751 Quantitative changes in intracardiac vortices between patients with different ventricular geometry

Abstract Aims Over the past decades growing evidence have demonstrated the promising role of intracardiac fluid-dynamics in evaluating cardiac performance. To investigate quantitative changes in vortices parameters in patients with different ventricular geometry. Methods and results We enrolled 50 consecutive patients with one of the following: LV concentric hypertrophy (CH), eccentric hypertrophy (EH), concentric remodelling, and normal LV geometry (CTRL). They underwent a complete echocardiographic examination with intracardiac fluid-dynamic analysis by Color Vector Flow Mapping (Hyperdoppler). The following parameters were obtained: vortex area (VA); vortex length (VL); and vortex depth (VD). Bland Altman Plot has been used to assess intra and inter-observer variability. Mean VD was higher in CR, CH, and EH compared to CTRL (P = 0.013, P = 0.001, and P = 0.022, respectively). Moreover, CH showed higher VL (P = 0.006) and larger VA (P = 0.012) compared to CTRL. A similar trend was noticed in EH patients, despite did not reach statistical significance (P = 0.21 and P = 0.07 for VA and VL, respectively). No significative differences in vortices parameters have been observed between CH and EH. Conclusions This is the first study providing quantitative echocardiographic parameters of vortex location and morphology in different LV geometries. Quantitative fluid-dynamic assessment was feasible and reliable in the whole population.

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Assessment of intracardiac flow dynamics for the evaluation of patients with different ventricular geometry

European Heart Journal ◽

10.1093/eurheartj/ehab724.0108 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

I Leo ◽

J Sabatino ◽

A Strangio ◽

M Maglione ◽

F Troilo ◽

...

Keyword(s):

Dynamic Analysis ◽

Fluid Dynamic ◽

Statistical Significance ◽

Left Ventricular ◽

Frame Rate ◽

Vortex Center ◽

Ventricular Geometry ◽

Longitudinal Length ◽

Echocardiographic Examination ◽

Intracardiac Flow

Abstract Background Over the last decades growing evidence have demonstrated the promising role of intracardiac flow dynamic analysis in evaluating cardiac performance. Diastolic forces contribute to the formation of vortices, complex structures capable of kinetic energy storage and responsible of a smoother transition of blood from left ventricular (LV) inlet to outlet. Change in shape and location of these structures has been related with cardiovascular disease and prognosis. Purpose To investigate quantitative changes in vortices parameters in patients with different ventricular geometry. Methods We enrolled 72 consecutive patients (age 66±11 years, 49 male, 68%) with LV concentric hypertrophy (CH, n=15), eccentric hypertrophy (EH, n=13), concentric remodeling (CR, n=15) and normal LV geometry (CTRL, n=29). Each patient underwent a complete echocardiographic examination and a non-invasive intracardiac fluid dynamic analysis by Color Vector Flow Mapping. A 3-chamber apical view with a frame rate between 22 and 25 Hz has been acquired and subsequently analyzed offline by a semi-automatic software obtaining the following parameters: vortex area (VA) (the ratio between the total vortex area and the left ventricular (LV) area); vortex length (VL) (the longitudinal length of the vortex relative to the total LV length; vortex depth (VD) (the distance of the vortex center from the LV base relative to the total LV long axis). Bland Altman Plot has been used to assess intra and inter-observer variability. Results Mean VD was higher in CR, CH and EH compared to CTRL (p=0.013, p=0.001 and p=0.022, respectively). Moreover, CH showed higher VL (p=0.006) and larger VA (p=0.012) compared to CTRL. A similar trend was noticed in EH patients, despite did not reach statistical significance (p=0.21 and p=0.07 for VA and VL respectively). No significative differences in vortices parameters have been observed between CH and EH. Conclusion(s) This is the first study providing quantitative echocardiographic parameters of vortex location and morphology in different LV geometries. Higher values of VD were found in CR, CH and EG. Quantitative intra dynamic fluid assessment was feasible and reliable in the whole population and could provide additional information to the standard echocardiographic examination. FUNDunding Acknowledgement Type of funding sources: None.

