Ventricular Myocardial Hypertrophy Research Articles

Risk of the occurrence of occupational diseases associated with somatic pathology

Introduction. Recent academic studies in the clinic of occupational medicine demonstrate a significant prevalence of cardiovascular and metabolic pathology associated with occupational activity. Objective. to analyze the role of somatic pathology in occurrence of occupational diseases in aluminum, refractory and asbestos-processing production workers in order to identify the directions of preventive measures. Material and methods. The results of the examination of aluminum, refractory and asbestos-processing production workers under the periodic medical check-up and in the clinic were analyzed. Results. According to the periodic medical check-up, only 5.57% of refractory workers, 1.5% of aluminum workers, and 22.7% of asbestos-processing workers were not diagnosed with somatic diseases. Most frequently, workers of the surveyed enterprises reported overweight (up to 68%). lipid storage disease was more likely to occur in the refractory industry (46%), carbohydrate metabolism - in the aluminum industry (22.3%) and asbestos-processing industry (22.6%). In cases with obesity, chronic gastritis, type 2 diabetes, decreased glomerular filtration rate, hyperuricemia, arterial hypertension, and CHD. A considerable influence of somatic pathology on the period of the development of occupational diseases’ has been identified. In patients average work experience before the development of asbestos is reduced from 6 to 12.7 years. In patients with high-grade arterial hypertension, left ventricular myocardial hypertrophy, IHD, overweight and obesity reduction in the average work experience before the development of occupational fluorosis was observed from 3.9 to 6 years. A reduction in the average work experience before the development of silicosis from 10.8 to 13 years was observed in women, as well as in the presence of high-grade arterial hypertension, cardiac arrhythmia and a decrease in blood hemoglobin. Conclusion. The significant impact of somatic pathology on the terms of the occurrence of occupational diseases in workers of aluminum, asbestos-processing and refractory industries was determined.

Предикторы начальной стадии хронической сердечной недостаточности при сахарном диабете 2-го типа

Introduction. Type 2 diabetes mellitus (T2DM) is considered to be the equivalent of cardiovascular disease due to its micro- and macrovascular complications. Insulin resistance and hyperinsulinemia, impaired glucose tolerance and fasting glucose, and their subsequent maladaptive responses lead to myocardial dysfunction several years before the onset of T2DM. Pathological changes in the cardiovascular system in T2DM can progress without any symptoms for a long time. Aim. To identify clinical, laboratory, echocardiographic predictors of the early manifestations of chronic heart failure (CHF) in patients with T2DM. Materials and methods. The study included 94 patients with T2DM with and without initial symptoms of CHF at the age of 40 to 65 years. All patients had obesity or excess body weight and arterial hypertension (AH), 37 patients had stable coronary heart disease (CHD). Patients underwent general clinical and laboratory examination, a 6-minute walk test (6MWT), echocardiography. The concentration of N-terminal pro-B-type natriuretic peptide (NT-proBNP ) was also determined. The patients were divided into 2 groups: without CHF symptoms (group 1, n = 54) and with initial symptoms of CHF (group 2, n = 40) and then these groups were compared. Results. Differences were revealed between the second and first groups in the duration of T2DM (10.5 vs 7.5 years, p = 0.02) and AH (15 vs 10 years, p = 0.009); the incidence of stable CHD (70 vs 16.7%, p < 0.0001); distance covered during 6MWT (375 vs 425 m, p < 0.0001); the median level of NT-proBNP (38.5 vs 27.2 pg/ml, p = 0.031); the left atrium (LA) size (4.4 vs 4.2 cm, p = 0.044); the left ventricular posterior wall thickness (PWT) (1.05 vs 0.95 cm, p = 0.02); the level of triglycerides (2.3 vs 1.6 mmol/l, p = 0.03) and the glomerular filtration rate (GFR) (74.1 vs 79.1 ml/min/1.73 m2, r = 0.04). The discriminant analysis revealed combination of factors associated with initial symptoms of CHF: the duration of CHD (taken as 0, if absent, p < 0.00001), PWT of the LV (p = 0.000007), GFR (p = 0.0009), the LA size (p = 0.005), the level of triglycerides (p = 0.03), the duration of T2DM (p = 0.046). The NT-proBNP level > 125 pg/ml was detected in 16% of patients with T2DM and correlated with the duration of diabetes over 10 years (p = 0.0085), the presence of stable CHD (p < 0.0001), and left ventricular mass index (p = 0.0005) and the ejection fraction of the LV (p < 0.0001). Conclusion. Predictors of the initial manifestations of chronic heart failure in patients with type 2 diabetes mellitus were the presence and duration of stable CHD, an increase in the PWT of the LV, the LA size, the level of triglycerides, and the duration of diabetes. An elevated level of NT-proBNP (more than 125 pg/ml) in patients with T2DM was detected in 16% of cases and was associated with the duration of diabetes for more than 10 years, presence of stable CHD, initial symptoms of CHF, left ventricular myocardial hypertrophy, and a lower left ventricular ejection fraction according to echocardiography.

