Type Of Left Ventricular Hypertrophy Research Articles

Developmental Aspects of Cardiac Adaptation to Increased Workload

The heart is capable of extensive adaptive growth in response to the demands of the body. When the heart is confronted with an increased workload over a prolonged period, it tends to cope with the situation by increasing its muscle mass. The adaptive growth response of the cardiac muscle changes significantly during phylogenetic and ontogenetic development. Cold-blooded animals maintain the ability for cardiomyocyte proliferation even in adults. On the other hand, the extent of proliferation during ontogenetic development in warm-blooded species shows significant temporal limitations: whereas fetal and neonatal cardiac myocytes express proliferative potential (hyperplasia), after birth proliferation declines and the heart grows almost exclusively by hypertrophy. It is, therefore, understandable that the regulation of the cardiac growth response to the increased workload also differs significantly during development. The pressure overload (aortic constriction) induced in animals before the switch from hyperplastic to hypertrophic growth leads to a specific type of left ventricular hypertrophy which, in contrast with the same stimulus applied in adulthood, is characterized by hyperplasia of cardiomyocytes, capillary angiogenesis and biogenesis of collagenous structures, proportional to the growth of myocytes. These studies suggest that timing may be of crucial importance in neonatal cardiac interventions in humans: early definitive repairs of selected congenital heart disease may be more beneficial for the long-term results of surgical treatment.

Prevalence of left ventricular hypertrophy in type 2 diabetics:A hospital-based study

Introduction: In the general population, left ventricular hypertrophy affects 15–20% of adults. Patients with cardiovascular disease frequently have LVH. Compared to the general population, patients with DM have an increased rate of LVH. Many studies indicate a connection between diabetes mellitus and left ventricularly function. Aim: The aim was to study the prevalence of LVH among DM patients in a hospital-based setting in south India. Methods: In a hospital-based population in south India, we looked at the relationship between diabetes Mellit sand left ventricular failure. The study comprised 133 diabetic patients from our institution who met the inclusion requirements. ECG and ECHO were used to assess the subjects for the presence of LVH. Diabetes patients had a25.6% prevalence of left ventricular hypertrophy. We found significant differences in the older age, hypertension, duration, duration of type 2 diabetes mellitus, mean fasting blood sugar (FBS), and HbA1c (P= 0.0020) when we compared both groups of participants with DM. However, neither the gender nor the body mass index (BMI)showed any significant results (P= 0.3112). Conclusion: LVH is more common in diabetics than in non-diabetics by a large margin. In diabetic patients with systemic hypertension, older age groups, those who have had diabetes and hypertension for a longer period of time, as well as those with higher FBS and HbA1c values, LVH prevalence rises even more

PARAMETERS OF CENTRAL AND INTRACARDIAC HAEMODYNAMICS IN WOMEN WITH THYROID HYPERPLASIA AND ACALCULOUS CHOLECYSTITIS.

Aim: The study aimed to investigate some parameters of functional status of central and intracardiac haemodynamics in women with thyroid hyperplasia and acalculous cholecystitis. Materials and Methods: Functional changes of haemodynamic status in women with thyroid hyperplasia and acalculous cholecystitis were investigated. All data are obtained through general and special clinical methods, standard and special laboratory methods of examination, physiological, biochemical and statistical methods. Parameters of central and intracardiac haemodynamics have been recorded by the method of two-dimensional M-mode echocardiography in the echo chamber "Toshiba-140" (Japan) at the resting state. Results: An increase in heart rate (by 45.6%) was observed in patients, which led to decreased duration of cardiac cycle and ejection time. Statistically significant (p<0.05, 11.7% on average) increase in total peripheral vascular resistance was indicated. Dynamics of changes of parameters of central and intracardiac haemodynamics indicates different parallel existing pathways of secondary disturbances in the part of cardiovascular system. A significant increase in peripheral vascular resistance associated with decreased elasticity (increased vascular rigidity) of the arteries is the element of concentric type of left ventricular hypertrophy. The increase in volume in the absence of vasospastic reactions and increasing venous tone is an element of eccentric hypertrophy. Conclusions: It is possible to talk about the presence of systolic dysfunction in patients, which, however, is predominantly of functional character. The revealed specific changes in homeostatic haemodynamic characteristics in the women's body with thyroid hyperplasia and acalculous cholecystitis require the development of new, more effective and preferably drug-free (due to liver pathology and detoxification dysfunction) approaches to medical treatment of such patients.