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Abstract P092: Longitudinal Impact Of Blood Pressure On Left Ventricular Geometry In The Hispanic Community Health Study/Study Of Latinos: Echocardiographic Study Of Latinos (Echo-SOL) Ancillary Study

Circulation ◽

10.1161/circ.143.suppl_1.p092 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Jennifer McLeod ◽

Barry E Hurwitz ◽

Daniela Sotres-Alvarez ◽

Mayank M Kansal ◽

Katrina Swett ◽

...

Keyword(s):

Blood Pressure ◽

Left Ventricular ◽

Health Study ◽

Left Ventricular Geometry ◽

Longitudinal Impact ◽

Ventricular Geometry ◽

Concentric Hypertrophy ◽

Echocardiographic Study ◽

Eccentric Hypertrophy ◽

Latino Adults

Introduction: Abnormal left ventricular geometry (LVG) is an independent predictor of cardiovascular mortality. We assessed the longitudinal transitions of LVG among Hispanic/Latino adults. Methods: Echo-SOL provided serial 2D echocardiograms of Hispanic adults. Each subject was identified as hypertensive or normotensive and categorized into four LVG patterns: normal, concentric remodeling (CR), concentric hypertrophy (CH), or eccentric hypertrophy (EH). Hypertensive adults were stratified on whether they maintained blood pressure (BP) control (<140/90mmHg) by visit 2. The normotensive adults were stratified on whether they developed incident hypertension (HTN) by visit 2. Logistic regression was used to evaluate the outcome of normal vs. abnormal LVG at visit 2 adjusting for age, sex, and follow-up time. Results: There were 1818 adults at visit 1 (mean age 56 years; 42.6% male, 44.7% hypertensive), with 1643 obtaining serial echocardiograms an average of 4.3 years later. At visit 1, LVG was distributed as follows: normal, 65.3%; CR, 30.6%, CH 3.1%, and EH 1.1%. Among hypertensive adults at visit 1, 59.7% had normal LVG and 34.1% had CR. By visit 2, there was a progression from normal LVG to CR among those with and without BP control; CR prevalence increased to 58.5% and 55.2%, respectively (Fig. 1). For visit 1 hypertensive adults, the incidence of abnormal LVG did not differ with regards to BP control (adjusted OR 1.1, 95% CI: 0.7-1.7). Among normotensive adults at visit 1, 69.8% had normal LVG. If they remained normotensive by visit 2, this prevalence decreased to 52.2%. If they developed HTN, there was an associated progression toward abnormal geometry (adjusted OR 2.5, 95% CI: 1.4-4.2), with the majority (59.2%) demonstrating a CR phenotype. Conclusion: Our findings suggest that BP control to 140mmHg is not adequate to prevent progressive LV remodeling among Hispanic/Latino adults. Further study is needed to understand this maladaptive process and how it contributes to cardiovascular disease in this population.

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P1569 Left ventricle structure and function relations with renin-angiotensin-aldosteron system activity and plasma markers of fibrosis in patients with ACS underwent PCI

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.989 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

M Krestjyaninov ◽

V A Razin ◽

R H Gimaev

Keyword(s):

