Risk Of Left Ventricular Hypertrophy Research Articles

Assessment of Left Ventricular Hypertrophy (LVH) Criteria by Surface Electrocardiography in a Sample of Iraqi Patients with Systemic Arterial Hypertension.

Background:Left ventricular hypertrophy (LVH) in hypertensive patients indicates an ongoing disease process involving the heart. Different electrocardiography (ECG) criteria were investigated; however, the results were conflicting.Objective:To evaluate different ECG criteria in diagnosis of LVH in hypertensive patients using echocardiography as a gold standard.Methods:A hospital based cross sectional observational study which included 140 adult patients with a history of hypertension. Patients were assessed for LVH using five ECG criteria: Romhilt-Estes, SokoloweLyon, Cornell voltage, Gubnere Ungerleider and Peguero-Lo Presti. Echocardiography was used to determine the left ventricular mass index for the patients. The sensitivity and specificity of each ECG criterion was determined considering echocardiography as a gold standard.Results:According to the echocardiographic results, 83 patients (59.29%) were found to have LVH. Age over 40 years, overweight and obesity, high systolic blood pressure (>170 mmHg) and using of antihypertensive drugs were significantly associated with the increased risk of LVH. All included ECG criteria showed low sensitivity and high specificity in detection of LVH in hypertensive patients. There were no significant differences in the efficiency of different ECG criteria in discrimination between mild, moderate and severe cases of LVH.Conclusion:LVH is very common among hypertensive patients, and the sensitivity of ECG criteria is low for these criteria to be clinically used for detection of LVH with high specificity, in which Cornell criterion is the best in detection.

Uric acid and left ventricular hypertrophy: another relationship in hemodialysis patients.

BackgroundThe impact of serum uric acid (UA) on morbidity and mortality in hemodialysis (HD) patients is quite controversial in relation to the general population. The aim of this study was to evaluate the association of serum UA with both mortality and left ventricular hypertrophy (LVH) in HD patients.MethodsThis longitudinal study enrolled 225 prevalent HD patients who were classified into three groups according to their follow-up-averaged UA (FA-UA) levels: low FA-UA (FA-UA <400 µmol/L), intermediate/reference FA-UA (FA-UA between 400 and 450 µmol/L) and high FA-UA (FA-UA >450 µmol/L). Echocardiography was performed on a nondialysis day and the presence of LVH was defined based on a left ventricular mass index (LVMI) >131 and >100 g/m2 for men and women, respectively. The patients were followed during a 60-month period.ResultsThe mean FA-UA level was 425 ± 59 µmol/L (range 294–620). There was a consistent association of higher FA-UA with better nutritional status (higher body mass index, normalized protein catabolic rate, creatinine, albumin and phosphorus), higher hemoglobin, but lower C-reactive protein and LVMI. During the 5-year follow-up, 81 patients died (36%) and the main causes of death were cardiovascular (CV) related (70%). When compared with the reference group, the hazard ratio for all-cause mortality was 1.75 [95% confidence interval (CI) 1.02–2.98; P = 0.041] in the low FA-UA group, but there was no significant association with the high FA-UA group. In contrast, FA-UA did not show an association with CV mortality neither with the lower nor with the high FA-UA group. The unadjusted odds ratio (OR) of LVH risk in the low FA-UA compared with the reference FA-UA group was 3.11 (95% CI 1.38–7.05; P = 0.006), and after adjustment for age, gender, diabetes and CV disease, ORs for LVH persisted significantly only in the low FA-UA group [OR 2.82 (95% CI 1.16–6.88,); P = 0.002].ConclusionsLow serum UA is a mortality risk factor and is associated with LVH in HD patients. These results are in contrast with the association of UA in the general population and should be the subject of further research.