Peculiarities of structural-functional indicators of the heart in the combined of hypertension and gastroesophageal reflux disease in liquidators of consequences of Chornobyl accidents

The Chornobyl accident in Ukraine affected more than 3 million people. The impact of the disaster on human health is multifaceted and is associated with both the direct effects of ionizing radiation and other negative factors of the accident. Diseases of the circulatory system are one of the leading causes of death in this population. The combination of hypertension disease and gastroesophageal reflux disease reveals forms of structural and functional indicators of the heart, characterized by a higher level of left ventricular myocardial hypertrophy, regardless of the stage of HD and the degree of blood pressure. The aim was to determine the features of structural and functional indicators of the heart in the combined course of HD and GERD in the liquidators of the Chornobyl accident, as well as to establish differences from the indicators of patients with isolated HD. Materials and methods of research. A comprehensive survey of 105 liquidators of the Chornobyl accident aged 52 to 69 years (mean age 58.5 ± 0.8 years), 85.7 % of men and 14.3 % of women was conducted. All of them were hospitalized in therapeutic and / or observed on an outpatient basis in the outpatient departments of the «Regional Clinical Specialized Dispensary for Radiation Protection of the Population» of Kharkiv. Patients were divided into 2 groups. The first group – 52 patients with a combined course of HD and GERD, 44 (84.6 %) men and 8 (15.4 %) women. The second – 53 patients with isolated HD, 46 (86.8 %) men and 7 (13.2 %) women. All patients in outpatient settings underwent a comprehensive medical examination, including Doppler echocardiography. Results and conclusions. When comparing the structural and functional parameters of the heart in the combined course of HD and GERD in the liquidators of the Chornobyl accident with an isolated course of HD, it was found that almost all indicators of systolic, diastolic and pumping heart function are statistically significantly increased, p ≤ 0.05, except for aortic pressure size gradient and diameter of right ventricule. Thus, patients with a combined course of pathology have more pronounced changes in the structural and functional parameters of the heart, thereby increasing the risk of cardiovascular complications. Prospects for the study are relevant and necessary for further prediction of the risk of complications and individual therapeutic approach in comorbid pathology in the liquidators of the Chernobyl accident.

