Changes In Ventricular Mass Research Articles

Comparison of electrocardiographic versus echocardiographic detection of left ventricular mass changes over time and evaluation of new onset left ventricular hypertrophy.

We assessed the value of 3 electrocardiographic (EKG) voltage criteria in detecting variations of left ventricular mass (LVM) over time, taking echocardiographic (ECHO) LVM as reference, in the Pressioni Arteriose Monitorate E Loro Associazioni study. In 927 subjects (age 47±13 years on entry, 49.9% men) an ECHO evaluation of LVM and EKG suitable for measurement of EKG-LVH criteria (Sokolow-Lyon voltage, Cornell voltage and R-wave voltage in aVL) were available at baseline and at a 2nd evaluation performed 10 years later. Δ (delta) LVM, Δ LVMI, and Δ EKG parameters values were calculated from 2nd evaluation to baseline. The sensitivity of the EKG criteria in the diagnosis of LVH, poor at baseline, becomes even worse after 10 years, reaching very low values. Only the sensitivity of R-wave amplitude exhibited slight increase over time but with unsatisfactory absolute values. Despite the prevalence of ECHO-LVH at the 2nd evaluation was threefold increased compared to baseline (29.3% and 33.7% for LVM indexed to BSA and height2.7 , respectively), the prevalence of EKG-LVH was unchanged when evaluated by Sokolow-Lyon criteria, significantly reduced when assessed by Cornell voltage index, while significantly increased using R-wave voltage in aVL criteria. Despite an ECHO-LVM increase over the time, mean EKG changes were of opposite sign, except for R-wave amplitude in aVL. Our study highlights the discrepancy between ECHO and EKG in monitoring LVM changes over the time, especially for Sokolow-Lyon and Cornell voltage. Thus, EKG is an unsuitable method for the longitudinal evaluation of LVM variations.

Cardiac remodeling in well-healed burn survivors after 6 months of unsupervised progressive exercise training.

Aerobic exercise is important in the rehabilitation of individuals with prior burn injuries, but no studies have examined whether adult burn survivors demonstrate cardiac remodeling to long-term aerobic exercise training. In this study, we tested the hypothesis that 6 months of progressive exercise training improves cardiac magnetic resonance imaging-based measures of cardiac structure and function in well-healed burn survivors. Secondary analyses explored relations between burn surface area and changes in cardiac structure in the cohort of burn survivors. V̇o2peak assessments and cardiac magnetic resonance imaging were performed at baseline and following 6 months of progressive exercise training from 19 well-healed burn survivors and 10 nonburned control participants. V̇o2peak increased following 6 months of training in both groups (Control: Δ5.5 ± 5.8 mL/kg/min; Burn Survivors: Δ3.2 ± 3.6 mL/kg/min, main effect of training, P < 0.001). Left ventricle (LV) mass (Control: Δ1.7 ± 3.1 g/m2; Burn survivors: Δ1.8 ± 2.7 g/m2), stroke volume (Control: Δ5.8 ± 5.2 mL/m2; Burn Survivors: Δ2.8 ± 4.2 mL/m2), and ejection fraction (Control: Δ2.4 ± 4.0%; Burn Survivors: Δ2.2 ± 4.3%) similarly increased following 6 months of exercise training in both cohorts (main effect of training P < 0.05 for all indexes). LV end-diastolic volume increased in the control group (Δ6.5 ± 4.5 mL/m2) but not in the cohort of burn survivors (Δ1.9 ± 2.7 mL/m2, interaction, P = 0.040). Multiple linear regression analyses revealed that burn surface area had little to no effect on changes in ventricular mass or end-diastolic volumes in response to exercise training. Our findings provide initial evidence of physiological cardiac remodeling, which is not impacted by burn size, in response to exercise training in individuals with well-healed burn injuries.NEW & NOTEWORTHY Aerobic exercise is important in the rehabilitation of individuals with prior burn injuries, but no studies have examined whether adult burn survivors demonstrate cardiac remodeling to long-term aerobic exercise training. In this study, we tested the hypothesis that 6 months of progressive exercise training would improve cardiac magnetic resonance imaging-based measures of cardiac structure and function in well-healed burn survivors. Our findings highlight the ability of exercise training to modify cardiac structure and function in well-healed burn survivors and nonburned sedentary controls alike.