Albuminuria and other target organ damage in Chinese patients with hypertension and diabetes: A data analysis based on the ATTEND study

AimsThe relationship between albuminuria and left ventricular hypertrophy (LVH) was well characterized in hypertension (HTN), but not in diabetes. Moreover, most studies have described the correlation between albuminuria and cardiovascular mortality, but not cardiovascular diseases (CVD) morbidity. This study aimed to explore the relationship between albuminuria and LVH, CVD morbidity in patients with HTN, diabetes mellitus (DM) or HTN + DM. MethodsConducted a data analysis based on the demographic, medical history and laboratory data of 2504 patients from the ATTEND study, a national registry study on HTN and DM in Chinese outpatients. ResultsThe prevalence of LVH and CVD was 7.7% and 21.5% in HTN + DM, 7.6% and 17.6% in HTN, 3.9% and 5.2% in DM patients. Subjects with HTN + DM implied higher risk of LVH (P = 0.023), CVD (P = 0.001) and 10-year coronary heart disease (CHD) (P < 0.001) than those with DM only. There was no significant relationship between albuminuria and LVH or CVD. ConclusionsMore than one-fifth of HTN and/or DM patients with microalbuminuria suffered from CVD. Comorbidity of DM and HTN significantly increases cardiovascular events than DM only. No statistical association between albuminuria and LVH or CVD was found.

Prognosis associated with geometric patterns of left ventricular remodeling: systematic review and network meta-analysis

Background:There are four geometric patterns (normal geometry, concentric remodeling, concentric and eccentric hypertrophy) used to describe cardiac remodeling. Although left ventricular hypertrophy (LVH) is associated with adverse prognosis, the incremental prognostic value of geometric patterns is less certain. We examined characteristics and prognosis associated with the four conventional patterns of left ventricle (LV) remodeling.Methods:A comprehensive literature search was performed on MEDLINE/PubMed, Embase and the Cochrane Library until January 2019. Network meta-analysis was used to pool data from direct and indirect prognostic comparisons of the four geometric patterns. All-cause mortality was defined as the study outcome. Results:A total of 22 echocardiographic studies (76,142 individuals; 50.1% males; 64.4±7.9 years) of diverse cardiovascular diseases were included. Concentric LVH was associated with the highest prevalence of cardiovascular risk factors and diseases; and eccentric hypertrophy was associated with a high prevalence of atrial fibrillation and low LV ejection fraction. Compared to normal geometry, the risk of all-cause mortality was increased in concentric hypertrophy (risk ratio 1.97 [95% confidence interval 1.63-2.39]) but similar to eccentric hypertrophy (risk ratio 1.15 [95% confidence interval 0.97-1.36]). Conclusions:The study populations examined in the meta-analysis were heterogeneous. Concentric LVH conferred the highest risk of all-cause mortality that overlapped with eccentric hypertrophy. Strategies to improve LVH risk stratification should be examined in future research.

Association of joint effect of overweight/obesity and elevated blood pressure with left ventricular hypertrophy in children

Objective: To examine the association of joint effect of overweight (including obesity) and elevated blood pressure (BP) with left ventricular hypertrophy (LVH) in children. Methods: A convenient cluster sampling method was used to conduct a cross-sectional survey from November 2017 to January 2018 in a primary school in Huantai County, Zibo City, Shandong Province. A total of 1 319 children aged 6-11 years old who had complete data on anthropometric indices and variables collected using a questionnaire were included in the study. LVH was defined as left ventricular mass index (LVMI) ≥90 th percentile for sex and age of this population. Based on weight status (yes vs. no) and elevated BP status (yes vs. no), all participants were divided into four subgroups (normal weight and normal BP, normal weight and elevated BP, overweight and normal BP, overweight and elevated BP). LVMI levels or prevalence of LVH across four subgroups were compared. The multivariate logistic regression model was used to examine the association of joint effect between overweight and elevated BP with LVH in children. Results: The age of children was (8.4±1.6) years, and boys accounted for 53.3% (n=703). There were significant differences in LVMI levels and prevalence of LVH across four subgroups (P<0.05); Children with both overweight and elevated BP (n=184) had the highest LVMI levels and prevalence of LVH [LVMI: (30.69±0.32) g/m(2.7); the prevalence of LVH: 24.46%]. After the adjustment for potential covariates, compared to children with both normal weight and normal BP (n=657), the risk of LVH in children with elevated BP alone (n=136) was not increased [OR (95%CI) was 0.89 (0.30-2.62)]. Children with overweight alone (n=342) [OR (95%CI) was 5.69(3.39-9.55)] and those with both overweight and elevated BP [OR (95%CI) was 9.45 (5.47-16.33)] were at higher risk of LVH. Conclusion: The joint effect between overweight and elevated BP could be highly correlated with LVH in children.

