585 Natural history of left ventricular hypertrophy in infants of diabetic mothers

Abstract Aims This study sought to describe the characteristics and the natural course of left ventricular hypertrophy (LVH) in a well-characterized consecutive cohort of infants of diabetic mothers (IDMs). Methods and results Sixty consecutive IDMs with LVH have been retrospectively identified and enrolled in the study. All IDMs were evaluated at baseline and every 6 months until LV wall thickness regression, defined as the decrease of wall thickness measurement into the normal reference range for cardiac parameters (z-score > −2 and <2). A comprehensive assessment was performed in those patients with diagnostic markers suggestive of a different cause and/or without significant reduction of the LVH during follow-up. At 1-year follow-up, all IDMs showed a significant reduction of maximal wall thickness MWT [6.00 mm (IQR: 5.00–712) vs. 5.50 mm (IQR: 5.00–6.00), P-value <0.001; MWT-z-score: 4.86 (IQR: 3.93–7.61) vs. 1.72 (IQR: 1.08–2.85), P-value <0.001] compared to baseline, and all patients showed LV wall thickness regression or residual mild or moderate LVH (57%, 28%, and 12%, respectively), except two patients with persistent severe LVH, that after a comprehensive clinical-genetic assessment were diagnosed as Noonan syndrome with multiple lentigines. At multivariate analysis, MWT was negatively associated with LV wall thickness regression at 1-year follow-up [MWT-mm: OR: 0.48 (0.29–0.79), P-value = 0.004; MWT-z-score: OR: 0.71 (0.56–0.90), P-value = 0.004]. Conclusions LVH in IDMs represents a benign condition with complete regression during the first years of life. In those patients without LV wall thickness regression, combined with clinical markers suggesting a specific disease, a complete work-up is required for a definite diagnosis.

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Natural history of left ventricular hypertrophy in infants of diabetic mothers

European Heart Journal ◽

10.1093/eurheartj/ehab724.1775 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

E Monda ◽

F Verrillo ◽

I Altobelli ◽

M Lioncino ◽

M Caiazza ◽

...

Keyword(s):

Left Ventricular Hypertrophy ◽

Wall Thickness ◽

Ventricular Hypertrophy ◽

Left Ventricular ◽

P Value ◽

Z Score ◽

Benign Condition ◽

Infants Of Diabetic Mothers ◽

Diabetic Mothers

Abstract Background Left ventricular hypertrophy (LVH) in infants of diabetic mothers (IDMs) has been generally considered a benign condition, which usually regresses as the stimulus for the insulin production disappears, resulting in normalized left ventricular wall thickness in the 6 months of life. However, these conclusions have been based on small, mostly outdated cohort studies. Indeed, it has been recently shown that increased left ventricular mass persists in late infancy (6 to 12 months), long after the intrauterine exposure has been removed, suggesting that other factors may potentially contribute. Purpose This study sought to describe the characteristics and the natural course of LVH in a well-characterized consecutive cohort of IDMs. Methods Sixty consecutive IDMs with LVH have been retrospectively identified and enrolled in the study. All IDMs were evaluated at baseline and every 6 months until LV wall thickness regression, defined as the decrease of wall thickness measurement into the normal reference range for cardiac parameters (z-score >−2 and <2). A comprehensive assessment was performed in those patients with diagnostic markers suggestive of a different cause and/or without significant reduction of the LVH during follow-up. Results At 1-year follow-up, all IDMs showed a significant reduction of maximal wall thickness (MWT) (MWT-mm: 6.67±2.37 vs. 5.83±1.70, p-value<0.001; MWT-z-score: 6.67±4.71 vs. 2.39±2.55, p-value<0.001) and left ventricular outflow tract (LVOT) gradient (15.35±15.58 vs. 11.22±8.14, p-value<0.004), compared to baseline, and all patients showed LV wall thickness regression or residual mild or moderate LVH (57%, 28%, and 12%, respectively) (Figure 1), except 2 patients with persistent severe LVH, that after a comprehensive clinical-genetic assessment were diagnosed as Noonan syndrome with multiple lentigines. At multivariate analysis, MWT was significantly associated with LV wall thickness regression at 1-year follow-up (MWT-mm: OR 0.48 [0.29–0.79], p-value=0.004; MWT-z-score: OR 0.71 [0.56–0.90], p-value=0.004) in an inversely proportional fashion. Overall, 59%, 72% and 79% of IDMs with LVH showed a complete LV wall thickness regression at 1-year, 2-year and 3-year follow-up, respectively (Figure 2). Excluding the two patients with a different cause of LVH, all IDMs showed a LV wall thickness regression in the first 6 years of life. Conclusions LVH in IDMs represents a benign condition with complete regression during the first years of life. In those patients without LV wall thickness regression, combined with clinical markers suggesting a specific disease, a complete work-up is required for a definite diagnosis. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