Left Ventricle ◽

Statistical Significance ◽

Structure And Function ◽

Myocardial Stiffness ◽

Renin Angiotensin ◽

Coronary Syndrome ◽

Concentric Hypertrophy ◽

Eccentric Hypertrophy ◽

And Function ◽

Plasma Markers

Abstract Renin-angiotensin-aldosterone system (RAAS) plays significant role in development of myocardial fibrosis and LV remodelling which may increase severity of stroke and myocardial infarction. The purpose of the study is to evaluate relations between activity of RAAS and left ventricle structure and function in patients with acute coronary syndrome (ACS) underwent PCI. We examined 204 patients (both men and women) with ACS which were undergoing PCI. The mean age of patients was 51.0 (11) years. In all patients was performed ECG in 12 leads; EchoCG; evaluation plasma levels of aldosterone, angiotensin 2 (AT2), angiotensin-converting enzyme (ACE), tissue inhibitor of metalloproteinases-1 (TIMP-1) and insulin-like growth factor 1 (IGF-1). Statistical significance was defined at the level of methods for p < 0,05. Results of correlative analysis revealed relations between ILV mass and aldosterone (R = 0.57; p < 0.001), ACE (R = 0.59; p < 0.001), AT2 (R = 0.58; p < 0.001) and TIMP-1 (R = 0.54; p < 0.001). There were relations between E/A and AT2 (R = 0.23; p = 0.049), TIMP-1 (R = 0.22; p = 0.038); between IGF-1 and DT (R = 0.21; p = 0.045). This could be due to the growth in fibroblasts and cardiaomyocytes and increase in myocardial stiffness. The results of the comparison of RAAS activity markers, structural and functional parameters of the LV in patients with different LV geometry can be seen in Table 1. Thus, the results of the study show that activation of RAAS leads to increase in myocardial stiffness; and that RAAS activity and plasma markers of fibrosis was significantly higher in patients with concentric and eccentric LV hypertrophy. RAAS activity & LV geometry and function Parameters LV geometry models Normal Geometry n = 25 Concentric Remodelling n = 18 Concentric Hypertrophy n = 89 Eccentric Hypertrophy n = 72 Angiotensin 2 (pg/ml) 36.2 (11.6) 28.2 (5.5) 58.4 (46.; 64.5)*†‡ 45.8 (13.2)*† ACE (u/l) 44.4 (17.4) 30.3 (20.1; 33.0)* 67.6 (28.3)*† 57.1 (39.0; 68.0)† Aldosterone (pg/ml) 111.0 (76.8; 136.6) 101.2 (80.0; 120.5)* 152.4 (135.2; 177.3)*†‡ 136.0 (129.0; 152.0)*† TIMP-1 (ng/ml) 222.9 (80.9) 237.5 (140.0; 322.0)* 358.0 (259.0; 493.0)*†‡ 329.2 (102.5)*† IGF-1 (ng/ml) 174.2 (25.1) 174.5 (160.0; 179.0) 146.0 (129.0; 167.0)*† 148.9 (20.7)*† ILV mass (g/m²) 85.0 (79.1; 92.4) 94.7 (92.4; 97.9)* 146.3 (127.0; 171.1)*†‡ 127.0 (115.7; 149.0)*† E/A 0.7 (0.1) 0.8 (0.7; 0.9) 0.9 (0.8; 1.2)* 0.9 (0.8; 1.1)*† DT (ms) 194.3 (22.2) 185.4 (19.5) 198.9 (44.3)† 179.1 (26.8) E/e" 8.0 (0.9) 6.1 (5.4; 8.6)* 6.9 (5.5; 9.2)* 8.8 (3.0)† * - p < 0.05 in comparison with patients with normal geometry; † - p < 0.05 in comparison with patients with concentric remodelling; ‡ - p < 0.05 in comparison with patients with eccentric hypertrophy.

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Difference of Clinical Outcomes According to Left Ventricular Hypertrophy and Its Subtype in Korean Patients with Acute Myocardial Infarction

Korean Journal of Medicine ◽

10.3904/kjm.2020.95.6.387 ◽

2020 ◽

Vol 95 (6) ◽

pp. 387-397

Author(s):

Hui Jeong Kim ◽

Myung Ho Jeong ◽

Hyun Ju Yoon ◽

Yong Cheol Kim ◽

Seok-Joon Sohn ◽

...