The association of obstructive sleep apnea and left ventricular hypertrophy in obese and overweight children with history of elevated blood pressure.

Obesity is a potent cardiovascular disease (CVD) risk factor and is associated with left ventricular hypertrophy (LVH). Obstructive sleep apnea (OSA) is common among individuals with obesity and is also associated with CVD risk. The authors sought to determine the association of OSA, a modifiable CVD risk factor, with LVH among overweight/obese youth with elevated blood pressure (EBP). This was a cross-sectional analysis of the baseline visit of 61 consecutive overweight/obese children with history of EBP who were evaluated in a pediatric obesity hypertension clinic. OSA was defined via sleep study or validated questionnaire. Children with and without OSA were compared using Fisher's exact tests, Student's t tests, and Wilcoxon rank sum test. Multivariable logistic regression evaluated the association between OSA and LVH. In this cohort, 71.7% of the children had LVH. Children with OSA were more likely to have LVH (85.7% vs 59.4%, P=0.047). OSA was associated with 4.11 times greater odds of LVH (95% CI 1.15, 14.65; P=0.030), remaining significant after adjustment for age, sex, race, and BMI z-score (after adjustment for hypertension, P=0.051). A severe obstructive apnea-hypopnea index (AHI >10) was associated with 14 times greater odds of LVH (95% CI 1.14, 172.64, P=0.039). OSA was significantly associated with LVH among overweight/obese youth with EBP, even after adjustment for age, sex, race, and BMI z-score. Those with the most severe OSA (AHI >10) had the greatest risk for LVH. Future studies exploring the impact of OSA treatment on CVD risk in children are needed.

Incident Left Ventricular Hypertrophy in Masked Hypertension.

In the PAMELA study (Pressioni Arteriose Monitorate e Loro Associazioni), clinical variables, an echocardiogram, as well as office and ambulatory blood pressure (ABP) were simultaneously measured at baseline and after a 10-year follow-up. The study design allowed us to assess the value of masked hypertension (MH) as a predictor of new-onset left ventricular hypertrophy (LVH). The present analysis included 803 participants without LVH at baseline (left ventricular mass index <115 g/m2 in men and <100 g/m2 in women). Based on office and 24-hour mean ABP values, subjects were divided into 3 groups: normal subjects (normotensive, office blood pressure [BP] <140/90 mm Hg and 24-hour mean ABP <130/80 mm Hg), MH (office BP, normal, and 24-hour mean ABP, elevated), and sustained hypertension (office and 24-hour BP, both elevated). At entry, 57 of 803 subjects fulfilled diagnostic criteria for MH (7.1%); 182 participants developed LVH (22.6%). Compared with subjects with normal in-office and out-of-office BP, the risk of new-onset LVH was greater in MH (odds ratio, 2.22; CI, 1.11-4.46, P=0.0250) after adjustment for potential confounders. This was also the case for the absolute increase of left ventricular mass index. Our study provides a new piece of evidence that MH, identified by office and ABP values, is associated with an increased risk of new-onset LVH. Moreover, our findings convey the notion that office BP may inaccurately estimate the risk of incident LVH in the general population.

Deletion Polymorphism of Angiotensin Converting Enzyme Gene is Associated with Left Ventricular Hypertrophy in Uighur Hypertension-Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS) Patients.

