Relation between Oscillometric Measurement of Central Hemodynamics and Left Ventricular Hypertrophy in Hypertensive Patients

Introduction: The augmentation index (AIx) or central systolic blood pressure (SBP), measured by radial applanation tonometry, has been reported to be independently associated with left ventricular hypertrophy (LVH) in Japanese hypertensive patients. Cuff-based oscillometric measurement of the AIx using Mobil-O-Graph® showed a low or moderate agreement with the AIx measurement with other devices. Methods: The AIx measured using the Mobil-O-Graph was validated against the tonometric measurements of the radial AIx measured using HEM-9000AI in 110 normotensive healthy individuals (age, 21–76 years; 50 men). We investigated the relationship between the central hemodynamics assessed using the Mobil-O-Graph and LVH in 100 hypertensive patients (age, 54–75 years; 48 men), presenting a wall thickness of ≥11 mm and ≥10 mm in men and women, respectively. Results: Although the Mobil-O-Graph-measured central AIx showed no negative values, it correlated moderately with the HEM-9000AI-measured radial AIx (r = 0.602, p < 0.001) in the normotensive individuals. The hypertensive patients did not show a significant difference in the central SBP between the sexes, but the central AIx was lower in men than in women. The independent determinants influencing left ventricle (LV) mass index (LVMI) (R2 = 0.362; adjusted R2 = 0.329, p < 0.001) were heart rate (β = −0.568 ± 0.149, p < 0.001), central SBP (β = 0.290 ± 0.100, p = 0.005), and aortic root diameter (β = 1.355 ± 0.344, p = 0.001). Age (β = −0.025 ± 0.124, p = 0.841) and the central AIx (β = 0.120 ± 0.131, p = 0.361) were not independently associated with the LVMI. The area under the receiver operator characteristic curve to evaluate the diagnostic performance of the central AIx for the presence of LVH (LVMI >118 g/m2 in men or >108 g/m2 in women) was statistically significant in men (0.875, p < 0.001) but not in women (0.622, p = 0.132). In men, a central AIx of 28.06% had a sensitivity of 83.3% and specificity of 80.0% for detecting LVH. Conclusions: AIx measurement in men provided useful prognostic information for the presence of LVH. Pulse-wave analysis assessed using the Mobil-O-Graph may be a valuable tool for detecting LVH in hypertensive patients.

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Abstract 124: The Effectiveness of Angiotensin Converting Enzyme Inhibitors, Angiotensin II Receptor blocker, or Combination in Reducing Left Ventricular Hypertrophy in Hypertensive Patients: A Systematic Review

Hypertension ◽

10.1161/hyp.60.suppl_1.a124 ◽

2012 ◽

Vol 60 (suppl_1) ◽

Author(s):

Roland F Njoh ◽

Basile Njei ◽

An Thu Nguyen

Keyword(s):

Left Ventricular Hypertrophy ◽

Ventricular Hypertrophy ◽

Enzyme Inhibitors ◽

Data Extraction ◽

Angiotensin Converting Enzyme Inhibitors ◽

Left Ventricular ◽

Angiotensin Ii Receptor ◽

Converting Enzyme Inhibitors ◽

Hypertensive Patients ◽

Significant Difference

Background: Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are well established antihypertensive medications. Their role in reducing left ventricular hypertrophy (LVH) over other antihypertensives has also been clearly delineated on previous trials and meta-analysis. However, the difference in LVH reduction between ACEIs, ARBs or their combination is still unknown. Data Sources: The Cochrane Control Trials Register, PUBMED (1970 to April 2012), and hand selected reference list of English-language trials. Study Selection: Fourteen clinical trials comparing ACEI, ARB or both with outcome of interest in hypertensive patients, with duration of at least 6 months and that had minimum 20 patients were found. Data extraction: A predefined data extraction protocol was establish that included study reference, objective, design, population demographics, various interventions, outcomes and study quality. Results: Eleven randomized double blinded trials, 2 randomized open label trials and one case control trials were identified. Nine compared ACEI to ARB only and the remaining 5 compared ACEI, ARB with ACEI and ARB. There is high evidence that the use of ACEI or ARB in hypertensive patient with LVH for duration of at least 6 months, results in significant reduction in left ventricular hypertrophy measured by echocardiography or MRI as left ventricular mass (LVM) and or left ventricular mass index (LVMI). There is no significant difference between the use of ACEI or ARB in LVH reduction. When comparing combination therapy of ACEI and ARB to monotherapy of either ACEI or ARB, there is some evidence of further regression in LVH with combination therapy. The difference was more pronounced in diabetics. Limitations: Studies had small sample sizes with varied duration of therapy in diverse clinical settings, using different ACEIs and ARBs. Conclusion: The current evidence shows that the use of ACEI or ARB in hypertensive patients with LVH results in reduction in LVH. There is no significant difference in LVH reduction between use of ACEI or ARB. The use of both ACEI and ARB provides additional reduction in LVH especially in diabetics; there is however need for larger studies to better delineate these differences.

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Left ventricular dysfunction in hypertensive patients: an echocardiographic assessment

Journal of Chitwan Medical College ◽

10.3126/jcmc.v8i3.23751 ◽

2018 ◽

Vol 8 (3) ◽

pp. 51-56

Author(s):

Rishi Khatri ◽

Devendra Khatri ◽

Dhan Bahadur Shrestha ◽

Parag Karki ◽

Chiranjeevi Panta ◽

...