Prognostic significance of geometric patterns of left ventricular hypertrophy in a 12-year cohort study

Objective. The contribution of left ventricular hypertrophy (LVH) to the risk of cardiovascular disease (CVD) and mortality is well established but the prognostic role of structural LVH patterns in the population is ambiguous. The aim of the work — to study the prognostic value of geometric variants of LVH in a 12-year cohort study.Design and methods. The study design—cross-sectional and cohort studies—based on the material from a series of echocardiographic examinations (Echo) in general population samples in Novosibirsk city. The cohort analysis included 2006 men and women 25–64 years old with special concerns about LVH (according to the criterion of increased myocardial mass index (IMM)) and for geometric variants of LVH. The mean follow-up period was of 12,2 years (SD = 3,2) and 220 endpoints (90 CVD deaths) were registered. The risk of incident fatal and nonfatal CVD and death was assessed by Cox regression analysis.Results. In the studied sample, the prevalence of LVH was of 22,8% (lower in men than in women, p &lt; 0,001). Population-specific criteria for increased IMM were 124 g/m2 (men) and 100 g/m2 (women). LVH independently increased the 12-year risk of myocardial infarction (MI) by 1,8 times, fatal MI — by 2 times, fatal CVD — by 1,8 times and all-cause mortality — by 1,6 times. Concentric and disproportional septal forms of LVH (DS LVH) had the most unfavorable prognosis; 40–80% of the excess-risk of CVD and death in these variants was explained by myocardial mass, but the impact of DS LVH was maintained independently of left ventricle myocardial mass. The pattern of segmental LVH (based on additional 2D measurement of the thickest segment) increased the risk of CVD and mortality by 1,9–2,5 times in men.Conclusions. In a population sample aged 25–64 years (Novosibirsk), LVH independently increased the 12-year risk of MI, fatal CVD and death from all causes by 1,6–2 times. Among the geometric types of LVH, concentric and DS LVH had the most unfavorable prognostic value; the impact of DS LVH to the risk of fatal CVD remained significant independently of myocardial mass. The pattern of segmental LVH based on additional 2D Echo measurements, increased the risk of CVD and death by 2–2,5 times. CVD risk and mortality levels depending on the LVH patterns suggest a number of preventive measures against cardiovascular complications and mortality.

Correlates and Severity of Left Ventricular Hypertrophy in Type 2 Diabetes Patients in an Afro-Arab-cross Ethnic Community

Background: The cardiovascular (CV) diseases, including left ventricular hypertrophy (LVH) are major causes of morbidity and mortality in T2DM. The LVH is associated with ventricular arrhythmias, ischemic heart disease (IHD), heart failure and sudden death. Although the LVH is frequent in T2DM, screening for this disorder is frequently done. Material and Methods: In this study, 120 Sudanese T2DM patients were recruited, (70 with and 50 without LVH) from four cardiac centers in Khartoum, the latter is inhabited by most of the Sudanese Afro-Arab ethnic groups. Clinical data were obtained from almost all patients together with measurement of glycemic and renal parameters. Echocardiography was performed for each patient, the left ventricle geometry components including the relative wall thickness (RWT) were estimated and the left ventricle mass index (LVMI) was calculated. Results: The commonest LVH type was eccentric (65.7%), and grade was severe (37.1%), and both were strongly associated, p&lt;0.001, while the frequency of the mild LVH was 28.6%. Out of 10 tested variables only HhA1c (p&lt;0.001), urea (p=0.039) and creatinine (p=0.043) were significantly associated with LVH, while the sex, age, T2DM duration, smoking, obesity, random and fasting blood glucose were not. Moreover, the LVMI was positively correlated with HbA1c (CC0.188, p&lt;0.039), and negatively with RWT (CC-0.495, p&lt;0.000). Finally, significantly higher number of patients with IHD (p=0.038) and cerebral complications (p=0.014) had LVH. Conclusion: In this unique setting of interethnic cross, the results suggest that more genetic than environmental factors could be involved in diabetic LVH development.