РЕЗУЛЬТАТЫ ТРАНСПЛАНТАЦИИ СЕРДЦА В ЗАВИСИМОСТИ ОТ СТЕПЕНИ ГИПЕРТРОФИИ МИОКАРДА ЛЕВОГО ЖЕЛУДОЧКА ДОНОРСКОГО СЕРДЦА

Objective. To evaluate the influence of donor LV hypertrophy on the survival of recipients after heart transplantation (HTx). Methods: The study included 446 patients who underwent orthotopic heart transplantation using the biatrial or bicaval technique in the period from 2009 to 2021. The study had a retrospective single-center cohort design. LV hypertrophy was assessed according to ECHO CG data, focusing on measuring the thickness of the walls of the donor heart according to the recommendations of the Ame- rican Society of Echocardiography: < 1.1 – no hypertrophy, 1.1–1.3 cm – mild, 1.4–1.6 cm – moderate LVH, ≥ 1.7 – severe. Control echocardiograms were performed immediately after HTx and 1 year later. According to the above criteria, the first group included recipients of donor heart without LVH and with in- significant LVH, the second group consisted recipients of heart with mod- erate and severe LVH. For a more detailed analysis of survival, 4 subgroups were subsequently identified: no LVH, insignificant, moderate and severe LVH. We analyzed the overall postoperative survival in groups/subgroups, as well as the thickness of IVS and GS in dynamics (after 1 year). The influence of the donor’s age (threshold age 45 years) and ischemia time (threshold – 240 min) of the donor heart on the results of using donor hearts with LVH was also investigated, due to this the corresponding subgroups were identified. Results. In the analysis of survival, no significant differences were found between the group of recipients who received a heart without hypertrophy or with insignificant LVH and the group of recipients who received an organ with moderate or severe LVH. Expanded survival analyzes also showed no significant differences between subgroups (p = 0.792). In the present study, the survival rate of heart recipients with LVH did not depend on the time of ischemia, but a significant decrease in the survival rate of heart recipients with LVH from donors older than 45 years was obtained (p = 0.035), while in the group with no or insignificant LVH, the donor age did not affect the HTx result. One year after TS a significant decrease in the thickness of both IVS (14.9 → 12.1) and PW (12.78 → 10.52) has been recorded. Conclusion. Heart transplantation with left ventricular myocardial hypertrophy (up to 17 mm) does not affect the survival of recipients (log-rank: p = 0.7), provided that the donor’s age is less than 45 years old, while over time, in the vast majority of cases, there is a regression of wall thickness left ventricular myocardium, which allows us to consider the use of heart transplantation with LVH as one of the options for expanding the pool of donor organs. Further studies of the effect of severe LVH with wall thickness greater than 1.7 cm using a larger sample are needed.

Comparative characteristics of patients with arterial hypertension and stenosing atherosclerosis, depending on the localization of the pathologicalprocess in the vascular bed

A comparative analysis of the clinical and functional state of patients suffering from arterial hypertension is given, depending on the localization of vascular stenosis of atherosclerotic origin. It is shown that stenosing atherosclerosis often affects men with hypertension. Lesions of the brachiocephalic arteries and renal arteries in patients suffering from arterial hypertension are detected at a younger age than with other localizations. Patients suffering from lesions of the coronary and brachiocephalic arteries are characterized by the presence of concentric left ventricular myocardial hypertrophy and hyperlipidemia. In patients suffering from damage to the renal arteries, leg arteries, and multivascular pathology, myocardial hypertrophy is eccentric, in addition, they have atherogenic dyslipidemia and significant signs of renal dysfunction. An excessive decrease in blood pressure at night is most often recorded in people suffering from coronary atherosclerosis, and its excessive increase in patients suffering from damage to the arteries of the legs. Arterial hypertension in patients with stenosing atherosclerosis in most cases is well-mediated, however, with stenosis of the renal arteries and with multivascular lesions, it is less likely to achieve a level of «normal» or «high normal» systolic blood pressure than with damage to other vascular pools. Significant differences in the levels of both systolic and diastolic blood pressure in all comparison groups indicate a different effect of local hemodynamic disturbances on systemic blood pressure.

Model for Prediction of Left Ventricular Myocardial Hypertrophy in Patients with Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is diagnosed in 25% of adults and associated with high fatal risks of cardiovascular complications. Left ventricular hypertrophy (LVH) is recognized as one of the markers of such risks. In this study, we attempted to create a mathematical model for predicting LVH among OAS patients with various levels of disease severity.Materials and methods. In a prospective cohort study, we included 368 patients (358 male; age 46.0 [42.0; 49.0] yr.) with diagnosed OSA, arterial hypertension, grade I-II obesity (WHO classification 1997). The severity of sleep apnea was verified during nighttime computed somnography (CSG) on WatchPAT-200 hardware (ItamarMedical, Israel) with original software zzzPATTMSW ver. 5.1.77.7 (ItamarMedical, Israel) by registering the main respiratory polygraphic characteristics from 11.00 PM to 7:30 AM. Verification of LVH was performed in one- and two-dimensional modes in standard echocardiographic positions using Xario-200 ultrasound scanner (Toshiba, Japan) with 3.5 MHz transducer. Hemodynamic parameters of left ventricular (LV) systolic function (EF %, ESV, EDV) were determined by quantitative assessment of two-dimensional echocardiograms using the modified Simpson method. Evaluation of the systolic function of the right ventricle (RV) was performed in the «M»-mode by measuring the systolic excursion of the fibrous ring of the tricuspid valve (TAPSE).Results. ESS and TSat90% (AUC = 0.975; SD = 0.00741; CI 95% [0.953; 0.988]) should be considered the best predictors for predicting LVH in various degrees of OSA severity, allowing us to offer a predictive model with a sensitivity of 93.7% and specificity of 93.8%, after conducting a questionnaire screening and computer somnographic study.Conclusions. Our proposed model of clinical prediction of LVH among patients with various degrees of OAS is based on a carefully planned analysis of questionnaire and instrumental data, and is well applicable in real diagnostic procedures by a wide range of therapeutic practitioners.

