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Nephrology (Carlton, Vic.) Jan 2022In the general population, central arterial blood pressure has proved to be more closely related to left ventricular hypertrophy (LVH) than brachial arterial blood...
AIMS
In the general population, central arterial blood pressure has proved to be more closely related to left ventricular hypertrophy (LVH) than brachial arterial blood pressure. We aimed to investigate whether this relationship was true in patients with chronic kidney disease (CKD).
METHODS
In this retrospective study, we reviewed the medical records of 289 adult patients with CKD from the Zhejiang Provincial People's Hospital in Zhejiang, China. Demographic, echocardiographic and brachial and central blood pressure parameters were retrieved from medical records. Central blood pressure was measured using the SphygmoCor® CvMS (AtCor, Australia) device and its corresponding software. Multivariate logistic regression analyses were performed to identify independent predictors of LVH. Receiver operating characteristic curves were used to determine the ability of central and brachial blood pressure to predict LVH.
RESULTS
The left ventricular mass index was positively associated with both central and brachial blood pressures. However, multiple logistic regression analysis demonstrated that a central pulse pressure (CPP) ≥ 58 mm Hg was an independent risk factor for LVH (OR = 5.597, 95%CI 2.363-13.259, p < .001). Brachial pulse pressure is not superior to CPP in predicting LVH (area under the curve [AUC] = 0.695, 95%CI 0.634-0.756, p < .001 vs. AUC = 0.687, 95%CI: 0.626-0.748, p < .001, respectively; p = .4824).
CONCLUSION
Our results suggested that, similarly to the general population, CPP is a better parameter for predicting the occurrence of LVH in patients with CKD.
Topics: Arterial Pressure; Blood Pressure Determination; China; Equipment Design; Female; Heart Ventricles; Humans; Hypertension; Hypertrophy, Left Ventricular; Male; Middle Aged; Organ Size; Predictive Value of Tests; Renal Insufficiency, Chronic; Retrospective Studies; Software; Sphygmomanometers
PubMed: 34431587
DOI: 10.1111/nep.13967 -
Pediatric Cardiology Jan 2022Pediatric hypertension (HTN) is an epidemic that is associated with HTN in adulthood and adverse cardiovascular outcomes. We hypothesized that children with HTN would...
Pediatric hypertension (HTN) is an epidemic that is associated with HTN in adulthood and adverse cardiovascular outcomes. We hypothesized that children with HTN would have left ventricular (LV) hypertrophy and abnormal LV global longitudinal strain (GLS) on echocardiogram and that these values would differ by weight, race, and HTN treatment. Data were collected from first visits to the HTN Program from 12/2011 to 9/2018, excluding patients with cardiac disease or heart transplantation. LV measurements including LV mass index (LVMI), LV GLS, and diastolic indices were compared between groups. Multivariable logistic regression was used to identify risk factors for an abnormal LVMI. There were 212 patients with an interquartile age range of 13-18 years. On univariate analysis, LVMI was higher in hypertensive, obese, and African American patients. LV strain was less negative in obese and African American patients. Adequately treated patients with HTN had a higher LVMI and a higher E/e' ratio compared to patients with no HTN. On multivariate analysis, only obesity was associated with an LVMI ≥ 95th percentile (OR 2.9, 95% CI 1.4, 5.8). LVMI is higher in hypertensive, obese, and African American patients; however, in the multivariate analysis, obesity was the only independent risk factor for an abnormal LVMI. LVMI was still higher in those adequately treated for HTN compared to patients without HTN, possibly due to concomitant obesity. Future studies should focus on subclinical changes in LV performance seen in obese and hypertensive patients and the impact on long-term health.
Topics: Adolescent; Adult; Antihypertensive Agents; Child; Heart Ventricles; Humans; Hypertension; Hypertrophy, Left Ventricular; Ventricular Dysfunction, Left
PubMed: 34426850
DOI: 10.1007/s00246-021-02706-x -
Journal of Molecular and Cellular... Apr 2020Cardiac hypertrophy is an adaptive response to manage an excessive cardiac workload and maintain normal cardiac function. However, sustained hypertrophy leads to...