Prevalence of left ventricular hypertrophy in type 2 diabetics: A hospital-based study

Introduction: In the general population, left ventricular hypertrophy affects 15–20% of adults. Patients with cardiovascular disease frequently have LVH. Compared to the general population, patients with DM have an increased rate of LVH. Many studies indicate a connection between diabetes mellitus and left ventricular dysfunction. Aim: The aim was to study the prevalence of LVH among DM patients in a hospital-based setting in south India. Methods: In a hospital-based population in south India, we looked at the relationship between diabetes mellitus and left ventricular failure. The study comprised 133 diabetic patients from our institution who met the inclusion requirements. ECG and ECHO were used to assess the subjects for the presence of LVH. Diabetes patients had a 25.6% prevalence of left ventricular hypertrophy. We found significant differences in the older age, hypertension, duration, duration of type 2 diabetes mellitus, mean fasting blood sugar (FBS), and HbA1c (P = 0.0020) when we compared both groups of participants with DM. However, neither the gender nor the body mass index (BMI) showed any significant results (P = 0.3112). Conclusion: LVH is more common in diabetics than in non-diabetics by a large margin. In diabetic patients with systemic hypertension, older age groups, those who have had diabetes and hypertension for a longer period of time, as well as those with higher FBS and HbA1c values, LVH prevalence rises even more.

Relationships between left ventricular mass and QRS duration in diverse types of left ventricular hypertrophy: A novel diagnosis clue

Hypertrophic cardiomyopathy (HCM) may be associated with very narrow QRS while left ventricular hypertrophy (LVH) may increase QRS duration. We investigated the relationship between QRS duration and LV mass in subtypes of abnormal LV wall thickness. Four groups of patients from Toulouse and Bordeaux University Hospitals were retrospectively included, with HCM, LVNC, LVH and controls with healthy hearts. Automatic measurement of LVM on MRI was correlated to automatic measurement of QRS duration on ECG. Uni- and multivariate analysis were performed between groups including explanatory variables expected to influence LVM and QRS duration. The relationships between QRS duration and LVM was further studied within each group. In total, 221 HCM, 28 LVNC, 16 LVH and 40 controls were retrospectively included. Mean QRS duration was 92 ms for HCM, 104 for LVNC, 110 for LVH and 92 for controls ( P < 0.01). Mean LVM was 100, 90, 108 and 68 g/m 2 respectively ( P < 0.01). QRS duration, LVM, hypertension, maximal wall thickness and LGE were significantly linked to HCM in multivariate analysis (w/wo bundle branch block). An independent negative correlation was found between LVM and QRS duration in the HCM group, while the relationship was reverse in LVNC, LVH and in controls. QRS duration increases with LVM in LVNC, LVH or in healthy hearts while reverse relationship is present in HCM. These relationships were independent of other parameters. These results warrant additional investigations for refining diagnosis criteria for HCM in the future.

Left ventricular remodelling in a large cohort of strength competitive athletes: not so common and differs by sex

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This research was supported by FMBA of Russia Background. There are still very limited data about physiological cardiac adaptation in strength athletes. Purpose. To describe structural and functional features of left ventricular (LV) in a large cohort of healthy strength athletes. Methods. A total of 673 Caucasian athletes (weight-lifting, males/females = 238/157, and Martial Arts, males/females = 200/78) competing in Russian National and International level events were recruited within 2010-2017. Data of standard 2D echocardiography (Echo) and comprehensive medical history were analyzed. Data are presented as median (IQR) and compared by nonparametric tests (table). To assess LV geometry all athletes were divided into 6 groups according to 4-tiered classification based on mass index, concentricity and end-diastolic volume (EDV) index of LV (Figure). Results. Both absolute and indexed values of LV structural features were higher in males. Females exhibited higher functional parameters. Only 54 (8%) athletes had elevated LV mass (no sex difference), 23 (3.4%) – LV wall ≥ 12mm (only males) and 78 (11.6%) – changes in LV geometry. There was a prevalence of females in eccentric non-dilated LV hypertrophy (LVH) group (p = 0.088), which was previously accepted as a benign pattern of LV remodelling in non-athlete populations. Males had more often concentric types of LV remodelling (36 of 54 athletes). Among dilated types of LVH, there was a prevalence of males (p = 0.070). Conclusions. LV remodelling is not common in strength athletes and differs by sex with a more favourable profile in females. Clinical and Echo parameters Total n = 673 males n = 438 females n = 235 males vs females p-value Age, years 20(4) 20(4) 20(5) 0.06 BSA, m&amp;sup2; 1.84(0.39) 1.96(0.39) 1.66(0.25) &amp;lt;0.001 Sports practice, years 10(6) 10(7) 10(6) 0.12 LV EDD, mm 49(6) 50(5) 46(4) &amp;lt;0.001 LV EDD/(BSA)^0.5 35.8(3) 35.9(3) 35.6(3) 0.017 LV EDV, ml 108(38) 118(32) 92(24) &amp;lt;0.001 LV EDV/(BSA)^1.5 42.8(9) 42.9(10) 42.3(9) 0.14 Maximal LV WT, mm 10(1) 10(2) 9(1) &amp;lt;0.001 LV mass/BSA, g/m&amp;sup2; 86(24) 91(22) 75(16) &amp;lt;0.001 LV Concentricity, g/(ml)^0.67 6.9(1.6) 7.4(1.6) 6.2(1.4) &amp;lt;0.001 LV EF, % 60(5) 60(4) 62(4) &amp;lt;0.001 Mitral E velocity, cm/sec 87(19) 85(19) 89(19) &amp;lt;0.001 BSA - body surface area; EDD - end-diastolic dimension; WT - wall thickness Abstract Figure. Types of LV geometry in athletes