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

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

Predicting the Risk of Developing Silicosis in Refractory Workers

We conducted a study of refractory workers exposed to multiple occupational hazards, the most important of which being dust aerosols of predominantly fibrogenic action. Our objective was to identify the spectrum of predictors of the occupational disease in refractory workers and to build a predictive mathematical model using multivariate analysis to assess the likelihood of developing silicosis. Materials and methods: The case reports of 172 refractory production workers were analyzed. The main group consisted of 75 silicosis patients and the control cohort consisted of 97 experienced workers without this occupational disease. The groups were comparable in gender (p=0.052), dust exposure (p=0.862), and the severity of the work process (p=0.147). We assessed a wide specter of factors related to refractory workers’ health and occupational conditions significantly affecting the timing of developing occupational pulmonary fibrosis. Results: In the silicosis patients, arterial hypertension (p=0.005), left ventricular myocardial hypertrophy (p=0.002), coronary heart disease (p=0.010), chronic circulatory depression (p=0.010), low hemoglobin level (p=0.022), and low speed and volume criteria of external respiration function were significantly more prevalent. We established four important independent factors associated with the development of silicosis in refractory workers including age, time-weighted average and maximum one-time dust concentrations, and the forced expiratory volume in the first second. Conclusions: We observed a medium work-relatedness of hypertension, a strong work-relatedness of left ventricular myocardial hypertrophy, sinus node tachycardia syndrome and obesity, and a very strong work-relatedness of impaired fasting glycemia. Using a logistic regression, we built a silicosis development predictive model having high predictive ability (82.8 %), sufficient sensitivity (85.2 %) and specificity (80.0 %). The model was tested and verified on clinical examples and can be used to predict the probability of silicosis in refractory workers.

Inhibition of the Notch1 pathway induces peripartum cardiomyopathy.

Increased expression and activity of cardiac and circulating cathepsin D and soluble fms‐like tyrosine kinase‐1 (sFlt‐1) have been demonstrated to induce and promote peripartum cardiomyopathy (PPCM) via promoting cleavage of 23‐kD prolactin (PRL) to 16‐kD PRL and neutralizing vascular endothelial growth factor (VEGF), respectively. We hypothesized that activation of Hes1 is proposed to suppress cathepsin D via activating Stat3, leading to alleviated development of PPCM. In the present study, we aimed to investigate the role of Notch1/Hes1 pathway in PPCM. Pregnant mice between prenatal 3 days and postpartum 3 weeks were fed with LY‐411575 (a notch inhibitor, 10 mg/kg/d). Ventricular function and pathology were evaluated by echocardiography and histological analysis. Western blotting analysis was used to examine the expression at the protein level. The results found that inhibition of Notch1 significantly promoted postpartum ventricular dilatation, myocardial hypertrophy and myocardial interstitial fibrosis and suppressed myocardial angiogenesis. Western blotting analysis showed that inhibition of Notch1 markedly increased cathepsin D and sFlt‐1, reduced Hes1, phosphorylated Stat3 (p‐Stat3), VEGFA and PDGFB, and promoted cleavage of 23k‐D PRL to 16‐kD PRL. Collectively, inhibition of Notch1/Hes1 pathway induced and promoted PPCM via increasing the expressions of cathepsin D and sFlt‐1. Notch1/Hes1 was a promising target for prevention and therapeutic regimen of PPCM.