Cardiac hypertrophy is an adaptive response to manage an excessive cardiac workload and maintain normal cardiac function. However, sustained hypertrophy leads to cardiomyopathy, cardiac failure, and death. Adrenergic receptors play a key role in regulating cardiac function under normal and pathological conditions. Mitochondria are responsible for 90% of ATP production in cardiomyocytes. Mitochondrial function is dynamically regulated by fusion and fission processes. Changes in mitochondrial dynamics and metabolism are central issues in cardiac hypertrophy. Stimulating cardiomyocytes with adrenergic agonists generates hypertrophy and increases mitochondrial fission, which in turn is associated with decreased ATP synthesis. Miro1 is a mitochondrial outer membrane protein involved in mitochondrial dynamics and transport in neurons. The objective of this work was to evaluate whether Miro1 regulates cardiomyocyte hypertrophy through changes in mitochondrial dynamics. In neonatal rat ventricular myocytes, we showed that phenylephrine induced cardiomyocyte hypertrophy and increased Miro1 mRNA and protein levels. Moreover, alpha-adrenergic stimulation provoked a mitochondrial fission pattern in the cardiomyocytes. Miro1 knockdown prevented both the cardiomyocyte hypertrophy and mitochondrial fission pattern. Our results suggest that Miro1 participates in phenylephrine-induced cardiomyocyte hypertrophy through mitochondrial fission.
Topics: Animals; Animals, Newborn; Cardiomegaly; Gene Expression Regulation; Heart Ventricles; Mitochondrial Dynamics; Mitochondrial Proteins; Myocytes, Cardiac; Phenylephrine; RNA, Messenger; Rats, Sprague-Dawley; rho GTP-Binding Proteins
PubMed: 32234389
DOI: 10.1016/j.yjmcc.2020.03.014 -
Journal of Cellular Physiology May 2021Cardiac hypertrophy is a compensatory response to pathological stimuli, ultimately progresses to cardiomyopathy, heart failure, or sudden death. Although many signaling...
Cardiac hypertrophy is a compensatory response to pathological stimuli, ultimately progresses to cardiomyopathy, heart failure, or sudden death. Although many signaling pathways have been reported to be involved in the hypertrophic process, it is still not fully clear about the underlying molecular mechanisms for cardiac hypertrophy. Hedgehog acyltransferase-like (Hhatl), a sarcoplasmic reticulum-resident protein, exhibits high expression in the heart and muscle. However, the biological role of Hhatl in the heart remains unknown. In this study, we first found that the expression level of Hhatl is markedly decreased in cardiac hypertrophy. We further studied the role of hhatla, homolog of Hhatl with the zebrafish model. The depletion of hhatla in zebrafish leads to cardiac defects, as well as an enhanced level of hypertrophic markers. Besides, we found that calcineurin signaling participates in hhatla depletion-induced cardiac hypertrophy. Together, these results demonstrate a critical role for hhatla in cardiac hypertrophy.
Topics: Acyltransferases; Animals; Biomarkers; Calcineurin; Cardiomegaly; Embryo, Nonmammalian; Gene Expression Regulation; Heart Ventricles; Male; Membrane Proteins; Mice, Inbred C57BL; Myocardium; Zebrafish; Zebrafish Proteins; Mice
PubMed: 33052609
DOI: 10.1002/jcp.30106 -
Circulation. Arrhythmia and... May 2022Maximal left ventricular wall thickness (MLVWT) is a risk factor for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). In adults, the severity of left...
BACKGROUND
Maximal left ventricular wall thickness (MLVWT) is a risk factor for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). In adults, the severity of left ventricular hypertrophy has a nonlinear relationship with SCD, but it is not known whether the same complex relationship is seen in childhood. The aim of this study was to describe the relationship between left ventricular hypertrophy and SCD risk in a large international pediatric HCM cohort.
METHODS
The study cohort comprised 1075 children (mean age, 10.2 years [±4.4]) diagnosed with HCM (1-16 years) from the International Paediatric Hypertrophic Cardiomyopathy Consortium. Anonymized, noninvasive clinical data were collected from baseline evaluation and follow-up, and 5-year estimated SCD risk was calculated (HCM Risk-Kids).