Relationships between left ventricular mass and QRS duration in diverse types of left ventricular hypertrophy.

Hypertrophic cardiomyopathy (HCM) may be associated with very narrow QRS, while left ventricular hypertrophy (LVH) may increase QRS duration. We investigated the relationships between QRS duration and LV mass (LVM) in subtypes of abnormal LV wall thickness. Automated measurement of LVM on MRI was correlated to automated measurement of QRS duration on ECG in HCM, left ventricular non compaction (LVNC), left ventricular hypertrophy (LVH), and controls with healthy hearts. Uni and multivariate analyses were performed between groups including explanatory variables expected to influence LVM and QRS duration. The relationships between QRS duration and LVM were further studied within each group. Two hundred and twenty-one HCM, 28 LVNC, 16 LVH, and 40 controls were retrospectively included. Mean QRS duration was 92 ms for HCM, 104 for LVNC, 110 for LVH, and 92 for controls (P < 0.01). Mean LVM was 100, 90, 108, and 68 g/m2 (P < 0.01). QRS duration, LVM, hypertension, maximal wall thickness, and late gadolinium enhancement were significantly linked to HCM in multivariate analysis (w/wo bundle branch block). An independent negative correlation was found between LVM and QRS duration in the HCM group, while the relationship was reverse in LVNC, LVH, and controls. QRS duration increases with LVM in LVNC, LVH, or in healthy hearts, while reverse relationship is present in HCM. These relationships were independent from other parameters. These results warrant additional investigations for refining diagnosis criteria for HCM in the future.

Albuminuria increased the risk of left ventricular hypertrophy in type 2 diabetes patients with early renal insufficiency

Albuminuria and left ventricular hypertrophy are important predictors of cardiovascular disease. We speculated that albuminuria increases the risk of left ventricular hypertrophy in patients with type 2 diabetes and early renal impairment. A total of 330 patients with type 2 diabetes and early renal insufficiency were recruited and classified according to albuminuria level (normal albuminuria, microalbuminuria, and macroalbuminuria). Plasma glucose, glycated hemoglobin (HbA1c), creatinine, uric acid, fasting insulin, albuminuria/urine creatinine ratio, renal function, insulin sensitivity, visceral fat index, body mass index, blood pressure, and left ventricular mass were assessed. The relationship between albuminuria and left ventricular hypertrophy was examined using logistic regression analysis and multiple linear regression. The risk of left ventricular hypertrophy was higher in the microalbuminuria group (odds ratio [OR] 14.602, 95% confidence interval [CI] 7.050–30.243) and macroalbuminuria group (OR 21.455, 95% CI 8.613–53.443) than in the normal albuminuria group. Albuminuria increases the risk of left ventricular hypertrophy in patients with type 2 diabetes and early renal insufficiency.