BackgroundThis study aimed to explore the association of angiotensin converting enzyme (ACE) gene insertion/deletion polymorphisms with left ventricular hypertrophy (LVH) in Han and Uighur hypertension-OSAHS (obstructive sleep apnea hypopnea syndrome) patients in China.Material/MethodsA total of 162 Han and 72 Uygur patients with hypertension-OSAHS were independently subdivided into an LVH group and a non-LVH (NLVH) group based on the left ventricular mass index. The insertion/deletion polymorphisms of ACE gene were determined by polymerase chain reaction. The association of ACE gene insertion/deletion polymorphisms with LVH was assessed by chi-squared test. Logistic regression analysis was performed to obtain the odds ratios and 95% confidence intervals for the risk of LVH after adjusting for confounding factors.ResultsIn Uighur patients, the distributions of D allele and DD genotype showed significant differences between the LVH group and the NLVH group. The difference of DD genotype remained significant after multivariate adjustment. In contrast, no significant differences were observed in the distributions of D allele and DD genotype between the LVH group and the NLVH group in Han patients. Moreover, moderate-severe OSAHS was an independent risk factor for LVH.ConclusionsD allele and DD genotype of ACE gene are possible genetic markers for the risk of LVH in Uighur but not Han hypertension-OSAHS patients.

Elektrokardiografia w diagnostyce przerostu mięśnia lewej komory u pacjentów ze schyłkową niewydolnością nerek leczonych powtarzanymi zabiegami hemodializ

Introduction. Left ventricular hypertrophy (LVH) is one of the most common cardiovascular risk factors in patients under- going haemodialysis (HD). Although standard ECG can help to identify patients at greater risk of LVH, its prognostic value in haemodialysed patients is uncertain. This study aimed to evaluate currently used ECG criteria for LVH in patients on renal replacement therapy. Material and methods. A group of 90 patients, who were undergoing qualification to renal transplantation, were included in the study. Every patient underwent 12-lead ECG and transthoracic echocardiography. Patients with any conduction disorders were excluded from the study. Finally, the study group consisted of 76 patients (21 women, mean age 53.1 ± 14.4 years). Results. LVH was diagnosed by echocardiography in 39 patients (51%, 27 men and 12 women). Only three out of six tested criteria showed satisfactory performance for LVH diagnosis in HD patients: the sum of S V3 and R aVL > 28 mm in men, and > 20 mm in women (area under curve [AUC] 68%, 95% confidence interval [CI] 56–80); the sum of S V1 and R V5 or V6 > 35 mm (AUC 63%, 95%CI 50–76); and the sum of SV2 and RV5 or V6 > 45 mm (AUC 63%; 95%CI 50–75). Conclusions. The present ECG diagnostic criteria for LVH are of very limited value in patients undergoing HD. Further studies should be performed to establish new ECG criteria for this group of patients. In the meantime, echocardiography should be recommended as the most precise diagnostic routine test to evaluate HD patients for LVH.

Hypertension and hypertensive left ventricular hypertrophy are associated with ACE2 genetic polymorphism

AimsRenin-angiotensin system modulates cardiac structure independent of blood pressure. The present study aimed at investigating whether single nucleotide polymorphism (SNP) and haplotype of angiotensin converting enzyme 2 (ACE2) could influence blood pressure and the susceptibility to hypertensive left ventricular hypertrophy (LVH). Subjects and methodsA total of 647 patients (347 females and 300 males) with newly diagnosed mild to moderate essential hypertension were enrolled in a blood pressure matched, case-control study. Four ACE2 tagSNPs (rs2074192, rs4646176, rs4646155 and rs2106809) were genotyped and major haplotypes consisting of these four SNPs were reconstructed for all subjects. Key findingsIn females, minor alleles of ACE2 rs2074192 and rs2106809 respectively conferred a 2.1 and 2.0 fold risk for LVH. ACE2 haplotype TCGT increased the risk for LVH while another haplotype CCGC decreased the risk in females. The covariates-adjusted mean left ventricular mass index was 11% greater in TCGT haplotype carriers than in noncarriers in women. In females, the covariates-adjusted mean systolic blood pressure was 3.4 mm Hg lower in CCGC haplotype carriers than in noncarriers. In males, the covariates-adjusted mean systolic blood pressure was 2.4 mm Hg lower in CCGC haplotype carriers than in noncarriers. SignificanceACE2 tagSNPs rs2074192 and rs2106809 as well as major haplotypes CCGC and TCGT may serve as novel risk markers for LVH in hypertensive patients.