Contextualizing the FHN Nocturnal Trial a Decade Later: How Nocturnal Home Hemodialysis Is Performed Matters to Outcomes.

Long, frequent hemodialysis (HD) was thought to be a sound treatment because of improved clearance of uremic toxins and control of extracellular fluid volume. After all, no solute or volume control is tantamount to no dialysis, and whatever its shortcomings, dialysis does keep people alive. The

Left ventricular mass index and ventricular contractility improvement in patients with severe obesity following rapid weight loss after bariatric surgery.

Obesity is a well-known risk factor for heart disease, resulting in a broad spectrum of cardiovascular changes. Left ventricular mass (LVM) and contractility are recognized markers of cardiac function. To determine the changes of LVM and contractility after bariatric surgery (BaS). University hospital, United States METHODS: To determine the cardiac changes in ventricular mass, ventricular contractility, and left ventricular shortening fraction (LVSF), we retrospectively reviewed the 2-dimensional echocardiographic parameters of patients with obesity who underwent BaS at our institution. We compared these results before and after BaS. A total of 40 patients met the inclusion criteria. The majority were females (57.5%; n = 23), with an average age of 63.5 ± 12.1. The excess body mass index (BMI) lost at 12 months was 48.9 ± 28.9%. The percent total weight loss after BaS was 16.46 ± 9.9%. The left ventricular mass was 234.9 ± 88.1 grams before and 181.5 ± 52.7 grams after BaS (P = .002). The LVM index was 101.3 ± 38.3 g/m2 before versus 86.7 ± 26.6 g/m2 after BaS (P = .005). The LVSF was 31% ± 8.8% before and 36.3% ± 8.2% after BaS (P = .007). We found a good correlation between the decrease in LVM index and the BMI after BaS (P = .03). Rapid weight loss results in a decrease of the LVM index, as well as improvement in the left ventricular muscle contractility. Our results suggest that there is left ventricular remodeling and an improvement of heart dynamics following bariatric surgery. Further studies are needed to better assess these findings.

Effects of Angiotensin II Receptor Blockers on Ventricular Hypertrophy in Hypertrophic Cardiomyopathy: A Meta-Analysis of Randomized Controlled Trials.

Animal studies have suggested that angiotensin II receptor blockers (ARBs) can attenuate or reverse the progression of hypertrophic cardiomyopathy, while clinical studies yielded conflicting results. We sought to conduct a meta-analysis to investigate the effect of ARBs in patients with hypertrophic cardiomyopathy. PubMed and EMBASE databases were searched through June 2020. Only randomized controlled trials (RCTs) were included, and each study's quality was assessed using the Jadad scale. The primary outcome was left ventricular mass reduction, and the secondary outcome was the change in left ventricular ejection fraction (LVEF). Data were pooled using the random effects model. A total of 1294 articles were screened. Five RCTs were included in the final analysis, enrolling 209 patients with hypertrophic cardiomyopathy (101 patients were in the ARB arm). ARB treatment was not associated with either significant left ventricular mass reduction (standardized mean difference: - 0.25; 95% CI: - 0.73, 0.22; p = 0.29) or change in LVEF (weighted mean difference: 0.73%; 95% CI: - 1.10%, 2.56%; p = 0.43). Subgroup analysis showed that losartan, one of the most investigated and commonly used ARBs, was also not associated with significant decreases of left ventricular mass (standardized mean difference: - 0.13; 95% CI: - 0.61, 0.36; p = 0.61). This meta-analysis showed that ARB treatment is not associated with reduced left ventricular mass nor remarkable LVEF change among patients with hypertrophic cardiomyopathy. Further studies with a larger number of patients will be required to confirm these findings.