Keyword(s):

Myocardial Infarction ◽

Clinical Outcomes ◽

Ventricular Hypertrophy ◽

Left Ventricular ◽

Left Ventricular Geometry ◽

Korean Patients ◽

Ventricular Geometry ◽

Concentric Hypertrophy ◽

Normal Left Ventricular ◽

Eccentric Hypertrophy

Background/Aims: Left ventricular hypertrophy (LVH) on clinical outcomes in patients with acute myocardial infarction (AMI) is not clear. This study was performed to investigate the effect of abnormal left ventricular geometry on clinical outcomes in Korean patients with AMI.Methods: A total of 852 consecutive patients with AMI were divided into two groups: normal left ventricular geometry (n = 470; 389 males) and LVH (n = 382; 214 males) groups. Major adverse cardiac events (MACEs) were defined as cardiac death, recurrent myocardial infarction, and rehospitalization.Results: During the clinical follow-up period of 21 ± 7.8 months, MACEs developed in 173 patients (20.0%), and the rate was higher in the LVH than normal left ventricular geometry groups (25.5% vs. 16.0%, respectively, p = 0.001). According to Kaplan-Meier survival curves, the MACE-free survival rate was significantly lower in the LVH group than in the left ventricular geometry group (p = 0.008). The rates of MACEs and all-cause mortality differed among the AMI with concentric remodeling, concentric hypertrophy, and eccentric hypertrophy subgroups (11.2% vs. 15.5% vs. 22.1%, respectively, p = 0.046). Eccentric hypertrophy was a predictive factor of MACE according to Cox proportional hazards analysis (hazard ratio 1.804, confidence interval 1.034-3.148, p = 0.038).Conclusions: LVH is a predictor of poor outcomes in patients with AMI, and eccentric hypertrophy is associated with a worse prognosis compared with concentric remodeling and concentric hypertrophy. Therefore, Korean patients with AMI and LVH, especially eccentric hypertrophy, require more careful observation and intensive treatment.

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Echocardiographic Characteristic Of Left Ventricular Geometry Of 12-17 Years Athletes

Sveikatos mokslai ◽

10.5200/sm-hs.2015.074 ◽

2015 ◽

Vol 25 (4) ◽

pp. 65-72 ◽

Cited By ~ 1

Author(s):

Aldona Bartkevičienė

Keyword(s):

Left Ventricular Hypertrophy ◽

Ventricular Hypertrophy ◽

Important Determinant ◽

Left Ventricular ◽

Left Ventricular Geometry ◽

Training Volume ◽

Ventricular Geometry ◽

Concentric Hypertrophy ◽

Concentric Left Ventricular Hypertrophy ◽

Eccentric Hypertrophy

Aim. To compare the type of left ventricular geometry associated with training among 12-17 years athletes currently competing in cycling, rowing and basketball playing and to determine the factors influencing left ventricular geometry. Methods. A total 167 male athletes 12-17 year-old, involved in basketball (n = 62), academic rowing (n =51) and cycling (n = 54) and 168 sedentary non-athletes, matched for age and sex were involved in this study. All participants underwent twodimensional, M-mode and Doppler echocardiography. To estimate left ventricular geometry relative wall thickness and left ventricular mass index were calculated. Left ventricular geometry was assessed as normal, eccentric ventricular hypertrophy, concentric left ventricular hypertrophy, concentric left ventricular remodeling. Results. Left ventricular hypertrophy was present in 48 % of all athletes, predominantly (34 %) eccentric hypertrophy. 16% of athletes had concentric hypertrophy. Only 7% of athletes manifested concentric remodeling. The prevalence of eccentric hypertrophy was more common in cyclists (54%), concentric hypertrophy was more frequent in rowers (38%), and normal left ventricular geometry was more common in basketball players (53%). Multivariate regression analysis showed that age was the important determinant of eccentric and concentric left ventricular hypertrophy. Eccentric left ventricular hypertrophy also was independently associated to training volume (hour per week) and cycling sporting discipline. Conclusion. Almost half of athletes (48%) had left ventricular hypertrophy, predominantly eccentric hypertrophy, and the age was the important determinant of left ventricular hypertrophy (eccentric and concentric). Training volume and cycling sporting discipline were significantly associated with eccentric left ventricular hypertrophy.