LEFT VENTRICULAR HYPERTROPHY IN WOMEN AND MEN WITH PRIMARY ALDOSTERONISM

Abstract Objective: Primary aldosteronism (PA) is the leading cause of secondary hypertension and has been associated with higher prevalence of left ventricular hypertrophy (LVH) compared to essential hypertension (EH). In EH, women have higher prevalence of LVH than men. Whether this also applies to PA patients remains unknown. We aimed to compare the prevalence and type of LVH in women and men with PA. Design and method: 109 patients (mean age 57 ± 11 years, 32% women) recently diagnosed with PA according to current guidelines, underwent echocardiography and ambulatory blood pressure monitoring. LVH was identified using guideline recommended sex-specific values. Post saline infusion test (SIT) aldosterone level was considered an indicator of PA-severity. Results: Women had a shorter duration of hypertension than men (9 ± 9 vs. 16 ± 10 years, p &lt; 0.001), lower BMI (28 ± 6 vs. 31 ± 5 kg/m2, p = 0.04) and lower prevalence of diabetes (6 vs. 23%, p = 0.034), while clinical and ambulatory blood pressure and post-SIT aldosterone level did not differ. LVH was more prevalent in men than women (63% vs. 41%, p = 0.04), eccentric hypertrophy was the most common geometric pattern in both sexes. In univariate logistic regression analyses, male sex, higher BMI, night-time blood pressure and co-presence of diabetes were all associated with prevalent LVH, while post-SIT aldosterone level was not. In multivariate analysis, the association of male sex with prevalent LVH became statistically non-significant when adjusted for confounder (Table 1). Conclusions: The higher prevalence of LVH in men than women with PA in our study was fully explained by differences in BMI and nocturnal hypertension, independent of PA-severity.

Eccentric hypertrophy predicts adverse events in patients undergoing percutaneous coronary intervention for acute coronary syndrome.

IntroductionThe effect of the type of left ventricular hypertrophy in patients presenting with an acute coronary syndrome (ACS) on long-term outcomes is ill-defined. The purpose of this study was to investigate the prognostic effect of concentric (CH) or eccentric hypertrophy (EH) on adverse outcomes in patients presenting with ACS undergoing percutaneous coronary intervention (PCI).Material and methodsWe analyzed 1-year follow-up data from a single-institution, retrospective, observational study that enrolled 1,153 patients who presented with ACS and were treated with PCI, for whom echocardiographic data were available.ResultsNormal geometry was observed in 718 (62.3%) patients, while 27.2% had CH and 10.5% had EH. The primary endpoint of all-cause death (n = 90, 7.8%) occurred in 6.4%, 8.0%, and 14.9% of patients with no, concentric, or eccentric hypertrophy, respectively (p = 0.005). Major adverse cardiac events (MACE – all-cause death, non-fatal myocardial infarction or stroke or hospitalization for bleeding) occurred in 13.9%, 17.8%, 30.6%, respectively (p < 0.001). Age (HR per year = 1.04 (1.02, 1.05), p < 0.001), female gender (HR = 1.56 (1.12, 2.16), p = 0.008), diabetes (HR = 1.49 (1.07, 2.06), p = 0.02), eccentric hypertrophy (HR = 1.58 (1.006, 2.47), p = 0.047), peak troponin I (HR per 1 ng/ml = 1.004 (1.001, 1.006), p = 0.004) and left ventricular ejection fraction < 50% (HR = 1.57 (1.12, 2.20), p < 0.008) were significant predictors of MACE.ConclusionsThe presence of eccentric hypertrophy in ACS patients undergoing PCI is an independent predictor of adverse outcomes at 1 year.

Relationship between left ventricular mass and QRS duration in diverse types of left ventricular hypertrophy: A novel diagnosis clue

Hypertrophic cardiomyopathy (HCM) may be associated with very narrow QRS while left ventricular hypertrophy (LVH) may increase QRS duration. To determine the correlations between left myocardial mass (LVM) and QRS duration in HCM, left ventricular non-compaction (LVNC), post-hypertensive hypertrophy (LVH) and a control population. HCM, LVNC, LVH and controls with healthy hearts from Toulouse and Bordeaux University Hospitals were retrospectively studied. Indexed automatic measurement of left ventricular mass (LVM) on MRI was correlated to automatic measurement of QRS duration on surface ECG. Potential confounding factors that can modify intraventricular conduction were listed and included in analysis. Two hundred and twenty-one HCM, 28 LVNC, 16 LVH and 40 controls were retrospectively included. Mean QRS duration was 92 ms for HCM, 104 for LVNC, 110 for LVH and 92 for controls ( P < 0.01). Mean LVM was 100, 90, 108 and 68 g/m 2 respectively ( P < 0.01). A negative correlation was found between LVM and QRS duration in the HCM group ( P = 0.03). The relationship was reverse in LVNC ( P = 0.01), although not significant in LVH and controls. Multivariate analysis confirms these trends with significant correlations within each group and significant difference between HCM and LVH + LVNC. A regression formula including QRS duration, LVM, maximal wall thickness and myocardial fibrosis was tested to predict the diagnosis of HCM vs. LVH in 54 additional patients, yielding sensitivity, specificity, negative and positive predictive value of around 80%. QRS duration significantly and independently increases with LVM in LVNC, LVH or in healthy hearts while reverse relationship is present in HCM. These results could be used as additional diagnosis criteria for borderline cases in the future.