RESULTS
MLVWT score was <10 in 598 (58.1%), ≥10 to <20 in 334 (31.1%), and ≥20 in 143 (13.3%). Higher MLVWT scores were associated with heart failure symptoms, unexplained syncope, left ventricular outflow tract obstruction, left atrial dilatation, and nonsustained ventricular tachycardia. One hundred twenty-two patients (71.3%) with MLVWT score ≥20 had coexisting risk factors for SCD. Over a median follow-up of 4.9 years (interquartile range, 2.3-9.3), 115 (10.7%) had an SCD event. Freedom from SCD event at 5 years for those with MLVWT scores <10, ≥10 to <20, and ≥20 was 95.6%, 87.4%, and 86.0, respectively. The estimated SCD risk at 5 years had a nonlinear, inverted U-shaped relationship with MLVWT score, peaking at score +23. The presence of coexisting risk factors had a summative effect on risk.
CONCLUSIONS
In children with HCM, an inverted U-shaped relationship exists between left ventricular hypertrophy and estimated SCD risk. The presence of additional risk factors has a summative effect on risk. While MLVWT is important for risk stratification, it should not be used either as a binary variable or in isolation to guide implantable cardioverter defibrillator implantation decisions in children with HCM.
Topics: Adult; Cardiomyopathy, Hypertrophic; Child; Death, Sudden, Cardiac; Defibrillators, Implantable; Heart Ventricles; Humans; Hypertrophy, Left Ventricular; Retrospective Studies; Risk Assessment; Risk Factors
PubMed: 35491873
DOI: 10.1161/CIRCEP.121.010075 -
American Journal of Physiology. Heart... Sep 2021Left ventricular (LV) remodeling, characterized by increased LV hypertrophy and depressed systolic and diastolic function, is observed in strength-trained athletes who...
Left ventricular (LV) remodeling, characterized by increased LV hypertrophy and depressed systolic and diastolic function, is observed in strength-trained athletes who use anabolic-androgenic steroids (AAS). Previous studies suggested a pathological remodeling with an increase in cardiac fibrosis in these athletes, which could promote intraventricular dyssynchrony. In this context, this study evaluated LV dyssynchrony in strength-trained athletes using AAS, hypothesizing that the use of AAS would lead to an increase in post-systolic shortening. Forty-four male subjects (aged 20-40 yr) were divided into three age-matched groups: strength-trained athletes using (users, = 14) or not (nonusers, = 15) AAS and healthy sedentary men (controls, = 15). After completing a survey, each participant was assessed with two-dimensional (2D)-strain echocardiography. LV dyssynchrony was quantified using the standard deviation (SD) of the time to peak for longitudinal strain of the 18 LV-segments (from the apical 4, 3, and 2 chambers views), the longitudinal strain delay index (LSDI), and the segmental post-systolic index (PSI). Users showed mean AAS dosages of 564 ± 288 mg[Formula: see text]wk with a mean protocol duration of 12 ± 6 wk and a history of use of 4.7 ± 1.8 yr. They exhibited a greater LV mass index and depressed systolic and diastolic function when compared with both nonusers and controls. The decrease in LV strain in users was predominantly observed at the interventricular septum level (-16.9% ± 2.5% vs. -19.2% ± 1.8% and -19.0% ± 1.6% in users, nonusers, and controls, respectively, < 0.01). Users showed higher SD than controls (43 ± 8 ms vs. 32 ± 5 ms, respectively, < 0.01). The LSDI was significantly higher in users compared with both nonusers and controls (-23.4 ± 9.5 vs. -15.9 ± 9.3 and -9.8 ± 3.9, respectively, < 0.01). PSI, calculated on the basal inferoseptal, basal anteroseptal, and basal inferolateral segments, were also greater in users compared with the two other groups. Our results reported an increase in LV dyssynchrony in young AAS users that brought new evidences of a pathologic cardiac remodeling in this specific population. Illicit androgenic anabolic steroids (AAS) use is widespread, but data on LV dyssynchrony are lacking, although it could be increased by a higher prevalence of myocardial fibrosis reported in this population. In AAS users, the decrease in LV strain was predominantly observed in interventricular segments. All dyssynchrony indices were higher in AAS users and several segments exhibited post-systolic shortening. These results showed an association between AAS consumption, LV remodeling, and dyssynchrony.
