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The Pan African Medical Journal Mar 2010Left ventricular hypertrophy can be due to various reasons including hypertension. It constitutes an increased cardiovascular risk. Various left ventricular geometric...
BACKGROUND
Left ventricular hypertrophy can be due to various reasons including hypertension. It constitutes an increased cardiovascular risk. Various left ventricular geometric patterns occur in hypertension and may affect the cardiovascular risk profile of hypertensive subjects.
METHODS
One hundred and eighty eight hypertensive participated in this study. Left ventricular hypertrophy was diagnosed by echocardiography. Relative wall thickness was derived by 2 × PWT/LVIDd. Subjects were arbitrarily categorized according to the duration of hypertension. Statistical analysis was done using SPSS 15.0.
RESULTS
The mean age of the study population was 55.95±10.71 years. Subjects who had hypertension for >5 years were more likely to be older and had a lower ejection fraction, larger left ventricular diastolic internal dimension than those with duration of hypertension <5 years. Concentric remodeling was the commonest left ventricular geometric pattern among the hypertensive subjects closely followed by normal left ventricular geometry. Concentric hypertrophy and eccentric hypertrophy were rare among the study population.Left ventricular geometry was associated mainly with left ventricular chamber and wall dimensions.
CONCLUSION
Concentric remodeling is the commonest pattern of left ventricular geometric pattern of the left ventricle among hypertensive subjects. Left ventricular geometry is associated with the chamber and wall dimensions. Eccentric hypertrophy is associated with the lowest left ventricular systolic function and therefore possibly an herald to progressive systolic impairment.
Topics: Adult; Aged; Aged, 80 and over; Antihypertensive Agents; Black People; Echocardiography; Female; Heart Ventricles; Hospitals, Teaching; Humans; Hypertension; Hypertrophy, Left Ventricular; Male; Middle Aged; Nigeria; Ventricular Dysfunction, Left; Ventricular Function, Left; Ventricular Remodeling
PubMed: 21119993
DOI: 10.4314/pamj.v4i1.53602 -
JAMA Cardiology Dec 2018Compared with white individuals, black individuals have increased electrocardiographic voltage and an increased prevalence of concentric left ventricular (LV)...
IMPORTANCE
Compared with white individuals, black individuals have increased electrocardiographic voltage and an increased prevalence of concentric left ventricular (LV) hypertrophy. Whether environmental or genetic factors lead to these racial differences is unknown.
OBJECTIVE
To determine whether proportion of genetically determined African ancestry among self-reported black individuals is associated with increased electrocardiographic voltage and concentric LV hypertrophy (LVH).
DESIGN, SETTING, AND PARTICIPANTS
The Dallas Heart Study is a probability-based cohort study of English- or Spanish-speaking Dallas County, Texas, residents, with deliberate oversampling of black individuals. Participants underwent extensive phenotyping, which included electrocardiography (ECG), cardiac magnetic resonance imaging (CMR), and dual-energy radiography absorptiometry (DEXA) at a single center. Participants aged 18 to 65 years who enrolled in the Dallas Heart Study between July 2000 and December 2002, self-identified as black (n = 1251) or white (n = 826), and had ECG, CMR, and DEXA data were included in this analysis. Data were analyzed from June 2017 to September 2018.
EXPOSURES
Proportion of African ancestry.
MAIN OUTCOMES AND MEASURES
Electrocardiographic voltage (12-lead and 9-lead) and markers of concentric LVH as assessed by CMR (LV concentricity0.67 [LV mass/end-diastolic volume0.67], LV wall thickness [LVWT], and prevalent LVH [defined by LV mass/height2.7]).
RESULTS
Of the 2077 participants included in the study, 1138 (54.8%) were women, and the mean (SD) age was 45.2 (9.9) years. Black race and African ancestry were individually associated with increased ECG voltage, LV concentricity0.67, LVWT, and prevalent LVH in multivariable analyses adjusting for age, sex, systolic blood pressure, antihypertensive medication use, and body composition. When African ancestry and black race were entered together into multivariable models, African ancestry but not black race remained associated with ECG voltage, LVWT, LV concentricity0.67, and prevalent LVH. Among black participants, African ancestry remained associated with these 4 phenotypes (12-lead voltage: β, 0.05; P = .04; LVWT: β, 0.05; P = .02; LV concentricty0.67: β, 0.05; P = .045; prevalent LVH: odds ratio, 1.2; 95% CI, 1.03-1.4; P = .02).
CONCLUSIONS AND RELEVANCE
Genetically determined African ancestry was associated with electrocardiographic voltage, measures of concentric LV remodeling, and prevalent LVH. These data support a genetic basis related to African ancestry for the increased prevalence of these cardiovascular traits in black individuals.