High Normal Blood Pressure and Left Ventricular Hypertrophy Echocardiographic Findings From the PAMELA Population.

Cross-sectional and longitudinal data analysis of the PAMELA (Pressioni Monitorate E Loro Associazioni) population was performed to assess the association between prehypertension and left ventricular hypertrophy (LVH) at entry and the risk of new-onset LVH associated to this condition in the subset of participants with normal LV mass index (LVMI). A total of untreated 1397 participants with measurable echocardiographic parameters at baseline were considered in the cross-sectional analysis. The longitudinal analysis included 880 participants without LVH at baseline and with measurable LVMI at follow-up examination performed 10 years later. At entry, after adjustment for major confounders LVH prevalence rates (LVM/body surface area) showed a significant, progressive increase from the normotensive (2.1%), to prehypertension (6.7%), and hypertension group (18.3%). The incidence of LVH increased progressively from the normotensive to prehypertension and hypertension group (9.0%, 23.2%, and 36.5%, respectively). The risk of new LVH was significantly greater in prehypertension who progressed to sustained hypertension (odds ratio, 4.21; CI, 1.64-10.83; P=0.003) than in those with persistent prehypertension (odds ratio, 1.89; CI, 0.77-5.11; P=0.21) compared with persistent normotensive participants after adjustment for age, sex, baseline LVMI, obesity, glucose, creatinine, total cholesterol and the use of antihypertensive drugs at follow-up. Further adjustments for changes in body mass index, metabolic variables, and creatinine during the follow-up did not modify the strength of association between prehypertension and new-onset LVH. Our findings offer a new piece of evidence on the association of prehypertension with LVH and support the view that preventive actions for this condition affecting a large fraction of the general population should be intensified.

Impaired systolic and diastolic left ventricular function in children and adolescents with congenital adrenal hyperplasia receiving corticosteroid therapy.

The study included 44 children with the diagnosis of classic congenital adrenal hyperplasia and 39 healthy children whose age, pubertal status, and gender were similar to those of the patient group. Anthropometric parameters and 17-hydroxyprogesterone levels were measured, and bone age was calculated. The average daily hydrocortisone dose was calculated over the last 1-year file records. Hyperandrogenic state was defined according to bone age SD score (⩾2) and 17-hydroxyprogesterone levels (&gt;10 ng/ml). Echocardiographic examinations were assessed by conventional two-dimensional Doppler echocardiography and tissue Doppler imaging. Patients had higher morphological parameters, such as left ventricular end-systolic diameter, interventricular septal thickness at end diastole, left ventricular posterior wall thickness at end diastole, left ventricular mass and index, than the control group (p&lt;0.05). On pulsed-wave and tissue Doppler echocardiography, significant subclinical alterations were observed in systolic (isovolumic contraction time), diastolic (isovolumic relaxation time), and global left ventricular functional (myocardial performance index) parameters in the congenital adrenal hyperplasia group compared to the control group (p&lt;0.05). In partial correlation analyses, after controlling the effect of hyperandrogenism, the mean hydrocortisone dosage was positively correlated with isovolumic relaxation time in congenital adrenal hyperplasia group (p&lt;0.05). This study demonstrated that the patients with congenital adrenal hyperplasia are at risk for left ventricular hypertrophy, systolic and diastolic myocardial subclinical alterations. Overtreatment may be responsible for the increased risk of myocardial dysfunction in patients with congenital adrenal hyperplasia.

Oxidative Stress and Cardiovascular Complications in Chronic Kidney Disease, the Impact of Anaemia.