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Natural history of left ventricular hypertrophy in infants of diabetic mothers

International Journal of Cardiology ◽

10.1016/j.ijcard.2021.12.043 ◽

2021 ◽

Author(s):

Emanuele Monda ◽

Federica Verrillo ◽

Ippolita Altobelli ◽

Michele Lioncino ◽

Martina Caiazza ◽

...

Keyword(s):

Natural History ◽

Left Ventricular Hypertrophy ◽

Ventricular Hypertrophy ◽

Left Ventricular ◽

Infants Of Diabetic Mothers ◽

History Of ◽

Diabetic Mothers

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Cardiac Amyloidosis with Discordant QRS Voltage between Frontal and Precordial Leads

Medicina ◽

10.3390/medicina57070660 ◽

2021 ◽

Vol 57 (7) ◽

pp. 660

Author(s):

Csilla-Andrea Eötvös ◽

Roxana-Daiana Lazar ◽

Iulia-Georgiana Zehan ◽

Erna-Brigitta Lévay-Hail ◽

Giorgia Pastiu ◽

...

Keyword(s):

Left Ventricular Hypertrophy ◽

Cardiac Amyloidosis ◽

Ventricular Hypertrophy ◽

Low Voltage ◽

Disease Process ◽

Left Ventricular ◽

Clinical Suspicion ◽

Immunoglobulin Light Chain ◽

Different Types

Among the different types, immunoglobulin light chain (AL) cardiac amyloidosis is associated with the highest morbidity and mortality. The outcome, however, is significantly better when an early diagnosis is made and treatment initiated promptly. We present a case of cardiac amyloidosis with left ventricular hypertrophy criteria on the electrocardiogram. After 9 months of follow-up, the patient developed low voltage in the limb leads, while still maintaining the Cornell criteria for left ventricular hypertrophy as well. The relative apical sparing by the disease process, as well as decreased cancellation of the opposing left ventricular walls could be responsible for this phenomenon. The discordance between the voltage in the frontal leads and precordial leads, when present in conjunction with other findings, may be helpful in raising the clinical suspicion of cardiac amyloidosis.

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Electrocardiographic changes in patients with cardiac rhabdomyomas associated with tuberous sclerosis

Cardiology in the Young ◽

10.1017/s1047951103000507 ◽

2003 ◽

Vol 13 (3) ◽

pp. 258-263 ◽

Cited By ~ 12

Author(s):

Junko Shiono ◽

Hitoshi Horigome ◽

Seiyo Yasui ◽

Tomoyuki Miyamoto ◽

Miho Takahashi-Igari ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Left Ventricular Hypertrophy ◽

