaging. Allostatic load index was calculated using 15 measures representing cardiovascular, metabolic, and inflammatory or oxidative stress markers. The SMD group exhibited a significantly higher allostatic load index than did control (Cohen's d=0.59). Additionally, they exhibited a greater left ventricular relative wall thickness (LVRWT, Cohen's d=0.39) and a less favorable mitral valve E/A ratio (Cohen's d=0.31), left ventricular ejection fraction (Cohen's d=0.51), and global longitudinal strain (Cohen's d=0.71). After demographic and clinical characteristics were adjusted for, multiple linear regression revealed that allostatic load index was positively associated with LVRWT (β=0.255) and negatively associated with mitral valve E/A ratio (β=-0.247) in the SMD group. This is the first study to suggest that allostatic load may play a critical role in accelerated adverse cardiac remodeling among young patients with SMDs. Future studies should elucidate the underlying mechanisms.

Significance of Relative Left Ventricle Wall Thickness in Predicting Acute Kidney Injury After Video-Assisted Thoracoscopic Surgery for Lung Cancer.

Aims/Background Given the strong association between relative wall thickness (RWT) and cardiovascular dysfunction, this study aims to explore RWT as a novel cardiovascular indicator to predict the risk of acute kidney injury (AKI) after lung cancer surgery and guide clinical interventions. Methods This study retrospectively analyzed 170 patients who underwent video-assisted thoracoscopic surgery (VATS) for lung cancer in Nanjing First Hospital, China, between January 2022 and December 2023. Patients were divided into AKI group (n = 52) and non-AKI group (n = 118) based on the occurrence of AKI. Univariate analysis was performed to identify factors affecting the development of AKI in patients undergoing VATS for lung cancer. Moreover, multivariate logistic regression analysis was conducted to determine influencing factors. Correlation analysis was used to analyze the relationships between variables, and receiver operating characteristic (ROC) curve analysis was conducted to assess predictive ability. Results There were no statistically significant differences in gender, comorbidities, smoking history, tumor location, Tumor-Node-Metastasis (TNM) Staging System, tumor differentiation, neutrophil count, red blood cell count, white blood cell count, creatinine, urea nitrogen, intraoperative blood loss, and operation time (p > 0.05). The comparison of age, Acute Physiology and Chronic Health Evaluation (APACHE II) score, mean arterial pressure, and RWT between the two groups showed statistically significant differences (p < 0.05). Multivariate logistic regression analysis indicated that age, APACHE II score, mean arterial pressure, and RWT significantly influenced the development of AKI in patients undergoing VATS for lung cancer (p < 0.05). RWT was negatively correlated with mean arterial pressure (r = -0.558, p < 0.05), and positively correlated with age and APACHE II Score (r = 0.573, 0.520, p < 0.05). Moreover, AKI showed a positive correlation with age, APACHE II Score, and RWT (r = 0.726, 0.685, 0.772, p < 0.05), and a negative correlation with mean arterial pressure (r = -0.724, p < 0.05). ROC analysis revealed that the area under the predicted curve for RWT was 0.864, and the standard error was 0.030 (95% confidence interval (CI): 0.805~0.923), with a Youden index of 0.55. At this time, the sensitivity was 87.29% and the specificity was 67.31%. Conclusion RWT shows excellent predictive value for postoperative AKI in patients undergoing VATS for lung cancer.

The Relationship Between Ambulatory Blood Pressure and Atherogenic Index with LV Geometry Pattern in Obese Children: Results from a Cross-Sectional Study in Serbia.