Patients with chronic kidney disease (CKD) have significant cardiovascular morbidity and mortality as a result of risk factors such as left ventricular hypertrophy (LVH), oxidative stress, and inflammation. The presence of anaemia in CKD further increases the risk of LVH and oxidative stress, thereby magnifying the deleterious consequence in uraemic cardiomyopathy (UCM), and aggravating progression to failure and increasing the risk of sudden cardiac death. This short review highlights the specific cardio-renal oxidative stress in CKD and provides an understanding of the pathophysiology and impact of uraemic toxins, inflammation, and anaemia on oxidative stress.

A1630 Association between growth differentiation factor 15 and left ventricular hypertrophy in hypertensive patients and healthy adults

Objectives: Growth differentiation factor 15 (GDF-15) as an independent biomarker of cardiovascular diseases merits further evaluation. Methods: We studied the association between plasma GDF-15 levels and left ventricular hypertrophy (LVH) in hypertensive patients and healthy adults. Hypertensive LVH measurements were performed via echocardiography and analyzed using the cube formula, and human GDF-15 together with interleukin-6 (IL-6) and matrix metalloproteinase-9 (MMP-9) concentrations were determined via enzyme-linked immunosorbent assay (ELISA). Results: A total of 302 participants were recruited for this clinical study. Circulating GDF-15, IL-6 and MMP-9 levels were significantly higher in LVH patients (n = 67) than in non-LVH patients (n = 172) and healthy controls (n = 63) (p < 0.001). After adjustment for confounders via multivariate logistic regression, elevated plasma GDF-15 concentrations remained independently associated with LVH in hypertensive patients. In addition, GDF-15 was positively correlated with IL-6 and MMP-9 levels in human plasma, respectively, suggesting that a link exists between GDF-15 expression and inflammation. We also calculated an optimal GDF-15 cut-off point with which LVH severity can be predicted in the current study. Conclusion: GDF-15 is associated with hypertensive LVH and may be a powerful biomarker with which LVH risk can be predicted in patients with hypertension.

A14716 Low-grade albuminuria is associated with left ventricular hypertrophy and diastolic dysfunction in patients with hypertension

Objectives: The aim of this study was to investigate the relationship of low-grade albuminuria, the higher levels of albuminuria below microalbuminuria threshold, with left ventricular hypertrophy (LVH) and diastolic dysfunction in patients with hypertension. Methods: A cross-sectional observational clinical study was retrospectively performed in a cohort of hypertensive patients from Fujian, China. Urinary albumin to creatinine ratio (UACR) was used to assess the levels of albuminuria. All patients were categorized based on UACR: normal albuminuria, microalbuminuria and macroalbuminuria, and normal albuminuria was further categorized into sex-specific tertiles. Results: A total of 870 eligible patients were enrolled in this study. Of which, 765 (87.9%) had normal albuminuria.There was a trend of increasing proportion of LVH and diastolic dysfunction with ascending UACR. UACR was independently associated with LVH and diastolic dysfunction. The association was observed even in patients with normal albuminuria. patients with the highest tertile had nearly 1.8 fold risk for LVH and nearly1.6 fold risk for diastolic dysfunction compared with those with the lowest tertile (adjusted OR for LVH 1.788, 95%CI 1.181 to 2.708, P = 0.006; adjusted OR for LV diastolic dysfunction 1.567, 95%CI 1.036 to 2.397, P = 0.034). When stratified analyses were performed in patients with normal albuminuria, the independent associations was shown to persist in female and the patients younger than 70 years old and those with duration of hypertension less than 15 years old. Conclusion: Low-grade albuminuria may be used to identify hypertensive patients at higher risk at early cardiac changes, especially in patients younger than 70 years old and with duration of hypertension less than 15 years.