Topics: Adolescent; Adult; Aged; Black People; Blood Pressure; Electrocardiography; Female; Follow-Up Studies; Heart Ventricles; Humans; Hypertrophy, Left Ventricular; Magnetic Resonance Imaging, Cine; Male; Middle Aged; Prevalence; Retrospective Studies; Texas; Ventricular Remodeling; Young Adult
PubMed: 30427995
DOI: 10.1001/jamacardio.2018.3804 -
Heart (British Cardiac Society) Dec 2003
Review
Topics: Electrocardiography; Electrocardiography, Ambulatory; Exercise; Forecasting; Heart; Heart Ventricles; Humans; Hypertrophy, Left Ventricular; Physical Endurance; Sports; Ventricular Function; Ventricular Function, Left
PubMed: 14617564
DOI: 10.1136/heart.89.12.1455 -
JACC. Cardiovascular Imaging Nov 2015
Topics: Heart Ventricles; Humans; Hypertension; Hypertrophy, Left Ventricular; Ventricular Function, Left; Ventricular Remodeling
PubMed: 26563856
DOI: 10.1016/j.jcmg.2015.08.012 -
Journal of Clinical Hypertension... Oct 2016Cardiovascular magnetic resonance (CMR) imaging in adults is considered the gold standard for assessment of left ventricular mass (LVM) and left ventricular hypertrophy... (Observational Study)
Observational Study
Cardiovascular magnetic resonance (CMR) imaging in adults is considered the gold standard for assessment of left ventricular mass (LVM) and left ventricular hypertrophy (LVH). The authors aimed to evaluate agreement of LVM measurements and LVH determination between echocardiography (ECHO) and CMR imaging in children with hypertension (HTN) confirmed by 24-hour ambulatory blood pressure monitoring (ABPM). The children (n=22) underwent contemporaneous ECHO, CMR imaging, and ABPM. Patients had a mean body mass index of 30.9±7.5 (kg/m ), and 81.8% had severe HTN. LVM measured by ECHO was 189.6±62.1 g and by CMR imaging was 164.6±44.7 g (P<.0001). Bland-Altman analysis revealed significant variability between ECHO and CMR imaging in the measurement of LVM. Interobserver error was higher with ECHO than with CMR imaging. ECHO had high sensitivity and low specificity in LVH determination. In conclusion, ECHO overestimates LVM and is less accurate in measuring LVM as compared with CMR imaging in children with HTN. Further prospective study using CMR imaging to assess LVM in children is warranted.
Topics: Adolescent; Child; Echocardiography; Female; Heart Ventricles; Humans; Hypertension; Hypertrophy, Left Ventricular; Magnetic Resonance Imaging, Cine; Male; Retrospective Studies; Young Adult
PubMed: 26988578
DOI: 10.1111/jch.12808 -
Journal of the American College of... Mar 1986To determine the prevalence and correlates of echocardiographic left ventricular hypertrophy among subjects in a general population, we studied 621 employed subjects....
To determine the prevalence and correlates of echocardiographic left ventricular hypertrophy among subjects in a general population, we studied 621 employed subjects. Patients with uncomplicated essential hypertension in a worksite-based treatment program included 145 with borderline hypertension and 316 with sustained hypertension by World Health Organization criteria. Normotensive subjects were randomly selected from members of the same unions. M-mode echocardiographic left ventricular dimensions were used to calculate left ventricular mass and other indexes of left ventricular anatomy. The specificity of 13 echocardiographic criteria of left ventricular hypertrophy was determined in normotensive individuals, and the prevalence of left ventricular hypertrophy by each criterion was assessed in patients with borderline or sustained essential hypertension. The results suggest that the most suitable reference standard for detection of left ventricular hypertrophy in a heterogeneous urban population utilizes sex-specific cutoff values for left ventricular mass index of 110 g/m2 or greater for women and 134 g/m2 or greater for men. With 97% specificity, the prevalence of left ventricular hypertrophy by these criteria is approximately 12% among patients with borderline hypertension and 20% among patients with relatively mild, uncomplicated sustained essential hypertension. Wall thickness measurements performed slightly less well. At similar levels of blood pressure, black patients were more likely than white patients to exhibit concentric left ventricular hypertrophy, especially among borderline hypertensive patients. Left ventricular hypertrophy occurred in patients with sustained hypertension who also exhibited increased cardiac output, strongly associated with low plasma renin activity.
Topics: Adult; Cardiomegaly; Echocardiography; Female; Heart Ventricles; Humans; Hypertension; Male; Middle Aged; Occupational Diseases; Risk
PubMed: 2936789
DOI: 10.1016/s0735-1097(86)80476-4 -
Annals of Biomedical Engineering May 2021Critical aortic stenosis (AS) of the fetal heart causes a drastic change in the cardiac biomechanical environment. Consequently, a substantial proportion of such cases...