Arterial hypertension and increased atherogenic index of plasma (AIP) are strong predictors of cardiovascular risk associated in individuals with obesity both in adults and children. Thus, we aimed to explore the relationship between AIP and systolic ambulatory blood pressure index (sABPI) with left ventricular geometry pattern in obese children. In this cross-sectional study, a total of 129 obese children (BMI greater or equal to the 95th percentile for age and sex) were examined. Fasting blood samples were taken to measure plasma glucose level, lipid profile, including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), serum uric acid (SUA), and insulin level. Two-dimensional (2-D) transthoracic echocardiography was performed to determine left ventricular geometry pattern. Ambulatory blood pressure recording wasobtained for 24h in all obese children. Linear regression analyses were conducted to explore relationships between AIP (calculated as logarithmic transformation of the ratio of TG to HDL-C) and sABPI with left ventricular myocardial mass index (LVMI) and relative wall thickness (RWT). We also used sex as a potential effect modifier, and calculated stratum-specific estimates of the effect. We demonstrated independent and positive association of age and AIP with RWT (Age: effect size = 0.83 (CI 0.22 - 1.45) p = 0.008; AI effect size 8.9 (CI 3.6 - 14.3); p = 0.01). In a subgroup analysis with sex as an effect modifier, independent positive association of borderline significance at p = 0.011 was found between AIP and RWT only in boys AIP: effect size 9.5 (CI 2.3 - 16.7) p = 0.01. LVMI was significantly associated with sex and BMI (sex: effect size = 6.8 CI (2.6 - 11) p = 0.002; BMI z score: effect size = 6.8 CI (3.2-10.4) p < 0.001). Independent positive association was also found between BMI and LVMI for girls, effect size = 11.9 (CI 4.1-19.8) (p = 0.005). AIP and age are independently associated with the presence of concentric left ventricular geometry with girls seeming more protected from atherogenic hypertrophic stimulus than boys. BMI and sex are independently associated with eccentric left ventricular remodeling, with BMI being a greater risk factor for girls.

Hypertensive Response to Exercise in Normotensive Men and Women with Abdominal Obesity: Association with Subclinical Adverse Cardiac Remodeling.

Background/Objectives: Hypertensive response to exercise (HRE) is an established risk factor for cardiovascular events. HRE is prevalent among people with excess adiposity. Both obesity and HRE have been individually associated with adverse cardiac remodeling. We hypothesized that HRE would be associated with adverse measures of cardiac structure and function in a subgroup of individuals with abdominal obesity. Methods: In a subgroup of 158 participants with elevated waist circumference (women: ≥80 cm, men: ≥94 cm) and resting blood pressure (BP) < 140/90 mm Hg, we evaluated maximal exercise BP and peak oxygen consumption (VO2peak) during cardiorespiratory exercise testing. HRE was defined as maximal exercise BP ≥ 90th percentile per sex and age. Cardiac structure and function on echocardiography were compared between HRE and no HRE (NHRE) groups for each sex. Multivariate linear regression was used to evaluate associations between maximal systolic BP (SBP) and echocardiographic variables, adjusting for age, body mass index, resting SBP, and VO2peak. Results: Participants (75% women) were aged 53 ± 11 years old. Women with HRE had higher resting SBP and subclinical cardiac remodeling abnormalities (increased left ventricular [LV] wall thickness, relative wall thickness, and mass) than NHRE women (p < 0.05). Men with HRE had higher relative wall thickness than NHRE men (p = 0.042). There was no difference in cardiac function between HRE groups (p > 0.05). After adjustment, maximal SBP remained associated with adverse cardiac remodeling parameters for each sex (p < 0.05). Conclusions: Among individuals with abdominal obesity and resting BP < 140/90 mm Hg, HRE was associated with adverse cardiac remodeling. HRE represents a potential screening tool and preventive target to detect those at higher risk of preclinical cardiac changes.