Topics: Adolescent; Adult; Athletes; Exercise; Heart Ventricles; Humans; Male; Myocardial Contraction; Testosterone Congeners; Ventricular Function, Left; Ventricular Remodeling
PubMed: 34242095
DOI: 10.1152/ajpheart.00136.2021 -
Journal of Hypertension Nov 2021Evidence on systolic dysfunction, as assessed by left ventricular (LV) mechanics, in hypertensive heart disease phenotyped by abnormal LV geometric patterns is still... (Meta-Analysis)
Meta-Analysis
AIM
Evidence on systolic dysfunction, as assessed by left ventricular (LV) mechanics, in hypertensive heart disease phenotyped by abnormal LV geometric patterns is still limited. Thus, we performed a systematic meta-analysis of 2D/3D speckle-tracking studies in order to provide an updated comprehensive information on this topic.
METHODS
The PubMed, OVID-MEDLINE, and Cochrane library databases were analyzed to search for articles published from the inception up to 31 January 2021. Studies were identified by using MeSH terms and crossing the following search items: 'myocardial strain', 'left ventricular mechanics', 'speckle tracking echocardiography', 'systolic dysfunction', 'hypertensive heart disease', 'left ventricular hypertrophy', left ventricular remodeling", 'concentric hypertrophy', 'eccentric hypertrophy'.
RESULTS
Overall, data of 267 normotensive controls and 712 hypertensive patients (234 normal geometry, 97 LV concentric remodeling, 176 eccentric LVH, and 205 concentric LVH) from eight studies were considered. Pooled ejection fraction was similar in normotensives and in the whole group of hypertensive patients: (SMD 0.037 ± 0.05, confidence interval (CI): 0.14/0.07, P = 0.51) as well as in hypertensive subgroups. LVMI, and E/e' gradually increased from hypertensive patients with normal geometry and concentric remodeling, to patients with eccentric and concentric LVH. LV global longitudinal strain (GLS) was lower in all hypertensive groups compared with normotensive controls, in particular, in the eccentric (SMD 1.14 ± 0.22, CI: 0.69/1.59, P < 0.0001) and concentric LVH group (SMD 1.37 ± 0.21, CI: 0.95/1.79, P < 0.0001). The meta-analysis restricted to hypertensive patients showed that GLS gradually deteriorated from hypertensive patients with normal LV geometry, across those with concentric remodeling, to participants with eccentric and concentric LVH (-19.5 ± 0.6 versus -18.8 ± 0.73 versus -17.6 ± 0.66 versus -16.5 ± 0.6%, P < 0.001 for trend). Statistical significance was reached when GLS of the concentric and eccentric LVH group but not the concentric remodeling was compared with the normal geometry one.
CONCLUSION
The present meta-analysis confirms that GLS performs better than ejection fraction in identifying systolic dysfunction in the hypertension setting. More importantly, it suggests that this occurs in patients with altered LV structure and geometry, such as LVH.
Topics: Echocardiography; Heart Ventricles; Humans; Hypertension; Hypertrophy, Left Ventricular; Ventricular Remodeling
PubMed: 34128494
DOI: 10.1097/HJH.0000000000002911 -
Heart Failure Reviews Sep 2022There has been ample data providing a convincing perception about the underlying mechanism pertaining to left ventricle (LV) hypertrophy progressing towards LV failure.... (Review)
Review
There has been ample data providing a convincing perception about the underlying mechanism pertaining to left ventricle (LV) hypertrophy progressing towards LV failure. In comparison, data available on the feedback of right ventricle (RV) due to volume or pressure overload is minimal. Advanced imaging techniques have aided the study of physiology, anatomy, and diseased state of RV. However, the treatment scenario of right ventricular failure (RVF) demands more attention. It is a critical clinical risk in patients with carcinoid syndrome, pulmonary hypertension, atrial septal defect, and several other concomitant diseases. Although the remodeling responses of both ventricles on an increase of end-diastolic pressure are mostly identical, the stressed RV becomes more prone to oxidative stress activating the apoptotic mechanism with diminished angiogenesis. This instigates the advancement of RV towards failure in contrast to LV. Empirical heart failure (HF) therapies have been ineffective in improving the mortality rate and cardiac function in patients, which prompted a difference between the underlying pathophysiology of RVF and LV failure. Treatment strategies should be devised, taking into consideration the anatomical and physiological characteristics of RV. This review would emphasize on the pathophysiology of the RVF and the differences between two ventricles in molecular response to stress. A proper insight into the underlying pathophysiology is required to develop optimized therapeutic management in RV-specific HF.