Tuberous Sclerosis ◽

Ventricular Hypertrophy ◽

Left Ventricular ◽

Cardiac Rhabdomyoma ◽

Ventricular Cavity ◽

Electrocardiographic Changes

Background:Cardiac rhabdomyomas associated with tuberous sclerosis induce various abnormalities in the electrocardiogram. Electrocardiographic evidence of ventricular hypertrophy may appear if the tumour is electrically active. To our knowledge, electrocardiographic evidence of ventricular hypertrophy has been reported only in association with congestive heart failure. Follow-up studies of changes in electrocardiographic findings are also lacking.Methods:We studied 21 consecutive patients with cardiac rhabdomyoma associated with tuberous sclerosis, 10 males and 11 females, aged from the date of birth to 9 years at diagnosis. The mean period of follow-up was 53 months. None of the patients developed congestive heart failure. We evaluated the electrocardiographic changes during the follow-up, and their association with echocardiographic findings.Results:Of the 21 patients, 12 showed one or more abnormalities on the electrocardiogram at presentation, with five demonstrating right or left ventricular hypertrophy. In all of these five cases, the tumours were mainly located in the respective ventricular cavity. In one patient with a giant tumour expanding exteriorly, there was marked left ventricular hypertrophy on the electrocardiogram. Followup studies showed spontaneous regression of the tumours in 12 of 19 patients, with abnormalities still present in only 7 patients. A gradual disappearance of left ventricular hypertrophy as seen on the electrocardiogram was noted in the patient with marked left ventricular hypertrophy at presentation in parallel with regression of the tumour.Conclusions:The presence of cardiac rhabdomyomas in patients with tuberous sclerosis might explain the ventricular hypertrophy seen on the electrocardiogram through its electrically active tissue without ventricular pressure overload or ventricular enlargement, although pre-excitation might affect the amplitude of the QRS complex. Even in cases with large tumours, nonetheless, the electric potential might not alter the surface electrocardiogram if the direction of growth of the tumour is towards the ventricular cavity. In many cases, electrocardiographic abnormalities tend to disappear, concomitant with regression of the tumours.

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P311Hypertrophic cardiomyopathy and other forms of left ventricular hypertrophy. The P wave can make the difference

EP Europace ◽

10.1093/europace/euaa162.180 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

S Raab ◽

L Roten ◽

M Branca ◽

N Nozica ◽

M Wilhelm ◽

...

Keyword(s):

Left Ventricular Hypertrophy ◽

Sensitivity And Specificity ◽

Scoring System ◽

Ventricular Hypertrophy ◽

Left Ventricular ◽

P Wave ◽

Predictive Score ◽

Youden Index ◽

P Value ◽

Athletes Heart

Abstract Background Structural disarray of hypertrophied myocytes and interstitial fibrosis characterize hypertrophic cardiomyopathy (HCM). These morphological changes also affect atrial myocytes and, together with hemodynamic alterations because of HCM, may lead to atrial cardiomyopathy. Purpose To investigate the incremental value of P-wave parameters to differentiate left ventricular hypertrophy (LVH) because of HCM from LVH in hypertensive heart disease (HHD) and athletes heart. Methods In a prospective study, we compared electrocardiographic (including signal-averaged ECG of the P wave) and echocardiographic data of patients with HCM, HHD and athletes heart. We developed a predictive model with a simple scoring system to identify HCM. Results We compared data of 27 patients with HCM (70% males, 49.8 ± 14.5 years), 324 patients with HHD (52% males, 74.8 ± 5.5 years), and 215 subjects with athletes heart (72% males, 42.3 ± 7.5). The table shows the significant differences among the 3 groups. We included the following parameters into a predictive score to differentiate HCM from other forms of LVH: QRS width (>88ms = 1 point), P-wave integral (>688µVs = 1 point) and septum thickness (>12mm = 2 points). A score >2 (Youden index 0.626) correctly classified HCM in 81% of the cases with a sensitivity and specificity of 82% an 81%, respectively. Conclusion Differentiation of HCM from other forms of LVH is improved by including atrial parameters. A simple scoring system including septum thickness, QRS width and P wave integral allowed identification of patients with HCM with a sensitivity and specificity of >80%. This score needs to be validated prospectively. Table 1 HCM HHD Athletes P-value HCM vs HHD* HCM vs Athletes* 95%-CI P-value 95%-CI P-value P-wave duration [ms] 152.7 ± 25.8 143.9 ± 16.5 133.5 ± 14.2 <0.001 -16.9 -24.6 to -9.1 <0.001 -16.3 -22.7 to -9.9 <0.001 P-wave integral [µVs] 850.4 ± 272.4 672.0 ± 235.4 773.1 ± 260.1 <0.001 -198.6 -320.8 to -76.3 0.002 -68.2 -169.7 to 33.2 0.187 QRS [ms] 110.3 ± 27.3 96.9 ± 20.3 95.1 ± 9.8 <0.001 -16.4 -24.7 to -8.1 <0.001 -13.8 -20.8 to -6.9 <0.001 QTc [ms] 447.9 ± 27.2 438.6 ± 24.5 414.0 ± 22.9 <0.001 -21.1 -32.7 to -9.5 <0.001 -30.8 -40.5 to -21.2 <0.001 LVMMI [g/m2] 153.6 ± 55.5 133.5 ± 30.3 98.6 ± 19.7 <0.001 -15.3 -29.7 to -0.9 0.038 -56.1 -67.7 to -44.6 <0.001 IVS [ms] 16.8 ± 4.2 11.8 ± 2.2 10.3 ± 1.5 <0.001 -5.2 -6.3 to -4.1 <0.001 -6.4 -7.3 to -5.6 <0.001 LAVI [ml/m2] 43.2 ± 13.9 30.5 ± 9.7 30.8 ± 9.5 <0.001 -14.6 -20.0 to -9.3 <0.001 -12.2 -16.6 to -7.9 <0.001 The table shows the study result after univariate and multivariate (*; adjusting for age and sex) analysis. Abstract Figure 1