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Echocardiographic Assessment of Left Ventricular Geometric Patterns in Hypertensive Patients in Nigeria

Clinical Medicine Insights Cardiology ◽

10.4137/cmc.s12727 ◽

2013 ◽

Vol 7 ◽

pp. CMC.S12727 ◽

Cited By ~ 1

Author(s):

Rasaaq A. Adebayo ◽

Olaniyi J. Bamikole ◽

Michael O. Balogun ◽

Anthony O. Akintomide ◽

Victor O. Adeyeye ◽

...

Keyword(s):

Diastolic Dysfunction ◽

Systolic Function ◽

Left Ventricular ◽

Geometric Pattern ◽

Color Flow ◽

Hypertensive Patients ◽

Geometric Patterns ◽

Concentric Hypertrophy ◽

Eccentric Hypertrophy ◽

Lv Systolic Function

Left ventricular (LV) hypertrophy is an important predictor of morbidity and mortality in hypertensive patients, and its geometric pattern is a useful determinant of severity and prognosis of heart disease. Studies on LV geometric pattern involving large number of Nigerian hypertensive patients are limited. We examined the LV geometric pattern in hypertensive patients seen in our echocardiographic laboratory. A two-dimensional, pulsed, continuous and color flow Doppler echocardiographic evaluation of 1020 consecutive hypertensive patients aged between 18 and 91 years was conducted over an 8-year period. LV geometric patterns were determined using the relationship between the relative wall thickness and LV mass index. Four patterns of LV geometry were found: 237 (23.2%) patients had concentric hypertrophy, 109 (10.7%) had eccentric hypertrophy, 488 (47.8%) had concentric remodeling, and 186 (18.2%) had normal geometry. Patients with concentric hypertrophy were significantly older in age, and had significantly higher systolic blood pressure (BP), diastolic BP, and pulse pressure than those with normal geometry. Systolic function index in patients with eccentric hypertrophy was significantly lower than in other geometric patterns. Doppler echocardiographic parameters showed some diastolic dysfunction in hypertensive patients with abnormal LV geometry. Concentric remodeling was the most common LV geometric pattern observed in our hypertensive patients, followed by concentric hypertrophy and eccentric hypertrophy. Patients with concentric hypertrophy were older than those with other geometric patterns. LV systolic function was significantly lower in patients with eccentric hypertrophy and some degree of diastolic dysfunction were present in patients with abnormal LV geometry.

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Co-morbidity (HFrEF and HFpEF): hypertension

ESC CardioMed ◽

10.1093/med/9780198784906.003.0415_update_002 ◽

2018 ◽

pp. 1808-1812

Author(s):

Francesco Paneni ◽

Massimo Volpe

Keyword(s):

Blood Pressure ◽

Ejection Fraction ◽

Left Ventricular ◽

Ventricular Dilation ◽

Hypertensive Patients ◽

Reduced Ejection Fraction ◽

Concentric Hypertrophy ◽

Drug Classes ◽

Left Ventricular Dilation ◽

Eccentric Hypertrophy

Hypertensive heart disease is a major cause of heart failure (HF) and mortality. Hypertension precedes HF occurrence in 75% of cases, and carries a sixfold increase in HF risk as compared to non-hypertensive individuals. Most importantly, a minority of patients survive 5 years after the onset of hypertensive HF. In hypertensive patients, the heart may present different patterns of adaptive remodelling: concentric remodelling, concentric hypertrophy, and eccentric hypertrophy. Although most hypertensive patients are at high risk of developing concentric hypertrophy, a growing proportion of subjects display a concentric-to-eccentric progression eventually leading to left ventricular dilation and systolic dysfunction. Several factors including myocardial ischaemia, ethnicity, genetic background, history of diabetes, and blood pressure pattern may significantly influence the pathway from hypertension to left ventricular dilation. Patients with a concentric hypertrophy usually develop HF with preserved ejection fraction (HFpEF), whereas those with an eccentric (dilated) phenotype develop HF with reduced ejection fraction (HFrEF). Lowering blood pressure has a striking effect in reducing the risk of HF. Although available antihypertensive drugs are all successful in lowering blood pressure, angiotensin-converting enzyme inhibitors, angiotensin receptor blocker (ARBs), and diuretics are more effective than other drug classes in preventing HF. The combination of the neprilysin inhibitor sacubitril with the ARB valsartan (LCZ696) has recently been shown to be highly effective in reducing HF-related outcomes in hypertensive subjects. An individualized treatment scheme taking into account blood pressure levels, type of HF (HFpEF or HFrEF), and relevant co-morbidities (i.e. renal disease, diabetes) is currently the best approach to improve morbidity and mortality in hypertensive patients with HF.