Abstract 16191: Association of Left Ventricular Mass Progression With Heart Failure Events: Implications for Understanding the Hispanic Paradox

Introduction: Hispanics have been described as paradoxically having a higher prevalence of cardiovascular (CV) risk factors (RFs) but lower CV mortality compared to non-Hispanic Whites (NHW). The association of left ventricular mass (LVM) change with heart failure (HF) has not been well studied and variability across race-ethnic groups is unknown. Methods: MESA participants with LVM measurements by cardiac MRI at baseline and exam 5 (10-year interval) were included and followed for HF events after exam 5. LVM was calculated as the percentage of the predicted value based on height, weight and sex in a healthy population. LVM absolute (exam 5 - baseline) and relative change were compared across race-ethnic groups (Hispanics, non-Hispanic blacks [NHB], NHW, Chinese). HF RFs included hypertension, diabetes and obesity. The association between LVM change with incident HF events was evaluated using age-gender adjusted Cox proportional hazard models. Results: Among 2,981 participants (mean age 60 years, 53% female, 20% Hispanics, 42% NHW, 25% NHB, 13% Chinese) LVM at both exams was higher in NHB followed by Hispanics, whereas NHW and Chinese had the lowest LVM (Table) . Over 10-years, NHB had the highest LVM relative change (+4.4%) and Hispanics had the lowest (+1.7%). HF RFs were more prevalent in NHB and Hispanics compared to the other groups (p&lt;0.01). After a mean follow-up time from exam 5 of 6.4 years, an 18% increase in HF risk was seen per 5-unit increase in LVM in the total population. In race-ethnicity stratified analyses, this association was seen only in NHB (22% increase in HF risk per 5-unit LVM increase, p=0.01), and Hispanics (34% increase in HF risk per 5-unit LVM increase, p&lt;0.01). Conclusions: Hispanics and NHBs had a high burden of HF risk factors and higher baseline LVM relative to other groups. Hispanics paradoxically exhibited the lowest whereas NHB had the highest degree of LVM change over time, and yet both groups had similarly increased HF risk associated with LVM change.

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

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

Mechanical diversity in the adaptation of left and right ventricular function to long-term exercise: 3D echocardiographic study in a large cohort of competitive athletes

Abstract Regular physical exercise results in complex remodelling of the left- (LV) and right ventricle (RV), commonly referred as the athlete's heart. Despite the well-known changes in ventricular volumes and mass, data are scarce regarding ventricular mechanics and its connection to exercise performance. Accordingly, our aim was to characterize biventricular morphological and functional changes and their association with peak exercise capacity in a large cohort of athletes using three-dimensional (3D) echocardiography. Competitive athletes of various training regimes (n=525, age: 20±6 years, training: 15±7 hours/week, 30% female) were enrolled, while 73 age- and gender-matched sedentary volunteers served as the control group. Full volume 3D echocardiographic datasets focused on the LV or the RV were acquired for further analysis: LV and RV end-diastolic volume (EDVi), LV mass (Mi) indices and ejection fraction (EF) were quantified. To characterize biventricular mechanics, LV and RV global longitudinal strain (GLS) and global circumferential strain (GCS) were also measured using dedicated software. Athletes also underwent cardiopulmonary exercise testing to determine peak oxygen uptake (VO2/kg). Athletes had significantly higher LV and RV EDVi (81±13 vs. 64±11 mL/m2; 83±14 vs. 63±11 mL/m2; both p&amp;lt;0.001) and also LVMi (87±15 vs. 65±12 g/m2; p&amp;lt;0.001) compared to controls. LV and RV EF were significantly lower in athletes (57±5 vs. 60±6%; 55±5 vs. 58±5%; both p&amp;lt;0.001). LV GLS (−19.5±2.1 vs. −20.6±2.6%; p&amp;lt;0.001) and also LV GCS (−27.9±3.2 vs. −29.8±4.4%; p&amp;lt;0.001) was lower in athletes compared to controls. In opposed to the LV, RV GLS did not differ between the two groups (−29.3±5.8 vs. −29.5±5.3%; p=NS), however, RVGCS was decreased in athletes compared to controls (−24.4±6.1 vs. −28.6±7.3%; p&amp;lt;0.001). In athletes, ventricular morphology measured by LV and RV EDVi correlated with VO2/kg (both r=0.37; p&amp;lt;0.001), while functional measures, such as lower resting LV GLS (r=0.22; p&amp;lt;0.001) and RV GCS (r=0.14; p&amp;lt;0.01) also showed relationship with better exercise performance. According to our results, regular physical exercise is associated with significant changes of LV and RV geometry and mechanics. Resting biventricular systolic function of the athlete's heart is characterized by a mild reduction, which is attributable to a lower longitudinal and circumferential shortening on the left side of the heart, while on the right side lower circumferential shortening can be seen along with a maintained longitudinal shortening. Moreover, this mechanical pattern also correlates with exercise performance. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): “National Heart Program” NVKP_16-1-2016-0017; NKFIH K_16 K120277 to BM