The correlation of blood pressure changes and cardiac morpho- functional restructuring in young athletes

A steady increase in the number of young sportsmen predetermines the relevance of studying the nature and severity of cardiovascular system remodeling in young athletes, including the development of arterial hypertension (AH) and left ventricular myocardial hypertrophy (LVHM).Objective. To study the prevalence and nature of arterial hypertension (AH) and its associations with signs of cardiovascular remodeling in young athletes taking into account pathogenetic relationship and genetic determination.Characteristics of children and methods. The study included 80 young athletes (including 42 boys, average age 14,5±1,54 years), divided into 4 groups depending on the kind of sports (1 – cyclic, 2 – game, 3 – complex coordination, 4 – power). We used the following research methods: “office” (i.e. during visit to the doctor) measurement of blood pressure, electrocardiography, echocardiography, color Doppler scanning of the neck vessels, daily monitoring of blood pressure, bicycle ergometry, genetic testing using the original panel with 448 markers.Results. An increase in blood pressure at rest was detected in 2,5% of children engaged in power sports, an insufficient decrease at night – in 16,3% of children, and an excessive reaction of blood pressure to dosed physical activity – in 25% of children. These changes correlated with signs of sports remodeling, in particular with the formation of left ventricular myocardial hypertrophy, which was diagnosed in 7–12,5% of athletes. According to the results of genetic testing, pronounced polymorphism in the NO synthase gene at three loci (rs10918594, rs12143842, rs16847548) was associated with a reorganization of the cardiovascular system in 45% of athletes.Conclusion. Violation of the circadian profile of blood pressure and excessive reaction to physical activity demonstrate 7,5–25% of young athletes, especially those involved in complex coordination and power sports. These changes were associated with the severity of sports remodeling and determined by a genetic predisposition.

Machine Learning Methods in Assessing the Risks of Target Organ Damage in Masked Hypertension

Aim To develop models for predicting the risk of target organs damage (TOD) in different phenotypes of "masked" arterial hypertension (MAH) based on methods of machine learning (ML).Material and methods A retrospective cohort analysis was performed for 284 clinical records of patients (261 males, 23 females; median age, 38 years). Group 1 included 125 patients with grade 1-2 arterial hypertension (AH) and low or moderate risk; group 2 included 159 subjects with normal "office" blood pressure (BP) exposed to chronic professional stress. The 24-h BP monitoring (24-h BPM) and ultrasound examination of the heart and carotid arteries were performed; glomerular filtration rate (GFR) was estimated using the СКD-EPI formula. MAH was phenotyped by clustering 24-h BPM data, and the risk of TOD was predicted by analysis of odd ratios (OR) and with the ML methods, random forest (RF) and artificial neural networks (ANN). Data were analyzed using the R language in the RStudio environment.Results According to results of the 24-h BPM and cluster analysis, 121 (76.1 %) subjects of group 2 had MAH. The MAH phenotypes were identified as follows: systolic-diastolic (SDMAH) (43.8 %); isolated systolic (ISMAH) (35.5 %), and isolated diastolic (IDMAH) (20.7%). As compared to stable AH, subjects with different MAH phenotypes showed both increases and decreases in individual 24-h BPM indexes. Thus, in subjects with IDMAH, mean 24-h values of systolic and diastolic BP were significantly lower than with AH while in SDMAH, they were considerably higher. The OR analysis demonstrated that odds of differently located TOD were associated with definite MAH phenotypes. With that, ISMAH was associated with the highest risk of glomerular hyperfiltration; IDMAH was associated with reduced GFR and vascular remodeling; and SDMAH was associated with left ventricular myocardial hypertrophy. The developed models for predicting the risk of TOD based on the RF and ANN methods showed a high accuracy, which was provided by multistep procedures of selecting the predictors and cross-validation.Conclusion Modern ML technologies enhance the risk stratification of patients with different clinical variants of AH.