Geometric patterns of the left ventricle in relation to left atrial size among hypertensive patients at a tertiary hospital in South-South Nigeria

Introduction: It is well established that left ventricular hypertrophy (LVH), determined by echocardiography, is a strong predictor of poor prognosis in cardiovascular disorders independent of the presence of traditional risk factors. The left ventricle undergoes morphological as well as functional alterations in its structure that impact adversely on the structure and overall function of the left atrium. The prevalence of left atrial (LA) enlargement in the hypertensive group was found to be 16% and 59% using LA linear diameter and LA maximum volume, respectively. Materials and Methods: The study was carried out on 200 adult hypertensive patients ≥18 years attending consultant cardiology outpatient clinics irrespective of blood pressure control, whether on antihypertensive medications or not. A transthoracic echocardiogram with ECG gating was performed according to established recommendations. Results: This study showed four different geometric patterns of left ventricular (LV) adaptation to chronic hypertension: concentric remodeling (CR) in 31.5%, concentric hypertrophy in 27.5%, eccentric hypertrophy in 12.5%, while 28.5% of the total population had normal LV geometry. LA size was discovered to be highest among patients with concentric patterns of hypertrophy compared to the eccentric geometric pattern. Findings suggest that LV pressure overload is more likely to impact on LA size than volume overload. This may be as a result of increased afterload in the left ventricle, leading to impairment of diastolic filling. Conclusion: Although CR of the LV is the most common type of geometric change among hypertensive patients, patients with dilated left atrium are more likely to have the concentric type of LVH than the eccentric type.

Концентрація розчинного ST2 у плазмі крові та дисфункція серця в пацієнтів з есенціальною гіпертензією

Мета роботи – оцінити роль розчинного ST2 (sST2) як можливого біомаркера ремоделювання та дисфункції серця у хворих з есенціальною гіпертензією (ЕГ) різної тяжкості.Матеріали і методи. Обстежено 150 чоловіків з підтвердженою ЕГ різної тяжкості та 70 чоловіків без серцево-судинних захворювань, репрезентативних за віком, які становили контрольну групу. Критерії залучення в дослідження: вік 40–60 років, чоловіча стать, верифікований діагноз ЕГ. Рівень sST2 у плазмі крові визначали методом імуноферментного аналізу. Результати та обговорення. Встановлено, що концентрація пептиду в плазмі крові в чоловіків без серцево-судинних захворювань статистично значуще не корелює з віком та особливостями конституції, функцією нирок, станом системної та внутрішньосерцевої гемодинаміки, морфометричними показниками серця. У пацієнтів з ЕГ середній рівень sST2 у плазмі крові статистично значуще вищий, ніж у осіб контрольної групи. Виявлено, що до статистично значущого зростання концентрації пептиду в плазмі крові у хворих з ЕГ призводить формування гіпертрофії лівого шлуночка (ЛШ), незалежно від її типу, та діастолічної дисфункції серця. Також у пацієнтів з ЕГ і фракцією викиду (ФВ) ЛШ менше 40 % концентрація пептиду статистично значуще більша, ніж у хворих зі збереженою ФВ ЛШ.Висновки. Таким чином, у чоловіків з ЕГ різної тяжкості рівень sST2 у плазмі крові статистично значуще вищий, ніж у осіб без серцево-судинних захворювань. В обох випадках концентрація пептиду в плазмі крові не пов’язана з віком та особливостями конституції. У пацієнтів з неускладненою ЕГ статистично значуще вищі рівні sST2 асоціюються з розвитком гіпертрофії ЛШ, незалежно від її типу, та з порушенням діастолічної функції серця. У разі розвитку серцевої недостатності на тлі ЕГ рівень sST2 у плазмі крові також статистично значуще вищий, особливо при формуванні систолічної дисфункції серця з ФВ ЛШ &lt; 40 %.