Prognostic impact of right ventricular mass change in patients with idiopathic pulmonary arterial hypertension

BackgroundCompensatory remodelling i.e. increased right ventricular (RV) mass frequently occurs as an adaptive response to the chronic pressure overload to maintain contractile function. The prognostic value of the serial change in RV mass is unclear. AimThe aim of our study was to examine the longitudinal changes in RV mass and survival in patients with idiopathic pulmonary arterial hypertension (IPAH). MethodsConsecutive newly diagnosed IPAH patients >18 years old were prospectively recruited from a tertiary referral center. All recruited patients were maintained on guideline-based therapy and were followed up with echocardiography and cardiac magnetic resonance for 2 years. ResultsSerial measures of RV mass revealed that survivors appeared to have had a compensatory increase in RV mass, which constituted adaptive RV remodelling early in the disease process, which was not seen in those who died. (Hazard ratio of 0.932, 95% confidence interval 0.893–0.973, p = 0.001). ConclusionThis study shows that serial measurement of RV mass in IPAH patients provides prognostic information. RV mass regression is an ominous prognostic sign, which may predict early mortality in these patients.

Effects of pericardiotomy on left ventricular muscle mass and hemodynamic parameters

Aim: It has been shown in many experimental animal studies that increased myocardial tension and ventricular filling after cardiac pericardiectomy leads to increased myocardial protein synthesis and increased left ventricular muscle mass. In this study, we aimed to show left ventricular muscle mass changes, left ventricular end-systolic-end-diastolic volume changes, significant changes in systolic-diastolic blood pressure and wall stress after pericardiectomy performed in patients with normal ejection fraction undergoing coronary artery bypass graft (CABG) operation.Material and Methods: Echocardiographic ventricular mass, end-diastolic volumes, end-systolic volumes, ejection fraction values were measured in the preoperative 1st day, postoperative 6th weeks and post operative 6th months in our 32 patients with normal ejection fraction who underwent elective coronary artery bypass operation in our clinic. Results: According to the preoperative values, echocardiographic evaluations showed that left ventricular muscle mass index (LVMMI) increased 15% at 6 weeks, %18 at 6 month after CABG operation ( p 0,05). The mean left ventricular end diastolic volume index (LVEDVI) was 55 ±8 ml/m2 preoperatively , 67 ±10 ml/m2 at the 6th week and 70 ±12 ml/m2 at 6th month; this increase was significant respectively (p0.05). This enlargement occurred with no changes in systolic and diastolic blood pressure and did not lead to significant changes in end-systolic volume and end-systolic circumferential wall stress.Conclusion: In conclusion, in patients undergoing coronary artery bypass graft surgery, pericardiectomy may lead to a partial increase in left ventricular end-diastolic volume and left ventricular muscle mass with better left ventricular filling.