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Fluid-dynamic assessment of sugarcane bagasse to use as feedstock in bubbling fluidized bed gasifiers

Applied Thermal Engineering ◽

10.1016/j.applthermaleng.2014.07.048 ◽

2014 ◽

Vol 73 (1) ◽

pp. 238-244 ◽

Cited By ~ 11

Author(s):

Nestor Proenza Pérez ◽

Einara Blanco Machin ◽

Daniel Travieso Pedroso ◽

Julio Santana Antunes ◽

Jose Luz Silveira

Keyword(s):

Fluidized Bed ◽

Sugarcane Bagasse ◽

Fluid Dynamic ◽

Dynamic Assessment ◽

Bubbling Fluidized Bed

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Cardiac response to pressure overload in 129S1/SvImJ and C57BL/6J mice: temporal- and background-dependent development of concentric left ventricular hypertrophy

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00816.2006 ◽

2007 ◽

Vol 292 (5) ◽

pp. H2119-H2130 ◽

Cited By ~ 82

Author(s):

Cordelia J. Barrick ◽

Mauricio Rojas ◽

Robert Schoonhoven ◽

Susan S. Smyth ◽

David W. Threadgill

Keyword(s):

Heart Failure ◽

Left Ventricular Hypertrophy ◽

Ventricular Hypertrophy ◽

Pressure Overload ◽

Left Ventricular ◽

Cardiac Response ◽

Dependent Manner ◽

Geometric Patterns ◽

Concentric Hypertrophy ◽

Eccentric Hypertrophy

Left ventricular hypertrophy (LVH), a risk factor for cardiovascular morbidity and mortality, is commonly caused by essential hypertension. Three geometric patterns of LVH can be induced by hypertension: concentric remodeling, concentric hypertrophy, and eccentric hypertrophy. Clinical studies suggest that different underlying etiologies, genetic modifiers, and risk of mortality are associated with LVH geometric patterns. Since pressure overload-induced LVH can be modeled experimentally using transverse aortic constriction (TAC) and since C57BL/6J (B6) and 129S1/SvImJ (129S1) strains, which have different baseline cardiovascular phenotypes, are commonly used, we conducted serial echocardiographic studies to assess cardiac function up to 8 wk of post-TAC in male B6, 129S1, and B6129F1 (F1) mice. B6 mice had an earlier onset and more pronounced impairment in contractile function, with corresponding left and right ventricular dilatation, fibrosis, change in expression of hypertrophy marker, and increased liver weights at 5 wk of post-TAC. These observations suggest that B6 mice had eccentric hypertrophy with systolic dysfunction and right-sided heart failure. In contrast, we found that 129S1 and F1 mice delayed transition to decompensated heart failure, with 129S1 mice exhibiting preserved systolic function until 8 wk of post-TAC and relatively mild alterations in histology and markers of hypertrophy at 5 wk post-TAC. Consistent with concentric hypertrophy, our results show that these strains manifest different cardiac responses to pressure overload in a time-dependent manner and that genetic susceptibility to initial concentric hypertrophy is dominant to eccentric hypertrophy. These results also imply that genetic background differences can complicate interpretation of TAC studies when using mixed genetic backgrounds.

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