Left ventricular Dysfunction in Normotensive Diabetic Patients

Background: Diabetes is a major risk factor for impaired left ventricular function independent of coronary artery disease and hypertension. Left ventricular diastolic dysfunction is demonstrated in diabetic patients who are normotensive and have no symptoms of cardiac disease. Increased mortality is evident among type II diabetic patients with left ventricular failure with preserved ejection fraction also suggests its causative role diastolic dysfunction. Objective: To describe Left ventricular dysfunction in normotensive diabetic patients. Method: A Cross Sectional Study was undertaken in Comilla Medical College Hospital in 51 patients .29 diabetic patients with normal blood pressure (blood pressure ≤140/90 mmHg) who are not on anti-hypertensive medications and 22 healthy controls enrolled into the study. All patients and control subjects underwent transthoracic echocardiographic evaluation using GE LOGIQ V2 machine. The categorical variables described as frequencies and percentages, while continuous variables presented as medians and interquartile range (IQR) values and means and standard deviations. Continuous variables were compared using the Student’s t- test, while categorical parameters were analyzed with the Chi-square test or two tailed Fischer’s exact test as appropriate. A P-value of 0.05 or less was considered statistically significant. Result: Among 51 patients, 29 were cases and 22 were control. Male to female ratio was 1:1.7. The mean ages were 50.03±12.75 and 41.59±11.25 in case and control group respectively. The body mass index in two groups did not showed any significant difference (21.12±4.1 versus 20.91±3.60: P=0.374). The cases had a normal but significantly lower mean ejection fraction than controls (56.98±13.06 versus 62.48±7.73, respectively: P=0.033). Left ventricular diastolic filling pattern was abnormal in 17 (59%) cases and 6 (28%) in control group. The mean relative wall thickness (RWT) was higher in cases than controls. (0.47±0.11 versus .42±0.08; P= 0.014). Also the same difference observed in case of left ventricular mass index. (101.55±35.45 versus 86.98±28.01; P=0.053). The respondents were normotensive but abnormal filling pattern was observed in 17 (59%) and 6 (28%) in cases and control groups respectively which was significant. (P= 0.00018). Conclusion: Normotensive diabetic patients have asymptomatic diastolic dysfunction. J Com Med Col Teachers Asso July 2024; 28(2): 53-57

Left Ventricular Reverse Remodeling After Successful Living Donor Kidney Transplantation: The VINTAGE Study.

The impact of kidney transplantation (KT) on left ventricular (LV) remodeling remains poorly understood. This study aimed to evaluate the effect of KT on LV reverse remodeling, utilizing echocardiographic LV geometric patterns as a key assessment tool. In 100 recipients who underwent living KT between 2012 and 2022, we evaluated changes in the distribution of LV geometric patterns (normal geometry, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy) between baseline and 1 year post-transplantation. These patterns were categorized based on LV mass index (LVMI) and relative wall thickness (RWT) assessed via echocardiography. Overall, LV geometric patterns improved or remained stable in 81% of recipients, with worsening in 19%. The proportion of normal geometry increased from 15% to 19%, and concentric remodeling from 30% to 45%, while eccentric hypertrophy decreased markedly from 20% to 3%. Concentric hypertrophy remained relatively stable at 33% (p=0.036). Subgroup analysis revealed that 47% of those with pre-KT normal geometry progressed to LV remodeling, while 77% with concentric remodeling remained stable. In contrast, 55% with eccentric hypertrophy experienced reverse remodeling, and 49% with concentric hypertrophy also showed reverse remodeling. These subgroup results suggest an interaction between the effect of KT on LV reverse remodeling and the pre-KT LV geometric patterns. Multivariable analysis identified E/e' > 9.5 (OR 2.01, 95% CI 1.10-3.67, p=0.024) and acute antibody-mediated rejection (OR 2.44, 95% CI 1.01-5.87, p=0.047) as independent predictors of LV remodeling progression. KT can lead to improvements in even advanced LV geometric patterns, although this effect may be diminished in the presence of pre-KT diastolic dysfunction or the occurrence of acute rejection. Since recipients rarely achieve complete renal recovery, echocardiographic monitoring remains crucial post-KT. Future studies are needed to establish whether these observed improvements in LV reverse remodeling directly translate into long-term reductions in cardiovascular events.

Eccentric hypertrophy impairs outcome after TAVR.

Aortic stenosis (AS) induces cardiac remodeling upon chronic left ventricular (LV) pressure overload. Here, we analyzed the clinical outcome of patients undergoing transcatheter aortic valve replacement (TAVR) for symptomatic AS with regard to varying LV hypertrophy patterns. Moreover, we investigated the genetic influence on development of different hypertrophy patterns, measured by polygenic risk scores (PRS). 1703 patients with severe AS undergoing TAVR were categorized according to LV mass index and relative wall thickness in four subgroups: normal geometry (NG, n = 57), concentric remodeling (CR; n = 388), concentric hypertrophy (CH; n = 993) and eccentric hypertrophy (EH; n = 265). Data was analyzed retrospectively with regard to clinical outcome. In a substudy, 520 patients affected by CH (n = 237), EH (n = 139) or CR (n = 164) were analyzed using two PRS that have been previously associated with hypertrophic and dilated cardiomyopathy. 1year after TAVR, for EH, in contrast to the remaining groups (NG, CR, CH), a significant difference in all-cause mortality was observable (mortality 17.4% EH, 14.0% NG, 12.4% CR, 14.0% CH, p = 0.001). This difference was observed up to 4years (mortality 41.9% EH, 26.9% CH, 28.1% CR, 26.4% NG, p = 0.001). Of note, higher percentiles in a PRS for hypertrophic cardiomyopathy were associated with a reduced likelihood of EH in patients with AS (p = 0.046). The EH group had a statistically significant poorer 1-year and 5-year outcomes than the other groups. PRS might help predict myocardial reactions in patients with aortic stenosis in future.