Left ventricular mass index as a prognostic factor in children with chronic kidney disease

Objective The objective of this study was to evaluate the effect of decreasing renal function on left ventricular mass index (LVMI) in children with chronic kidney disease (CKD) on regular hemodialysis attending Assiut University Hospital for Children, and also to evaluate left ventricular mass changes as predictor of morbidity and mortality of uremic children by using echocardiography, aiming to use it in the future. Patients and methods Baseline clinical characteristics were collected by careful history and examination. Routine laboratory methods were used to measure biochemical parameters: hemoglobin, C-reactive protein, phosphorus, calcium, parathyroid hormone, and lipid profile after patients fasted for 8 h. Echocardiographic parameters were measured within 2–24 h after a dialysis session. Results In this study, we studied 36 children on regular hemodialysis. The age of our patients ranged from 3.5 to 16 years, and the number of male patients was similar to female patients. In our study. we found eccentric left ventricular hypertrophy was predominant (38.9%) compared with concentric left ventricular hypertrophy (13.9%). We found that 52.8% of patients had increased LVMI and 47.2% had normal LVMI. Regarding the fate of our cases, 39% died during the study period, whereas the other 61% survived. Mortality among patients with increased LVMI was higher (28%) than among patients with normal LVMI (11%). Conclusion Children with CKD are prone to development of cardiac dysfunctions, so early and regular echocardiographic studies of all children with CKD to detect early cardiac changes and institute interventions and follow-up are required.

Highlights From the Circulation Family of Journals.

Highlights From the Circulation Family of Journals.

Usefulness of left ventricular mass change to predict progression of renal dysfunction in Hispanics

ABSTRACTThere is a strong relation between metabolic syndrome (MetS) and left ventricular (LV) mass in Hispanic patients. This population also tends to have a higher incidence of kidney disease, with progression to dialysis. We analyzed the change in LV mass in 982 Hispanic patients with MetS and used these data to anticipate the progression of renal dysfunction. Glomerular filtration rate (GFR) was calculated using the formula described by the Chronic Kidney Disease Epidemiology Collaboration. Echocardiographic data were collected using 2-dimensionally guided M-mode echocardiography measures. The data collected were then analyzed using linear regression analyses. Results showed a lower average GFR in individuals classified as having a severe change in LV mass in comparison to those with milder change in LV mass (P < 0.0001). This relation was also demonstrated when those with severe change in LV mass were compared with the control group (P < 0.0001). In those ≥54 years old, the presence of MetS and LV mass were negatively correlated with GFR (regression coefficient [RC] = 14.76, P < 0.063; RC = 0.11, P < 0.0001 respectively). In patients <54 years old, no statistically significant association between the presence of MetS and GFR was seen. However, LV mass was once again negatively correlated with GFR (RC = 0.15, P < 0.0001). In conclusion, results demonstrated the association between the MetS, change in LV mass, and chronic kidney disease progression.

Assessment of left ventricular mass changes after arteriovenous fistula surgical banding in end-stage renal disease.

Left ventricular hypertrophy (LVH) is a multifactorial complication frequently seen in patients with advanced chronic kidney disease. An arteriovenous fistula (AVF) is the preferred method for hemodialysis access. Once functional, AVFs demonstrate better patency rates and fewer complications when compared to other forms of vascular access. AVFs have been implicated in cardiac remodeling, but it is controversial whether those changes can be reversed by surgical ligation or blood flow reduction. In this study, we describe a cohort of asymptomatic patients with LVH who underwent AVF banding with a two-dimensional-echocardiogram done before and after the intervention to evaluate the association between AVF surgical banding and left ventricular mass (LVM) changes. Our results show that AVF surgical banding did not alter the left ventricular mass index (LVMI) with a mean prebanding LVMI of 70.3 ± 57.5 g/m2 and mean postbanding LVMI of 81.9 ± 55.9 g/m2, (P = 0.4). Our study shows that AVF flow reduction by surgical banding did not alter LVMI, and therefore LVH, in end-stage renal disease patients who have not yet shown clinical manifestations of cardiac disease.

Prognostic impact of left ventricular mass change in patients with ST-elevation myocardial infarction.