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1059-24 Physical activity attenuates the risk of stroke in middle-age men with left ventricular hypertrophy: 40-year follow-up (1961–2001) of the Corfu cohort (Seven countries study)

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(04)90063-0 ◽

2004 ◽

Vol 43 (5) ◽

pp. A15 ◽

Cited By ~ 1

Author(s):

Demosthenes B Panagiotakos ◽

Christos Pitsavos ◽

Christina Chrysohoou ◽

Alessandro Menotti ◽

John Skoumas ◽

...

Keyword(s):

Physical Activity ◽

Left Ventricular Hypertrophy ◽

Ventricular Hypertrophy ◽

Middle Age ◽

Left Ventricular ◽

Seven Countries Study

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Blood Pressure Control and Left Ventricular Hypertrophy in Long-Term Capd and Hemodialysis Patients: A Cross-Sectional Study

Peritoneal Dialysis International ◽

10.1177/089686080302300608 ◽

2003 ◽

Vol 23 (6) ◽

pp. 563-567 ◽

Cited By ~ 15

Author(s):

Ali Ihsan Günal ◽

Erdogan Ilkay ◽

Ercan Kirciman ◽

Ilgin Karaca ◽

Ayhan Dogukan ◽

...

Keyword(s):

Blood Pressure ◽

Left Ventricular Hypertrophy ◽

Wall Thickness ◽

Left Atrial ◽

Ventricular Hypertrophy ◽

Left Ventricular ◽

Volume Control ◽

Left Ventricular Chamber ◽

Significant Difference

Background It is still not clear whether hypertension and left ventricular hypertrophy (LVH) are more common in continuous ambulatory peritoneal dialysis (CAPD) than in hemodialysis (HD) patients. Methods To examine this subject, the indices of cardiac performance were compared between 50 HD and 34 CAPD patients. Patients were further divided into two subgroups [long-term (L) CAPD and L-HD] according to dialysis modality and duration of dialysis (more than 60 months’ duration). Results The blood pressure and cardiothoracic index of CAPD patients did not differ from HD patients. On average, the left atrial index was 2 mm/m2 higher in HD patients than in CAPD patients. Left ventricular chamber sizes, wall thickness, and left ventricular mass index (LVMI) in patients on CAPD were similar to those of HD patients. Isovolumic relaxation time (IVRT) of CAPD patients was insignificantly less than that of HD patients (101 ± 22 and 115 ± 27 msec respectively). There was no significant difference between the two subgroups (L-HD and L-CAPD) in blood pressure, left atrial diameter, left ventricular chamber size, wall thickness, LVMI, ejection fraction, or IVRT. Conclusion If normovolemia and normotension are obtained by strict volume control without using antihypertensive drugs, the effects of the two modalities of chronic dialysis treatment (HD and CAPD) on cardiac structure and function are not different from each other.

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