The Capabilities of Amlodipine/Lisinopril Single-Pill Combination in the Treatment of Newly Diagnosed Arterial Hypertension in a Middle-Aged Patient (Case Report)

Arterial hypertension (AH) is one of the most significant modifiable risk factors that increase cardiovascular morbidity and mortality worldwide, including Russia. The complex of structural and functional changes in the heart that occurs during AH consists not only in the formation of left ventricular (LV) myocardial hypertrophy, but also in the myocardial stiffness increasing due to collagen formation and cardiomyocytes apoptosis. These abnormalities are substrate for diastolic function disturbances, electrical myocardial instability and ischemia. The article provides a clinical case of amlodipine/lisinopril single-pill combination (A/L SPC) use in real clinical practice in a patient with stage II grade 2 newly diagnosed AH and its effect on blood pressure and echocardiographic myocardial fibrosis markers, including speckle tracking parameters The high antihypertensive efficacy of A/L SPC, a favorable effect on blood pressure circadian rhythm, as well as pronounced target-organ protective properties, in particular the ability to reduce LV and left atrial stiffness, were demonstrated. So, we conclude that A/L SPC improve the elastic properties of the left heart.

Clinical profile and drug therapy of outpatients with arterial hypertension

Aim. To study clinical profile and antihypertensive treatment features in outpatients observed in ambulatory facilities.Material and methods. 140 arterial hypertension (AH) outpatients were examined, questioning and anthropometry were performed. Blood pressure (BP) was measured on both hands, then twice on the hand with larger value, the medium value was calculated. Tests results were obtained from outpatient cards.Results. The sampling included 100 (71.4%) females and 40 (28.6%) males. Median of systolic BP at first measurement was 140.0 mm Hg (130.0;150.0), mean value of three BP measurements was 138.0 mm Hg (127.0;150.0) (p<0.001); median diastolic BP at first measurement was 83.0 mm Hg (80.0;90.0), mean BP value was 82.0 mm Hg (78.0;88.0) (p<0.001). Grade 1 AH was identified in 11.4% of patients, Grade 2 – in 35.7%, Grade 3 in 52.9%. No target organ damage was found in 26.4% of AH patients, asymptomatic target organ damage was diagnosed in 26.4%, and 61.4% had associated clinical conditions. Cardiovascular event risk was assessed as moderate in 13.6%, high – in 24.3% and very high – in 62.1% of patients. Every third patient had myocardial hypertrophy signs; Cornell index was detected more often than Sokolov-Layon index (p=0.006). Chronic kidney disease was diagnosed in 65.1% of patients: 44.0% of them had stage C2, 13.8% – stage C3A, 6.5% – stage C3B, and 1.8% – stage C4. 97.9% of AH patients received antihypertensive treatment. Daily medication consumption was reported by 127 people, and 10 patients reported taking medication as needed. Monotherapy was prescribed in 14.3% of patients; combined treatment was performed in 83.6% people. BP target value was achieved in 59 patients (42.1%) at first measurement results and in 71 (50.7%) ones at calculated mean value (p=0.002). Indications for statin use were identified in 86.4% of patients. Statins were administered in 56.2% patients having indications and in 21.1% of subjects without indications (p=0.006). Indications for antiplatelet therapy use were identified in 56.4% of patients. Antiplatelet treatment was administered in 58.2% of patients with indications and in 23.0% of subjects without indications (p<0.001).Conclusion. Glomerular filtration rate and left ventricular myocardial hypertrophy amplitude criteria calculation allow to diagnose subclinical target organ damage in outpatients at physician visit without additional costs. Compliance with the current antihypertensive therapy guidelines allows to achieve target BP in current practice. Compliance with the BP measuring rules allows to adequately assess the effectiveness of antihypertensive therapy. A significant proportion of AH outpatients have a very high cardiovascular risk, which requires lipid-lowering and antiplatelet therapy.

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.

Revisiting the transplantation of donor heart with left ventricular myocardial hypertrophy

Despite the widespread use of mechanical circulatory support systems, modern optimal drug therapy and various interventional methods of heart transplantation remain the "gold standard" for the treatment of end-stage heart failure patients.At the same time the required number of heart transplants is significantly increasing due to the progressively increasing number of patients needing transplants and the actual donor pool. In recent years there has been a trend towards the increase in the number of recipients and the decrease in the number of donor organs. However, the use of donor hearts with pathological changes, including left ventricular myocardial hypertrophy, remains a controversial topic. It is believed that the use of expanded criteria significantly increases the risk of graft failure in the post-transplant period and leads to deterioration of immediate and long-term results. This work aimed to analyze the data on using donor hearts with left ventricular myocardial hypertrophy for allotransplantation.Authors declare no conflict of interest.