Prognostic significance between progression of left ventricular hypertrophy (LVH) and clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) is uncertain. The objective of this study was to investigate prognostic impact of progression of LV mass index (LVMI) in patients with STEMI.We analyzed the data and clinical outcomes of patients with STEMI who received successful coronary intervention. A total of 200 patients who had echocardiographic follow-up between 12 and 36 months were finally enrolled. According to change in LVMI compared to baseline LVMI, patients were classified into progression group and nonprogression group. Progression of LVMI was defined when increment of LMVI was greater than 10% compared to baseline LVMI. End points were major adverse cardiac events within 5 years, including death, recurrent MI, target vessel revascularization, and hospitalization due to heart failure.Progression of LVMI occurred in 55 patients. In the progression group, rate of recurrent MI was higher (13 vs 2%, P = .026) and the event-free survival of recurrent MI was significantly worse (log-rank P < .001) than that in the nonprogression group. Adjusted hazard ratio of progression of LVMI for recurrent MI was 10.253 (95% confidence intervals 2.019–52.061, P = .005).Increased LVMI was an independent predictor for adverse events, especially for recurrent MI, in patients with STEMI.

Determinants of Left Ventricular Characteristics Assessed by Cardiac Magnetic Resonance Imaging and Cardiovascular Biomarkers Related to Kidney Transplantation.

Background:Cardiac magnetic resonance (CMR) imaging accurately and precisely measures left ventricular (LV) mass and function. Identifying mechanisms by which LV mass change and functional improvement occur in some end-stage kidney disease (ESKD) patients may help to appropriately target kidney transplant (KT) recipients for further investigation and intervention. The concentration of serum adiponectin, a cardiovascular biomarker, increases in cardiac failure, its production being enhanced by B-type natriuretic peptide (BNP), and both serum adiponectin and BNP concentrations decline posttransplantation.Objective:We tested the hypothesis that kidney transplantation alters LV characteristics that relate to serum adiponectin concentrations.Design:Prospective and observational cohort study.Setting:The study was performed at 3 adult kidney transplant and dialysis centers in Ontario, Canada.Patients:A total of 82 KT candidate subjects were recruited (39 to the KT group and 43 to the dialysis group). Predialysis patients were excluded.Measurements:Subjects underwent CMR with a 1.5-tesla whole-body magnetic resonance scanner using a phased-array cardiac coil and retrospective vectorographic gating. LV mass, LV ejection fraction (LVEF), LV end-systolic volume (LVESV), and LV end-diastolic volume (LVEDV) were measured by CMR pre-KT and again 12 months post-KT (N = 39), or 12 months later if still receiving dialysis (N = 43). LV mass, LVESV, and LVEDV were indexed for height (m2.7) to calculate left ventricular mass index (LVMI), left ventricular end-systolic volume index (LVESVI), and left ventricular end-diastolic volume index (LVEDVI), respectively. Serum total adiponectin and N-terminal proBNP (NT-proBNP) concentrations were measured at baseline, 3 months, and 12 months.Methods:We performed a prospective 1:1 observational study comparing KT candidates with ESKD either receiving a living donor organ (KT group) or waiting for a deceased donor organ (dialysis group).Results:Left ventricular mass index change was −1.98 ± 5.5 and −0.36 ± 5.7 g/m2.7 for KT versus dialysis subjects (P = .44). Left ventricular mass change was associated with systolic blood pressure (SBP) (P = .0008) and average LV mass (P = .0001). Left ventricular ejection fraction did not improve (2.9 ± 6.6 vs 0.7 ± 4.9 %, P = .09), while LVESVI and LVEDVI decreased more post-KT than with continued dialysis (−3.36 ± 5.6 vs −0.22 ± 4.4 mL/m2.7, P < .01 and −4.9 ± 8.5 vs −0.3 ± 9.2 mL/m2.7, P = .02). Both adiponectin (−7.1 ± 11.3 vs −0.11 ± 7.9 µg/mL, P < .0001) and NT-proBNP (−3811 ± 8130 vs 1665 ± 20013 pg/mL, P < .0001) declined post-KT. Post-KT adiponectin correlated with NT-proBNP (P = .001), but not estimated glomerular filtration rate (eGFR) (P = .13). Change in adiponectin did not correlate with change in LVEF in the KT group (Spearman ρ = 0.16, P = .31) or dialysis group (Spearman ρ = 0.19, P = .21).Limitations:Few biomarkers of cardiac function were measured to fully contextualize their role during changing kidney function. Limited intrapatient biomarker sampling and CMR measurements precluded constructing dose-response curves of biomarkers to LV mass and function. The CMR timing in relation to dialysis was not standardized.Conclusions:The LVESVI and LVEDVI but not LVMI or LVEF improve post-KT. LVMI and LVEF change is independent of renal function and adiponectin. As adiponectin correlates with NT-proBNP post-KT, improved renal function through KT restores the normal heart-endocrine axis.