Prognostic Model of Typical Complications Caused by Transcatheter Aortic Valve Replacement.

The aim of the study was to develop a prognostic model based on statistical discriminant analysis to assess the risk of postoperative disturbance of cardiac conduction and paraprosthetic regurgitation after transcatheter aortic valve replacement.Materials and MethodsClinical data of 10 patients implanted with CoreValveTM prostheses (Medtronic Inc., USA) were used to develop prognostic models. To that end, we analyzed changes in hemodynamic and functional parameters provided by echocardiography in the pre- and postoperative periods.ResultsWe observed significant positive changes in the severity of left ventricular myocardial hypertrophy; on the contrary, volume indicators did not significantly change, which might be associated with the concentric type of left ventricular hypertrophy. The discriminant analysis made it possible to determine major (preoperative) morphological and functional indicators associated with the two most common complications of the procedure: left bundle branch block and paraprosthetic regurgitation. Left ventricular posterior wall thickness, interventricular septal thickness, left atrium dimension, and myocardial mass are the critical factors that determine the development of these complications.ConclusionIn the prognostic model, the proposed weighting coefficients allow one to assess the risk of postoperative complications; however, the presence of false-positive results requires further refinement of these coefficients within the linear equation.

HEART AND VESSEL REMODELING IN DIFFERENT AGE GROUPS OF PATIENTS WITH ARTERIAL HYPERTENSION

Actuality. It is known that each of the factors (arterial hypertension (AH) and age) has a negative effect on the remodeling of both the heart and vessels, while their combined effect has not been sufficiently studied. The aim. Assessment of manifestations of cardiac and vascular remodeling (by the example of common carotid arteries (СCA) and vasomotor endothelium function (right brachial artery)) in patients with AH degree I-III in different age groups.Material and methods. The study involved 124 (86 men and 38 women) patients at the age from 27 to 81 years (average age of patients 55.7+1.01 years) with AH degree I-III. The presence and variant of myocardial remodeling with calculation of criteria of left ventricular hypertrophy (LVH), myocardial mass (MM) and MM index (MMI) of LV by indexation to the patient’s body surface area were studied in all patients by means of echocardiographic investigation (EchoCG) using the Vivid S5 3Sc-RS echocardiograph with a multifrequency sensor 2.0-3.5 MHz. Normal values of MM were considered to be 67-162 grams (g) for women and 88-224 for men, and MMI - not more than 95 and 115 g/m2, respectively. Types of LVH were determined according to recommendations of Pugliese N.R. et al. (2017), being subdivided into concentric (C) and eccentric (E) LVH. Ultrasound scanning was used to investigate CCA on both sides. The results of reactive hyperemia test on the right brachial artery and blood lipid profile were studied with the calculation of atherogenicity coefficient (AC). The data analysis was carried out with the help of Statistica 12 application package with determination of mean values (M), minimum, maximum and mean error (m), median and interquartile range for the CCA intima-media thickness (IMT). The Spearman rank correlation coefficient (r) was used to estimate the relationship between these variables. The significance level of all statistical tests was accepted at p˂0.05.The results of the study confirmed the presence of cardiac and vascular remodeling in patients with AH of different degrees with the tendency to increase in older age groups. The CCA remodeling parameter values were also significantly higher in the groups of middle-aged and elderly persons, some of which also had atherosclerotic plaques (AP). The number of patients with disturbed endothelial vasomotor function also somewhat increased with age.Conclusion. Thus, the age of the examined patients with AH had a significant influence on aggravation of the heart and vessel remodeling processes and increasing frequency of endothelial dysfunction development