Critical aortic stenosis (AS) of the fetal heart causes a drastic change in the cardiac biomechanical environment. Consequently, a substantial proportion of such cases will lead to a single-ventricular birth outcome. However, the biomechanics of the disease is not well understood. To address this, we performed Finite Element (FE) modelling of the healthy fetal left ventricle (LV) based on patient-specific 4D ultrasound imaging, and simulated various disease features observed in clinical fetal AS to understand their biomechanical impact. These features included aortic stenosis, mitral regurgitation (MR) and LV hypertrophy, reduced contractility, and increased myocardial stiffness. AS was found to elevate LV pressures and myocardial stresses, and depending on severity, can drastically decrease stroke volume and myocardial strains. These effects are moderated by MR. AS alone did not lead to MR velocities above 3 m/s unless LV hypertrophy was included, suggesting that hypertrophy may be involved in clinical cases with high MR velocities. LV hypertrophy substantially elevated LV pressure, valve flow velocities and stroke volume, while reducing LV contractility resulted in diminished LV pressure, stroke volume and wall strains. Typical extent of hypertrophy during fetal AS in the clinic, however, led to excessive LV pressure and valve velocity in the FE model, suggesting that reduced contractility is typically associated with hypertrophy. Increased LV passive stiffness, which might represent fibroelastosis, was found to have minimal impact on LV pressures, stroke volume, and wall strain. This suggested that fibroelastosis could be a by-product of the disease progression and does not significantly impede cardiac function. Our study demonstrates that FE modelling is a valuable tool for elucidating the biomechanics of congenital heart disease and can calculate parameters which are difficult to measure, such as intraventricular pressure and myocardial stresses.
Topics: Aortic Valve Stenosis; Biomechanical Phenomena; Cardiomyopathies; Fetal Heart; Finite Element Analysis; Heart Ventricles; Humans; Hypertrophy, Left Ventricular; Models, Cardiovascular; Ultrasonography; Ventricular Function, Left
PubMed: 33175989
DOI: 10.1007/s10439-020-02683-x -
Hypertension (Dallas, Tex. : 1979) Mar 2017Patients with repaired coarctation of the aorta are thought to have increased afterload due to abnormalities in vessel structure and function. We have developed a novel...
Patients with repaired coarctation of the aorta are thought to have increased afterload due to abnormalities in vessel structure and function. We have developed a novel cardiovascular magnetic resonance protocol that allows assessment of central hemodynamics, including central aortic systolic blood pressure, resistance, total arterial compliance, pulse wave velocity, and wave reflections. The main study aims were to (1) characterize group differences in central aortic systolic blood pressure and peripheral systolic blood pressure, (2) comprehensively evaluate afterload (including wave reflections) in the 2 groups, and (3) identify possible biomarkers among covariates associated with elevated left ventricular mass (LVM). Fifty adult patients with repaired coarctation and 25 age- and sex-matched controls were recruited. Ascending aorta area and flow waveforms were obtained using a high temporal-resolution spiral phase-contrast cardiovascular magnetic resonance flow sequence. These data were used to derive central hemodynamics and to perform wave intensity analysis noninvasively. Covariates associated with LVM were assessed using multivariable linear regression analysis. There were no significant group differences (≥0.1) in brachial systolic, mean, or diastolic BP. However central aortic systolic blood pressure was significantly higher in patients compared with controls (113 versus 107 mm Hg, =0.002). Patients had reduced total arterial compliance, increased pulse wave velocity, and larger backward compression waves compared with controls. LVM index was significantly higher in patients than controls (72 versus 59 g/m, <0.0005). The magnitude of the backward compression waves was independently associated with variation in LVM (=0.01). Using a novel, noninvasive hemodynamic assessment, we have shown abnormal conduit vessel function after coarctation of the aorta repair, including abnormal wave reflections that are associated with elevated LVM.