Keyword(s):

Left Ventricular Hypertrophy ◽

Diastolic Dysfunction ◽

Ventricular Hypertrophy ◽

Left Ventricular Systolic Dysfunction ◽

Systolic Dysfunction ◽

Age Distribution ◽

Left Ventricular ◽

Cross Sectional ◽

Hypertensive Patients ◽

Significant Difference

Introduction: Echocardiography is noninvasive procedure to assess heart. Ventricular mass increases due to left ventricular hypertrophy and performance of left ventricle decreases with increase in blood pressure. Left ventricular diastolic dysfunction (LVDD) is early sign of heart weakness which can be picked up early with Echo. This study was aimed to study cardiac anatomic and functional parametric alteration in echocardiography among hypertensive patients. Methods: This was a non-invasive, cross sectional hospital based retrospective review of the patient record from echo room among the hypertensive patient who undergone echocardiographic assessment from September 2017-February 2018 in Shree Birendra Hospital (SBH), Chhauni, Kathmandu. Results: Among 447 hypertensive cases, 232(51.9%) were having normal diastolic function while rest 215(48.1%) were having diastolic dysfunction of the heart. Among total cases evaluated, only 12(2.7%) patients were having ejection fraction lower than 55%, while in rest it was normal. There were 53 (11.9%) cases having some form of associated complication. Gender, Concentric Left Ventricular Hypertrophy and left atrial dilatation has significant difference (p<0.05) with LVDD. Statistically significant differences in age distribution of individuals with different categories of left ventricular systolic dysfunction (LVSD) and LVDD (p˂0.001) was observed. Conclusion: Significant number of hypertensive individuals were having LVDD though in most of the individual LV ejection fraction was maintained.

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OXY-SCORE: a new perspective for left ventricular hypertrophy diagnosis

Therapeutic Advances in Chronic Disease ◽

10.1177/2040622320936417 ◽

2020 ◽

Vol 11 ◽

pp. 204062232093641

Author(s):

Begoña Quintana-Villamandos ◽

Laia Pazó-Sayós ◽

Irene González del Pozo ◽

Pilar Rodríguez-Rodríguez ◽

Jose María Bellón ◽

...

Keyword(s):

Oxidative Stress ◽

Left Ventricular Hypertrophy ◽

Oxidative Damage ◽

Antioxidant Capacity ◽

Ventricular Hypertrophy ◽

Characteristic Curve ◽

Left Ventricular ◽

Control Group ◽

Global Index ◽

Significant Difference

Background: A recently developed global indicator of oxidative stress (OXY-SCORE), by combining individual plasma biomarkers of oxidative damage and antioxidant capacity, has been validated in several pathologies, but not in left ventricular hypertrophy (LVH). The aim of this study was to design and calculate a plasma oxidative stress global index for patients with LVH. Methods: A total of 70 consecutive adult patients were recruited in our institution and assigned to one of the two study groups (control group/LVH group) by an echocardiography study. We evaluated plasmatic biomarkers of oxidative damage (malondialdehyde and thiolated proteins) and antioxidant defense (total thiols, reduced glutathione, total antioxidant capacity, catalase, and superoxide dismutase activities) by spectrophotometry/fluorimetry in order to calculate a plasma oxidative stress global index (OXY-SCORE) in relation to LVH. Results: The OXY-SCORE exhibited a highly significant difference between the groups ( p < 0.001). The area under the receiver operating characteristic curve was 0.74 (95% confidence interval (CI), 0.62–0.85; p < 0.001). At a cut-off value of −1, the 68.6% sensitivity and 68.6% specificity values suggest that OXY-SCORE could be used to screen for LVH. A multivariable logistic regression model showed a positive association ( p = 0.001) between OXY-SCORE and LVH [odds ratio = 0.55 (95% CI, 0.39–0.79)], independent of gender, age, smoking, glucose, systolic and diastolic arterial pressure, dyslipidemia, estimated glomerular filtration rate, body mass index, and valvular/coronary disease. Conclusion: OXY-SCORE could help in the diagnosis of LVH and could be used to monitor treatment response.

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Serum MicroRNA-27b as a Screening Biomarker for Left Ventricular Hypertrophy

Texas Heart Institute Journal ◽

10.14503/thij-16-5955 ◽

2017 ◽

Vol 44 (6) ◽

pp. 385-389 ◽

Cited By ~ 6

Author(s):

Yan Wang ◽

Shuyan Chen ◽

Yanhong Gao ◽

Song Zhang

Keyword(s):

Left Ventricular Hypertrophy ◽

Healthy Volunteers ◽

Ventricular Hypertrophy ◽

Quantitative Polymerase Chain Reaction ◽

Characteristic Curve ◽

Area Under The Curve ◽

Left Ventricular ◽

Stem Loop ◽

Hypertensive Patients ◽

Serum Microrna

MicroRNA-27b (miR-27b) is frequently upregulated in pressure-overloaded hypertrophic hearts. The clinical implications of aberrant circulating miR-27b in the diagnosis and management of left ventricular hypertrophy warrant study. We investigated whether serum miR-27b is a biomarker for left ventricular hypertrophy (LVH). We used stem-loop reverse-transcription quantitative polymerase chain reaction techniques to analyze serum miR-27b levels in 200 hypertensive patients with LVH, 100 hypertensive patients without LVH, and 100 healthy volunteers. We found that serum miR-27b levels were significantly higher in the hypertensive patients with LVH than in the hypertensive patients without LVH and in the healthy volunteers. Upon receiver operating characteristic curve analysis, serum miR-27b had an area under the curve of 0.885 with 91% sensitivity and 73% specificity in distinguishing hypertensive patients with LVH from healthy volunteers (P=0.021), and an area under the curve of 0.818 with 79.1% sensitivity and 70.3% specificity in distinguishing hypertensive patients with LVH from those without LVH (P=0.036). We conclude that circulating miR-27b might serve as a specific, noninvasive biomarker in screening for LVH.

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