Study of unexpectedly detected repolarization in a group of black athletes

IntroductionIl est considéré que la mort subite qui survient lors d'une activité sportive touche un patient ayant une cardiopathie ignorée. L'ECG du sportif de race noire a été peu étudié et des particularités liées à l'ethnie ont été évoquées. Notre travail a pour objectif d'étudier le profil épidémiologique et les particularités de la repolarisation du sportif de race noire.MéthodesUne étude descriptive a été menée durant 8 mois de mars à octobre 2014, incluant des sportifs de race noire sélectionnés parmi tous les sportifs qui étaient suivi dans le centre sectoriel de la Médecine et des Sciences de sports de Sousse. Le recueil de données a été réalisé grâce à un questionnaire medical.RésultatsTrente-cinq (35) athlètes ont été colligés, avec une prédominance masculine (94,28%), ayant un âge moyen de 24,34 ans. Quatre athlètes avaient une hypertrophie ventriculaire gauche à l'échographie cardiaque. Il y'avait 8 athlètes avec un BAV de 1er degré et 8 athlètes avaient un HVG électrique. Les modifications du segment ST étaient plus marquées au niveau des dérivations précordiales. Cinq athlètes (14,2%) avaient des ondes T négatives en V2 et V3, et il s'agissait des mêmes athlètes qui avaient le sus décalage du segment ST dans ces mêmes dérivations. Un aspect de repolarisation précoce a été constaté chez 3 athlètes. Tous ces cas étaient type notch.ConclusionLes sportifs de race noire semblent avoir des modifications électriques assez spécifiques dont il importe de connaitre. Toutefois, notre échantillon n'est pas suffisamment important pour affirmer ces résultats. Une étude comparative avec des sportifs de race blanche serait très intéressante.

Relationship of Remodeling of Carotid Arteries and Left Ventricular Geometry in Patients With Chronic Glomerulonephritis.

to study clinical-functional features of remodeling of carotid arteries and its relation to restructuring of the left ventricle (LV) in patients with chronic glomerulonephritis at pre-dialysis stage. We examined 269 patients (189 men, 80 women) with chronic glomerulonephritis (CGN) aged 17-71 years, at pre-dialysis stages of the disease. We analyzed biochemical parameters of peripheral blood with the determination of daily proteinuria and glomerular filtration rate (GFR). For identification of structural changes of carotid arteries (CA) and LV we used Doppler ultrasound and echocardiography. Atherosclerotic changes of CA were found in 79 patients (29.3%). Four patients (1.4%) had history of acute disturbance of cerebral circulation. Concentric type of left ventricular hypertrophy (LVH) was significantly more prevalent among patients with CA remodeling compared with those without (37.84 vs. 18.75%; p=0.006). Eccentric variant of LVH was significantly more prevalent among patients without atherosclerotic lesions in CA compared with those with CA remodeling (81.25% vs. 62.16%; p=0.001). Increased CA intima media thickness positively correlated with body mass index (r=0.273; p=0.014) and negatively - with GFR (r= -0.222; p=0.048). Statistically significant relationships were also found between the presence of carotid atherosclerosis and structural rearrangements of the heart. We demonstrated a clear relationship between GFR, restructuring of CA and concentric type of change of LV geometry, regardless of the presence of traditional risk factors.

Left Ventricular Hypertrophy and Predictive Factors among Congolese Hypertensive Patients

A cross-sectional study of hypertensive patients was carried out in Brazzaville between January 2011 and December 2013. The objectives of the present study are to determine the different types of left ventricular hypertrophy (LVH) and to identify the predictive factors of LVH. It included 556 hypertensive patients with LVH, characterized by left ventricular mass index (LVMI) > 135 g/m2 in men, and > 111 g/m2 in women. Patients’ sociodemographic data and echocardiographic parameters were gathered and analyzed. There were 342 males (61.5%) and 214 females (38.5%), with mean age 53.5 ± 11.5 years. The indications of the test were hypertension initial evaluation in 402 cases (72.3%), investigation of ischemic stroke in 62 cases (11.2%), heart failure in 58 cases (10.4%), dyspnea and chest pain in respectively 22 and 12 cases. Hypertension, old of 5.2 ± 4.5 years, was associated with overweight/obesity in 408 cases (73.4%), physical inactivity in 325 cases (58.5%), hypertension family history in 274 cases (49.3%), diabetes mellitus in 76 cases (13.7%), dyslipidemia in 63 cases (11.3%), tobacco use in 9 cases (1.6%). The prevalence of LVH was 49.4% and consisted into concentric LVH in 470 cases (84.5%), eccentric LVH in 70 cases (12.6%), and in 16 cases (2.9%), it was a concentric left ventricular remodeling. Age, male gender, seniority of hypertension and treatment were predictive factors of LVH. The latter is the most predominant abnormality in the echocardiographic profile of Congolese hypertensive patients. Efficient management on hypertension will lead to reducing its morbidity and mortality.