A3981 Relationship between methylenetetrahydrofolate reductase C677T gene polymorphism and left ventricular hypertrophy with hypertension

Objectives: This study was performed to explore the effects of homocysteine (Hcy) and 5,10-methylenetetrahydrofolate reductase (MTHFR) C677T on the left ventricular hypertrophy (LVH) among hypertensive Chinese Han population. Methods: This study included 456 hypertensive patients. MTHFR C677T polymorphism was analyzed by by taqman probe and fluorescent quantitative PCR. Cardiac structure and function indicators were measured by transthoracic echocardiography. According to left ventricular mass index (LVMI), 132 cases were elected out as essential hypertension with LVH group and 324 cases as non-left ventricular hypertrophy (NLVH) group. According to LVMI and left ventricular relative wall thickness (LVRWT), essential hypertension was divided into 4 subgroups: normal geometry (NG) group, concentric remodeling (CR) group, concentric hypertrophy (CH) group, and eccentric hypertrophy (EH) group. Results: (1) The frequency of TT genotype and T allele in LVH group was higher than those in NLVH group (P < 0.05). (2) The level of Hcy in TT genotype was higher than that in CT and CC genotype (P < 0.01). The values of LVMI and LVPWT in CT and TT genotype, were higher than that in CC (P < 0.01). (3) Subgroup analysis showed that there were significant differences in genotype frequency and level of Hcy among different subgroups, and highest frequency of TT genotype and highest level of Hcy were in EH group. (4) 1 umol/l increase in Hcy was associated with a 7.9% increase in the incident risk of LVH. Genetic model analysis showed that MTHFR were associated with LVH [OR 2.264 (95% CI 1.337–3.834),P = 0.002]. Conclusion: Hcy and MTHFR C677T polymorphism were an independent risk factor for LVH. TT genotype carriers or T allele carriers had a higher susceptibility to LVH incidence, especially EH.

Time-averaged hemoglobin values, not hemoglobin cycling, have an impact on outcomes in pediatric dialysis patients.

During erythropoietin-stimulating agent (ESA) treatment, hemoglobin (Hb) levels usually fluctuate; this phenomenon is known as "Hb cycling (HC)." In this study, we aimed to evaluate the predictors of HC and its impact on left ventricular hypertrophy (LVH) as a patient-important outcome parameter in pediatric dialysis patients. Records of patients followed up in nine pediatric nephrology centers between 2008 and 2013 were reviewed. More than 1g/dL decrease or increase in Hb level was considered as HC. Patients were divided into two groups according to 12-month Hb trajectory as rare cycling (RC) (≤ 3) and frequent cycling (FC) (> 3 fluctuation) as well as three groups based on T-A-Hb levels: < 10, 10-11, and > 11g/dL. Two hundred forty-five dialysis (160 peritoneal dialysis (PD) and 85 hemodialysis (HD)) patients aged 12.3 ± 5.1 (range 0.5-21)years were enrolled in this study. Fifty-two percent of the patients had RC, 45% had FC, and only 3% had no cycling. There were no differences between HC groups with respect to age, dialysis modality, having anemia, hospitalization rate, residual urine volume, and mortality. Although left ventricular mass index (LVMI) tended to be higher in RC than FC group (65 ± 37 vs 52 ± 23g/m2.7, p= 0.056), prevalence of LVH was not different between the groups (p= 0.920). In regression analysis, FC was not a risk factor for LVH, but low T-A Hb level (< 10g/dL) was a significant risk for LVH (OR = 0.414, 95% CI 0.177-0.966, p= 0.04). The target Hb levels were more often achieved in PD patients, and the number of deaths was significantly lower in non-anemic patients (Hb level > 11g/dL). Hb cycling is common among dialysis patients. Severity of anemia rather than its cycling has more significant impact on the prevalence of LVH and on inflammatory state.