Haemoglobin levels are associated with echocardiographic measures in a Finnish midlife population

Background Within normal variation, higher haemoglobin (Hb) levels are associated with unhealthier body composition, adverse metabolism and cardiovascular disease (CVD)-related mortality. Global longitudinal strain (GLS) is a direct, well validated and reproducible echocardiographic measure for the evaluation of cardiac contractile function, providing additional prognostic value for prediction of a variety of cardiac events. This study investigated the relation between Hb levels and cardiac function measures, including GLS, in a Finnish midlife population. Materials and methods Echocardiography was carried out in a subpopulation of the Northern Finland Birth Cohort 1966 at age of 46 (n = 1155). GLS was available for n = 796. Subjects with diabetes, severe cardiac diseases, echocardiographic abnormalities, heart rate ≥85 bpm during echocardiography or Hb level outside the Finnish reference intervals (117–155 g/L for females and 134–167 g/L for males) were excluded from the analysis. The study population included 635 subjects (46% males). The data were analysed in Hb tertiles and in multivariable linear regression models. Results The highest Hb tertile had adverse anthropometric and metabolic parameters compared to other Hb tertiles. Of the studied echocardiographic parameters, the highest Hb tertile had the highest left ventricular mass (LVM, p < .01), LVM index (LVMi, p < .05), LV end-diastolic volume (LVEDV, p < .05), posterior wall thickness (PWT, p < .001), relative wall thickness (RWT, p < .05) and the lowest absolute GLS (p < .001) but no difference in LV ejection fraction (LVEF) was observed between the Hb tertiles. In linear models, when adjusted for covariates, Hb levels were associated positively and independently with GLS (B = 0.153 [0.071; 0.235]) and LVM (B = 0.272 [0.193; 0.350]). Conclusions Higher Hb levels are associated with an adverse metabolic and inflammatory profile and more adverse cardiac function measures, including GLS, in both sexes in midlife.

Performance of Clinical Scoring Systems in the Diagnosis of Transthyretin Amyloid Cardiomyopathy in a Diverse Patient Cohort.

Two diagnostic clinical scoring systems, the ATTR-CM Score and the T-AMYLO Score, have been proposed but not validated in diverse populations, despite Black race being an important risk factor for transthyretin amyloid cardiomyopathy (ATTR-CM). The aim of this study was to evaluate their performance in diagnosing ATTR-CM in a diverse patient cohort. This retrospective single-center study analyzed patients who underwent a 99mTc-pyrophosphate single photon emission computed tomography scan (Tc-PYP) for workup of suspected ATTR-CM. ATTR-CM was considered present in those exhibiting Perugini scores of 2 or 3, confirmed by myocardial radiotracer uptake via single photon emission computed tomography. The diagnostic performance of a multivariate regression model and the two scoring systems was tested against Tc-PYP as the gold standard. Our cohort included 476 patients, of which 308 (65%) were non-Hispanic Black, 93 (20%) were Hispanic, and 215 (45%) were female. A total of 164 (34%) had a positive Tc-PYP. Age ≥74 years, male sex, history of carpal tunnel, LVEF <55%, posterior wall thickness over 12mm, and relative wall thickness over 0.57 were independent predictors of positive Tc-PYP in our cohort, and hemoglobin <10 mg/dL, glomerular filtration rate <30 ml/min/1.73m2, and coronary artery disease were independent predictors of negative Tc-PYP. The multivariate model had an area under the curve (AUC) of 0.92 (95% CI, 0.90-0.95). The ATTR-CM Score (AUC, 0.86; 95% CI, 0.83-0.90) had better diagnostic accuracy than the T-AMYLO Score (AUC, 0.75; 95% CI, 0.71-0.80) (P < 0.001). Two simple clinical scoring systems, derived to identify patients at high risk of having ATTR-CM necessitating further diagnostic evaluation, showed good predictive accuracy in our diverse patient cohort. The ATTR-CM Score was superior to the T-AMYLO Score in our cohort.