Topics: Adult; Aortic Coarctation; Blood Pressure; Female; Follow-Up Studies; Heart Ventricles; Humans; Hypertrophy, Left Ventricular; Magnetic Resonance Angiography; Male; Postoperative Complications; Pulse Wave Analysis; Time Factors; Vascular Resistance; Vascular Surgical Procedures; Young Adult
PubMed: 28115510
DOI: 10.1161/HYPERTENSIONAHA.116.08763 -
Journal of the American College of... Jan 1986The morphologic concepts of the "athlete heart" have been enhanced and clarified over the last 10 years by virtue of M-mode echocardiographic studies performed on more... (Review)
Review
The morphologic concepts of the "athlete heart" have been enhanced and clarified over the last 10 years by virtue of M-mode echocardiographic studies performed on more than 1,000 competitive athletes. Long-term athletic training produces relatively mild but predictable alterations in cardiac structure that result in an increase in calculated left ventricular mass. This increase in mass observed in highly trained athletes is due to a mild increase in either transverse end-diastolic dimension of the left ventricle or left ventricular wall thickness, or both. Cardiac dimensions in athletes compared with matched control subjects show increases of about 10% for left ventricular end-diastolic dimension, about 15 to 20% for wall thickness and about 45% for calculated left ventricular mass. Furthermore, there is evidence that the modest degree of "physiologic" left ventricular hypertrophy (both the cavity dilation and wall thickening) observed in athletes is dynamic in nature, that is, it may develop rapidly within weeks or months after the initiation of vigorous conditioning and may be reversed in a similar time period after the cessation of training. Several echocardiographic studies also suggest that the precise alterations in cardiac structure associated with training may differ depending on the type of athletic activity undertaken (that is, whether training is primarily dynamic [isotonic] or static [isometric]). Although the ventricular septal to free wall thickness ratio (on M-mode echocardiogram) is almost always within normal limits (less than 1.3), occasionally an athlete will show mild asymmetric thickening of the anterior basal septum (usually 13 to 15 mm). This circumstance may mimic certain pathologic conditions characterized by primary left ventricular hypertrophy such as nonobstructive hypertrophic cardiomyopathy. The long-term significance of increased left ventricular mass in trained athletes has not been conclusively defined. However, there is no evidence at this time suggesting that this form of hypertrophy is itself deleterious to the athlete or predisposes to (or prevents) the natural occurrence of cardiovascular disease later in life.
Topics: Adolescent; Adult; Aged; Atrial Function; Cardiomegaly; Cardiomyopathy, Hypertrophic; Child; Competitive Behavior; Death, Sudden; Echocardiography; Female; Heart; Heart Atria; Heart Ventricles; Humans; Male; Middle Aged; Physical Education and Training; Physical Endurance; Physical Exertion; Sports; Time Factors; Ventricular Function
PubMed: 2934463
DOI: 10.1016/s0735-1097(86)80282-0 -
American Journal of Hypertension Jan 2016Left ventricular hypertrophy (LVH) and concentric remodeling are associated with adverse cardiovascular outcomes. We hypothesized that measures of arterial load are...
BACKGROUND
Left ventricular hypertrophy (LVH) and concentric remodeling are associated with adverse cardiovascular outcomes. We hypothesized that measures of arterial load are associated with LVH and concentric remodeling, and that associations differ by sex.
METHODS
We studied 600 non-Hispanic whites (59% women) belonging to hypertensive sibships. By integrating arterial tonometry with echocardiography, we obtained the following hemodynamic measures: aortic characteristic impedance (Z c), proximal aortic compliance (PAC), systemic vascular resistance, augmentation index, and carotid-femoral pulse wave velocity (cfPWV). LVH and concentric remodeling were assessed by left ventricular mass indexed to body surface area (LVMI) and relative wall thickness (RWT), respectively. LVMI was log-transformed to reduce skewness. Hemodynamic measures were indexed to body size. Sex-specific multivariable linear regression analyses adjusting for confounders were performed to assess the associations of measures of arterial load with log LVMI and RWT.
RESULTS
None of the hemodynamic measures were associated with LVMI in either sex, or with RWT in men. However, in women, measures of aortic stiffness and early, pulsatile hemodynamic load were independently associated with increased RWT: β ± SE = 0.008 ± 0.004 for Z c; 0.003 ± 0.001 for cfPWV, and -0.009 ± 0.003 for PAC (P ≤ 0.05 for each). Female sex was a significant effect modifier of the associations of Z c, cfPWV, and PAC with RWT (P ≤ 0.03 for each of the interaction terms).
CONCLUSIONS
Greater Z c and cfPWV and lower PAC are independently associated with increased RWT in women but not in men. Our findings suggest that aortic stiffness and greater early, pulsatile hemodynamic load affect left ventricular concentric remodeling in a sex-specific manner.
Topics: Adult; Aorta, Thoracic; Blood Pressure; Echocardiography; Female; Follow-Up Studies; Heart Ventricles; Humans; Hypertrophy, Left Ventricular; Male; Middle Aged; Morbidity; Ontario; Retrospective Studies; Risk Assessment; Sex Distribution; Sex Factors; United States; Vascular Resistance; Vascular Stiffness; Ventricular Remodeling
PubMed: 26031305
DOI: 10.1093/ajh/hpv071