Topics: Comorbidity; Diastole; Heart Failure; Heart Ventricles; Humans; Hypertension, Pulmonary; Ventricular Dysfunction, Right; Ventricular Function, Right
PubMed: 34826024
DOI: 10.1007/s10741-021-10192-9 -
Heart Failure Reviews Jan 2020Heart failure (HF) with either reduced or preserved ejection fraction is an increasingly prevalent condition. Cardiac imaging plays a central role in trying to identify... (Review)
Review
Heart failure (HF) with either reduced or preserved ejection fraction is an increasingly prevalent condition. Cardiac imaging plays a central role in trying to identify the underlying cause of the underlying systolic and diastolic dysfunction, as the imaging findings have implications for patient's management and individualised treatment. The imaging modalities used more frequently in patients with heart failure in clinical routine are echocardiography and cardiac magnetic resonance. Both techniques keep some strengths and weakness due to their spatial and temporal resolution. Notably, several features in the diagnostic algorithm of heart failure with preserved systolic function (HFpEF) may be improved by an integrated approach. This review focuses on the role of each modality in characterising cardiac anatomy, systolic and diastolic function as well as myocardial tissue characterisation in the most common phenotypes of dilated and hypertrophied hearts.
Topics: Diastole; Echocardiography; Heart Failure; Heart Ventricles; Humans; Magnetic Resonance Imaging, Cine; Myocardium; Phenotype; Stroke Volume; Systole
PubMed: 31724111
DOI: 10.1007/s10741-019-09880-4 -
Journal of the American College of... Aug 2019Several studies have demonstrated the benefits of transcatheter aortic valve replacement (TAVR) in patients with aortic stenosis, but the presence of persistent fibrosis...
BACKGROUND
Several studies have demonstrated the benefits of transcatheter aortic valve replacement (TAVR) in patients with aortic stenosis, but the presence of persistent fibrosis and myocardial hypertrophy has been related to worse prognosis.
OBJECTIVES
The aim of this study was to explore the potential benefits of renin-angiotensin system (RAS) inhibitors on left ventricular remodeling and major clinical outcomes following successful transcatheter aortic valve replacement (TAVR).
METHODS
Patients from 10 institutions with severe aortic stenosis who underwent TAVR between August 2007 and August 2017 were included. All baseline data were prospectively recorded, and pre-specified follow-up was performed. Doses and types of RAS inhibitors at discharge were recorded, and matched comparison according to their prescription at discharge was performed.
RESULTS
A total of 2,785 patients were included. Patients treated with RAS inhibitors (n = 1,622) presented similar surgical risk scores but a higher rate of all cardiovascular risk factors, coronary disease, and myocardial infarction. After adjustment for these baseline differences, reduction of left ventricular volumes and hypertrophy was greater and cardiovascular mortality at 3-year follow-up was lower (odds ratio: 0.59; 95% confidence interval: 0.41 to 0.87; p = 0.007) in patients treated with RAS inhibitors. Moreover, RAS inhibitors demonstrated a global cardiovascular protective effect with significantly lower rates of new-onset atrial fibrillation, cerebrovascular events, and readmissions.
CONCLUSIONS
Post-TAVR RAS inhibitors are associated with lower cardiac mortality at 3-year follow-up and offer a global cardiovascular protective effect that might be partially explained by a positive left ventricular remodeling. An ongoing randomized trial will help confirm these hypothesis-generating findings. (Renin-Angiotensin System Blockade Benefits in Clinical Evolution and Ventricular Remodeling After Transcatheter Aortic Valve Implantation [RASTAVI]; NCT03201185).
Topics: Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors; Aortic Valve; Aortic Valve Stenosis; Echocardiography; Female; Follow-Up Studies; Heart Ventricles; Humans; Male; Postoperative Complications; Postoperative Period; Retrospective Studies; Risk Factors; Transcatheter Aortic Valve Replacement; Treatment Outcome; Ventricular Dysfunction, Left; Ventricular Function, Left; Ventricular Remodeling
PubMed: 31370954
DOI: 10.1016/j.jacc.2019.05.055