Reproducibility of Left Ventricular Dimension Versus Area Versus Volume Measurements in Pediatric Patients With Dilated Cardiomyopathy.

Multiple echocardiographic methods are used to measure left ventricular size and function. Clinical management is based on individual evaluations and longitudinal trends. The Pediatric Heart Network VVV study (Ventricular Volume Variability) in pediatric patients with dilated cardiomyopathy has reported reproducibility of several of these measures, and how disease state and number of beats impact their reproducibility. In this study, we investigated the impact of observer and sonographer variation on reproducibility of dimension, area, and volume methods to determine the best method for both individual and sequential evaluations. In 8 centers, echocardiograms were obtained on 169 patients prospectively. During the same visit, 2 different sonographers acquired the same imaging protocol on each patient. Each acquisition was analyzed by 2 different observers; first observer analyzed the first acquisition twice. Intraobserver, interobserver, interacquisition, and interobserver-acquisition (different observers and different acquisition) reproducibility were assessed on measurements of left ventricular end-diastolic dimension, area, and volume. Left ventricular shortening fraction, ejection fraction, mass, and fractional area change were calculated. Percent difference was calculated as (interobservation difference/mean)×100. Interobserver reproducibility for both acquisitions was better for both volume and dimension measurements (P≤0.002) compared with area measurements, whereas intraobserver, interacquisition (for both observers), and interobserver-acquisition reproducibilities (for both observer-acquisition sets) were best for volume measurements (P≤0.01). Overall, interobserver-acquisition percent differences were significantly higher than interobserver and interacquisition percent differences (P<0.001). In pediatric patients with dilated cardiomyopathy, compared with dimension and area methods, left ventricular measurements by volume method have the best reproducibility in settings where assessment is not performed by the same personnel. URL: https://www.clinicaltrials.gov. Unique identifier: NCT00123071.

Acclimation to prolonged hypoxia alters hemoglobin isoform expression and increases hemoglobin oxygen affinity and aerobic performance in a marine fish

Hemoglobin (Hb) multiplicity is common in fish, yet despite its ubiquitous nature, the functional significance is unclear. Here we explore the hypothesis that Hb multiplicity plays a role in hypoxia tolerance using the red drum (Sciaenops ocellatus). Red drum is an economically and ecologically important species native to coastal regions and estuaries of the Gulf of Mexico – habitats that routinely experience pronounced hypoxic events. Using a transcriptomic approach, we demonstrate that red drum red blood cells express 7 and 5 Hbα and Hbβ isoforms, respectively. Phylogenetic analysis grouped these isoforms into distinct isoHb clades, and provided evidence of lineage specific expression of particular isoHbs. In normoxia, three isoHbs predominated (Hbα-3.1, -3.2, and Hbβ-3.1). A three-week hypoxia acclimation (48 mmHg) resulted in significant up-regulation of Hbα-2, Hbα-3.2, and Hbβ-3.1, effectively switching the predominantly expressed isoforms. Changes in subunit expression were correlated with a decrease in non-stripped hemolysate P50. Similarly, hypoxia acclimation resulted in a 20% reduction in whole animal critical oxygen threshold (Pcrit). Hypoxia acclimation was not associated with changes in gill morphology, hematocrit, or relative ventricular mass. Overall, these data provide support for the hypothesis that Hb isoform switching can provide a physiological benefit to counteract environmental stress in fishes.