Simulation of the process of transverse-forward extrusion with expansion

Levchenko V. M., Aliiev I. S., Chepelenko O. Yu., Kartamyshev D. O., Malii O. G. Simulation of the process of transverse-forward extrusion with expansion Combined extrusion methods are a competitive solution for the production of complex-profiled and hollow parts in optimal power mode. By simulation of the combined transverse-forward extrusion process with using the energy method of kinematic modules, calculated correlations were obtained and an assessment of the influence of technological parameters on the deformation pressure was given. The possibility of considering the process of combined extrusion as sequentially composed one of two plane modules with the addition of normalized pressures of transverse and forward extrusion with expansion has been confirmed. For the transverse extrusion module the correlations obtained by the upper bound method and showing results close to experimental data and similar solutions for problems of plane upsetting (final stage of die forming) and differing in two types of discontinuous velocity field were used. For a rectangular module of forward extrusion with expansion, a discontinuous velocity field was constructed and the correlation for calculating the pressure components on the velocity discontinuity lines was obtained. It has been found that there is an optimal value for the angle of the triangular module in the range of 42–45°, according to which it is recommended to tilt the semi-die wall. A graphical analysis of the dependence of the normalized combined extrusion pressure has allowed to identify that the relative parameters have the greatest influence on the pressure level: the height of the transverse extrusion deformation zone h/R0 and the thickness of the ledge h/s, which characterize the degree of metal deformation. The correlations that make it possible to evaluate the influence of the relative wall thickness of a hollow product h/s on the normalized deformation pressure were experimentally confirmed on workpieces made of aluminum alloy AA1135.

Effect of insulin resistance on left ventricular remodelling in essential hypertensives: a cross-sectional study.

In clinical practice, left ventricular hypertrophy (LVH) is defined by physical findings and electrocardiographic criteria, which are useful but imperfect tools, echocardiographic criteria and cardiac magnetic resonance imaging. In echocardiography, LVH is defined not by left ventricular wall thicknesses but by left ventricular mass. The latter is calculated according to Devereux's formula, and is increased by insulin resistance/hyperinsulinaemia. It is however unclear whether insulin resistance, hyperinsulinaemia, or both, is actually causative and what their collective or individual influence is on the components of Devereux's formula and parameters of left ventricular diastolic function. This study evaluated the associations of the homeostatic model assessment for insulin resistance (HOMAIR) and fasting plasma insulin levels with components of Devereux's formula and parameters of left ventricular diastolic function. Relevant clinical data were collected from 220 hypertensive patients recruited between January and December 2019. The associations of components of Devereux's formula and parameters of diastolic function with insulin resistance were tested using binary ordinal, conditional and classical logistic regression models. Thirty-two (14.5%) patients (43.9 ± 9.1 years), 99 (45%) patients (52.4 ± 8.7 years) and 89 (40.5%) patients (53.1 ± 9.8 years) had normal left ventricular geometry, concentric left ventricular remodelling and concentric left ventricular hypertrophy, respectively. In multivariable adjusted analysis, 46.8% of variation in interventricular septum diameter (R² = 0.468; overall p = 0.001) and 30.9% of E-wave deceleration time (R² = 0.309; overall p = 0.003) were explained by insulin level and HOMAIR, 30.1% of variation in left ventricular end-diastolic diameter (R² = 0.301; p = 0.013) by HOMAIR alone, and 46.3% of posterior wall thickness (R² = 0.463; p = 0.002) and 29.4% of relative wall thickness (R² = 0.294; p = 0.007) by insulin level alone. Insulin resistance and hyperinsulinaemia did not have the same influence on the components of Devereux's formula. Insulin resistance appeared to act on left ventricular end-diastolic diameter, while hyperinsulinaemia affected the posterior wall thickness. Both abnormalities acted on the interventricular septum and contributed to diastolic dysfunction via the E-wave deceleration time.