Cardiac Evaluation using Two-Dimensional Speckle-Tracking Echocardiography and Conventional Echocardiography in Taiwanese Patients with Mucopolysaccharidoses.

Background: Mucopolysaccharidoses (MPSs) are a group of rare inherited metabolic disorders that can damage various organs, including the heart. Cardiac abnormalities have been observed in patients with all MPS types, with the most documented abnormalities being cardiac valvular regurgitation and stenosis, valvular thickening, and hypertrophic cardiomyopathy. Methods: Cardiac features of 53 Taiwanese patients with MPS (31 men and 22 women; age range 1.1–34.9 years; seven with MPS I, 16 with MPS II, nine with MPS III, 14 with MPS IVA, and seven with MPS VI) were evaluated using two-dimensional speckle-tracking echocardiography and conventional echocardiography. Results: The mean z scores of the global longitudinal strain (GLS), left ventricular mass index (LVMI), interventricular septum diameter in diastole (IVSd), left ventricular posterior wall diameter in diastole (LVPWd), and aortic diameter of the 53 patients with MPS were 1.71, 0.35, 1.66, 1.03, and 3.15, respectively. Furthermore, z scores >2 were identified in 45%, 13%, 40%, 13%, and 70% of the GLS, LVMI, IVSd, LVPWd, and aortic diameter, respectively. The most severe GLS was observed in those with MPS VI, followed by in those with MPS II and MPS I. The GLS z score was positively correlated with the LVMI z score (p < 0.01). Moreover, diastolic dysfunction (reversed ratio between early and late (atrial) ventricular filling velocity (E/A ratio < 1)) was identified in 12 patients (23%). Ejection and shortening fractions were abnormal in four (8%) and seven (13%) patients, respectively. Mitral regurgitation (MR) (92%) was the most common valvular heart disease, followed by aortic regurgitation (AR) (57%), mitral stenosis (MS) (21%), and aortic stenosis (AS) (15%). The z scores of the GLS and LVMI and severity scores of the MS, MR, AS, and AR were all positively correlated with increasing age (p < 0.05). Twenty patients (38%) had a left ventricular remodeling pattern. Conclusions: The most significant left ventricular myocardial deformation, hypertrophy and valvular heart disease were observed in the patients with MPS VI, II, and I, followed by those with MPS IV; in contrast, patients with MPS III had the mildest manifestations. Cardiac abnormalities in patients with MPS worsened with increasing age in accordance with the progressive nature of this disease.

Exome sequencing identifies a FHOD3 p.S527del mutation in a Chinese family with hypertrophic cardiomyopathy.

Hypertrophic cardiomyopathy (HCM) is the most common inheritable cardiac disease and is characterised by unexplained ventricular myocardial hypertrophy. HCM is highly heterogeneous and is primarily caused by the mutation of genes encoding sarcomere proteins. As a result of its genetic basis, we investigated the underlying cause of HCM in a Chinese family by whole-exome sequencing. Whole-exome sequencing was performed for seven clinically diagnosed HCM family members and the resulting single nucleotide variants associated with cardiac hypertrophy or heart development were analysed by a polymerase chain reaction and Sanger sequencing. A non-frameshift deletion mutation (p.S527del) of Formin Homology 2 Domain Containing 3 (FHOD3) was detected in all of the affected family members and was absent in all unaffected members, with the exception of one young member. Moreover, three single nucleotide variants associated with heart development and morphogenesis were identified in the proband but were absent in the other affected subjects. This is the first HCM family case of FHOD3 (p.S527del) variation in Asia. Additionally, RNF207 (p.Q268P), CCM2 (p. E233K) and SGCZ (p.Q134X) may be related to the clinical heterogeneity of the family. The present study could enable the provision of genetic counseling for this family and provide a basis for future genetic and functional studies.

Functional characterization of human myosin-binding protein C3 variants associated with hypertrophic cardiomyopathy reveals exon-specific cardiac phenotypes in zebrafish model.