The Effect of the Superior Cavopulmonary Anastomosis on Ventricular Remodeling in Infants with Single Ventricle

Infants with single ventricular physiology have volume and pressure overload that adversely affect ventricular mechanics. The impact of superior cavopulmonary anastomosis (SCPA) on single left ventricles versus single right ventricles is not known. As part of the Pediatric Heart Network placebo-controlled trial of enalapril in infants with single ventricularphysiology, echocardiograms were obtained before SCPA and at 14 months and analyzed in a core laboratory. Retrospective analysis of the following measurements included single ventricular end-diastolic volume (EDV), end-systolic volume (ESV), mass, mass-to-volume ratio (mass/volume), and ejection fraction. Qualitative assessment of atrioventricular valve regurgitation and assessment of diastolic function were also performed. A total of 156 participants underwent echocardiography at both time points. Before SCPA, mean ESV and mass Z scores were elevated (3.4±3.7 and 4.2±2.9, respectively) as were mean EDV and mass/volume Z scores (2.1±2.5 and 2.0±2.9, respectively). EDV, ESV, and mass decreased after SCPA, but mass/volume and the degree of atrioventricular valve regurgitation did not change. Subjects with morphologic left ventricles demonstrated greater reductions in ventricular volumes and mass than those with right ventricles (mean change in Zscore: left ventricular [LV] EDV, -1.9±2.1; right ventricular EDV, -0.7±2.5; LV ESV, -2.3±2.9; right ventricular ESV, -0.9±4.6; LV mass, -2.5±2.8; right ventricular mass, -1.3±2.6; P≤.03 for all). Approximately one third of patients whose diastolic function could be assessed had abnormalities at each time point. Decreases in ventricular size and mass occur in patients with single ventricle after SCPA, and the effect is greater in those with LV morphology. The remodeling process resulted in commensurate changes in ventricular mass and volume such that the mass/volume did not change significantly in response to the volume-unloading surgery.

A new look at left ventricular remodeling definition by cardiac imaging

Left ventricular remodeling (LVR) typically manifests as compensatory changes in ventricular mass, composition, and volume as a response to cardiac performance inadequacy [ [1] Cohn J.N. Ferrari R. Sharpe N. Cardiac remodeling–concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. Behalf of an International Forum on cardiac remodeling. J. Am. Coll. Cardiol. 2000; 35: 569-582 Abstract Full Text Full Text PDF PubMed Scopus (1924) Google Scholar ]. Cardiac multimodality imaging allows us to investigate both counterparts of remodeling, namely structural and functional remodeling [ 2 Mewton N. Liu C.Y. Croisille P. Bluemke D. Lima J.A. Assessment of myocardial fibrosis with cardiovascular magnetic resonance. J. Am. Coll. Cardiol. 2011; 57: 891-903 Abstract Full Text Full Text PDF PubMed Scopus (677) Google Scholar , 3 Grothues F. Smith G.C. Moon J.C. Bellenger N.G. Collins P. Klein H.U. et al. Comparison of interstudy reproducibility of cardiovascular magnetic resonance with two-dimensional echocardiography in normal subjects and in patients with heart failure or left ventricular hypertrophy. Am. J. Cardiol. 2002; 90: 29-34 Abstract Full Text Full Text PDF PubMed Scopus (1099) Google Scholar ]. Considering the morbi-mortality burden of LVR, these parameters appear to be of value for diagnosing subclinical disease, conducting patient risk stratification, and monitoring response to therapy [ [1] Cohn J.N. Ferrari R. Sharpe N. Cardiac remodeling–concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. Behalf of an International Forum on cardiac remodeling. J. Am. Coll. Cardiol. 2000; 35: 569-582 Abstract Full Text Full Text PDF PubMed Scopus (1924) Google Scholar ].