Women with polycystic ovary syndrome exhibit an increased risk of left ventricular hypertrophy

Women with polycystic ovary syndrome exhibit an increased risk of left ventricular hypertrophy

Determinants of Left Ventricular Hypertrophy and Diastolic Dysfunction in an HIV Clinical Cohort

The aim of this work was to investigate determinants of structural myocardial abnormalities in persons living with human immunodeficiency virus (PLWH). We reviewed archived transthoracic echocardiograms (TTEs) performed on PLWH at Duke University Medical Center from 2001 to 2012. The primary outcomes were presence of left ventricular hypertrophy (LVH) or diastolic dysfunction (DD). TTEs for 498 human immunodeficiency virus-infected persons were reviewed (median age 44 years, 38% female, 72% black, 34% with hypertension, 15% with diabetes). Among those with usable images, LVH was detected in 174 of 473 persons (37%) according to LV mass criteria and in 99 of 322 persons (31%) according to American Society of Echocardiography LV mass index criteria. Definite DD was detected in 18 of 224 persons (8%). LVH was more common in PLWH with a CD4 count ≤ 200 cells/mm3 proximal to TTE (adjusted OR 1.68, 95% CI 1.08-2.62), CD4 nadir ≤ 200 cells/mm3 (adjusted OR 1.63, 95% CI 1.04-2.54) and less common in persons with viral suppression (OR 0.46, 95% CI 0.27-0.80). Lower CD4 nadirs (P = .002) and proximal CD4 counts (P = .002) were also associated with DD. Persons with a history of advanced human immunodeficiency virus-associated immune suppression are at higher risk of LVH and DD than infected persons with preserved immune function.

Fibroblast growth factor-23 (FGF-23) / soluble Klotho protein (sKlotho) / sclerostin glycoprotein ratio disturbance is a novel risk factor for cardiovascular complications in ESRD patients receiving treatment with regular hemodialysis or hemodiafiltration.

Aim of the study was to explore the role of the FGF-23/sKlotho/sclerostin ratio disturbance in the determining of cardiovascular risk in end stage renal disease (ESRD) patients, receiving treatment with regular hemodialysis (НD) or hemodiafiltration (НDF) online in Russia. 42 patients with ESRD, at the age of 18-55 years, treated with HD or HDF on line for at least 6 months, were examined. 22 (52.3%) patients received traditional HD, the remaining 20 (47.7%) - HDF online. In all the patients, in addition to a general examination, the serum levels of FGF-23, sKlotho, sclerostine (by ELISA), their associations with cardiovascular risk factors (left ventricular hypertrophy (LVH), acute coronary syndrome (ACS), serum troponin I levels) with the numbers of techniques (ECG; Eho-CGF (with calculation of left ventricular myocardium mass index (LVMMI), as well as the relative thickness of the walls of the left ventricle (RWT); sphygmography (central (aortal) blood pressure (CBP), subendocardial blood flow (SBF) - by «Sphygmocor»), and the effect of regular HD and HDF on serum levels of the studied markers, were assessed. An independent effect of FGF-23 on the risk of LVH, as well as on the increase of serum troponin I in the studied ESRD patients [β=3.576 p&lt;0.01, and β=1.115, p&lt;0.05, respectively] was found. Serum Klotho was the factor most associated with the CBP [β=-0.023; p&lt;0.001]. The increased serum sclerostin was correlated with a lower incidence of both reduced SBF [r=0.492; p&lt;0.05], symptoms of coronary heart disease [r=-0.449; p&lt;0.05] and rhythm disturbances [r=-0.446; p&lt;0.05]. In addition, in HD patients higher FGF-23 and lower Klotho and sclerostine serum levels were associated with: inadequate dialysis syndrome (Kt/V &lt;1.1; r=0.463; p&lt;0.05), chronic inflammation (C-reactive protein &gt;10 mg/L; r=0.612; p&lt;0.01), and with a decrease in serum albumin level (&lt;35 g/l; r=0.459; p&lt;0.05). The FGF-23/sKlotho/sclerostin ratio disturbance was more pronounced in patients treated with traditional HD then HDF online. A direct correlation (r=0.445; p&lt;0.05) was established between FGF-23 serum levels and serum phosphorus, which was more pronounced in HD patients (r=0.545; p&lt;0.01). In HD and HDF ESRD patients, higher serum FGF-23 and lower sKlotho and sclerostin levels were associated with a chronic inflammation, malnutrition, secondary hyperparathyroidism, and may considered as predictors of cardiovascular complications such as LVH, ACS, rhythm disturbances, persisting of subincreased serum troponin I.