Myosin-binding protein C 3 (MYBPC3) variants are the most common cause of hypertrophic cardiomyopathy (HCM). HCM is a complex cardiac disorder due to its significant genetic and clinical heterogeneity. MYBPC3 variants genotype-phenotype associations remain poorly understood. We investigated the impact of two novel human MYBPC3 splice-site variants: V1: c.654+2_654+4dupTGG targeting exon 5 using morpholino MOe5i5; and V2: c.772+1G>A targeting exon 6 using MOe6i6; located within C1 domain of cMyBP-C protein, known to be critical in regulating sarcomere structure and contractility. Zebrafish MOe5i5 and MOe6i6 morphants recapitulated typical characteristics of human HCM with cardiac phenotypes of varying severity, including reduced cardiomyocyte count, thickened ventricular myocardial wall, a drastic reduction in heart rate, stroke volume, and cardiac output. Analysis of all cardiac morphological and functional parameters demonstrated that V2 cardiac phenotype was more severe than V1. Coinjection with synthetic human MYBPC3 messenger RNA (mRNA) partially rescued disparate cardiac phenotypes in each zebrafish morphant. While human MYBPC3 mRNA partially restored the decreased heart rate in V1 morphants and displayed increased percentages of ejection fraction, fractional shortening, and area change, it failed to revert the V1 ventricular myocardial thickness. These results suggest a possible V1 impact on cardiac contractility. In contrast, attempts to rescue V2 morphants only restored the ventricular myocardial wall hypertrophy phenotype but had no significant effect on impaired heart rate, suggesting a potential V2 impact on the cardiac structure. Our study provides evidence of an association between MYBPC3 exon-specific cardiac phenotypes in the zebrafish model providing important insights into how these genetic variants contribute to HCM disease.

Cardiac structural and functional findings in Persian cats with autosomal dominant polycystic kidney disease

ABSTRACT: Autosomal dominant polycystic kidney disease (ADPKD) has been related to left ventricular structural and functional abnormalities in human patients. The present study aimed to evaluate the cardiac structural and functional findings in Persian cats with ADPKD. Client-owned ADPKD (n=12) and non-ADPKD (n=12) Persian cats were enrolled in this study. The animals underwent echo- and electrocardiographic (ECG) examinations, and non-invasive measurements of systolic blood pressure (SBP) were obtained. Both groups were similar regarding hematological and biochemical parameters, including white blood cell count and levels of blood urea nitrogen, creatinine, total protein and thyroxine. There were no differences related to ECG parameters between ADPKD and non-ADPKD cats. Left ventricular hypertrophy (LVH) was demonstrated in 6/12 (50%) normotensive ADPKD cats with preserved renal function. There were no differences between animal groups regarding the echocardiographic parameters, including left ventricular ejection fraction and shortening fraction; however, basal interventricular septal thickness at end-diastole near the left ventricular outflow tract and aortic artery flow velocity showed slightly elevated values in ADPKD-cats. Our study revealed that Persian cats with ADPKD do not reproduce the functional and structural cardiac phenotype reported in human patients; however, large-scale cohort studies are necessary to distinguish the possibilities of a true linkage between ventricular myocardial hypertrophy and ADPKD in this breed.

Трудности диагностики и варианты клинического течения гипертрофической кардиомиопатии у больных пожилого возраста

Hypertrophic cardiomyopathy (HCM) is a genetically determined disease with a morphological abnormality of myocardial contractile proteins, manifested by asymmetric left ventricular myocardial hypertrophy. Currently, there is evidence that the HCM incidence rate in the population can be up to 1:200, as opposed to the traditionally quoted 1:500. In early works on HCM, this disease has been mostly perceived as a pathology of young and middle age with a high risk of sudden cardiac death. Now it is generally accepted that patients with HCM are likely to reach the old or even geriatric age subject to the benign course of the disease. Comorbidity in such patients contributes to the clinical aspect of the disease. The article deals with problem areas of HCM diagnostics in elderly patients with an emphasis on differential diagnosis of HCM and left ventricular hypertrophy as part of hypertension. It contains a discussion of differential diagnosis of ischemic heart disease in HCM. The authors also focus on the specifics of the course of HCM in old age patients and present factors affecting the prognosis for this group of patients.