Abstract 3154: Interacton of Left Ventricular Geometry and Cardiovascular Hemodynamics in 57,307 Patients wth Preserved Ejection Fraction

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Richard V Milani ◽  
Carl J Lavie
Keyword(s):  
Left Ventricular ◽  
Left Ventricular Geometry ◽  
Prognostic Impact ◽  
Preserved Ejection Fraction ◽  
Cardiovascular Hemodynamics ◽  
Non Invasive ◽  
Concentric Hypertrophy ◽  
Echocardiographic Evaluation ◽  
Eccentric Hypertrophy

We and others have demonstrated the prognostic impact of LV geometry on subsequent survival in patients with preserved ejection. The purpose of this investigation was to describe parameters of cardiovascular hemodynamics and energetics associated with normal and abnormal LV geometry, including concentric remodeling (CR), eccentric hypertrophy (EH), and concentric hypertrophy (CH) fraction in patients who were referred for routine echocardiographic evaluation. Measures were obtained using standard non-invasive methods previously reported. Survival was obtained by the National Death Index after a mean follow-up of 2.8 years. Conclusion: Changes in LV geometry are associated with significant abnormalities in cardiac and vascular hemodynamics and energetics that in general progress from CR to frank hypertrophy. Intervention directed towards modifying these parameters are needed in order to evaluate the potential for improving clinical outcomes.

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 ◽  
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.

scholarly journals Echocardiographic left ventricular geometry profiles for prediction of stroke, coronary heart disease and all-cause mortality in the Chinese community: a rural cohort population study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tan Li ◽  
Guangxiao Li ◽  
Xiaofan Guo ◽  
Zhao Li ◽  
Yingxian Sun
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Left Ventricular Geometry ◽  
Geometric Patterns ◽  
Concentric Hypertrophy ◽  
All Cause Mortality ◽  
Eccentric Hypertrophy

Abstract Background The utility of echocardiographic left ventricular (LV) geometry in the prediction of stroke/coronary heart disease (CHD) and all-cause mortality is not well characterized. This study aimed to evaluate the overall and sex-specific prognostic value of different geometric patterns on the incidence of stroke/CHD and all-cause mortality in a Chinese population-based cohort. Methods We conducted a prospective study in the general population in Northeast China, and a total of 9940 participants aged ≥ 35 years underwent echocardiography for LV geometry and were successfully followed up for incident stroke/CHD and all-cause death. Cox proportional hazards models were utilized to estimate the association of baseline LV geometry with adverse outcomes. Results Over a median follow-up of 4.66 years, abnormal LV geometric patterns had increased crude incident rates of stroke/CHD and all-cause mortality compared with normal geometry in overall population and each sex group (all P < 0.05). Multivariable Cox analysis reported that LV concentric and eccentric hypertrophy were associated with incident stroke/CHD (concentric hypertrophy: hazard ratio (HR) = 1.39, 95% confidence interval (CI) = 1.04–1.86; eccentric hypertrophy: HR = 1.42, 95% CI = 1.11–1.82) and all-cause mortality (concentric hypertrophy: HR = 1.50, 95% CI = 1.07–2.12; eccentric hypertrophy: HR = 1.58, 95% CI = 1.19–2.10), and LV concentric remodeling was related to stroke/CHD incidence (HR = 1.42, 95% CI = 1.09–1.84) in total population compared to normal geometry after the adjustment for potential confounders. In men, a significant increase was observed from LV eccentric hypertrophy for incident stroke/CHD, whereas in women, LV concentric hypertrophy was associated with elevated incidence of both stroke/CHD and all-cause death, and eccentric hypertrophy was correlated with increased all-cause mortality (all P < 0.05). Conclusions Our prospective cohort supports that abnormal LV geometry by echocardiography has a prognostic significance for incident stroke/CHD and all-cause mortality, implying that early detection and intervention of LV structural remodeling in rural China are urgently needed to prevent adverse outcomes.

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

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, <i>p</i> = 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 (<i>p</i> = 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, <i>p</i> = 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, <i>p</i> = 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.

Abstract 98a: A Novel Rodent Model of HFpEF: a Potential Platform for Understanding Disease Mechanisms and Evaluating New Therapies

2017 ◽  
Vol 121 (suppl_1) ◽  
Author(s):  
Huawei Zhao ◽  
Barry R Campbell ◽  
Xiaolan Shen ◽  
Jeffrey B Madwed ◽  
Maarten Hoek
Keyword(s):  
Ejection Fraction ◽  
Experimental Models ◽  
Left Ventricular ◽  
Rodent Model ◽  
Preserved Ejection Fraction ◽  
Concentric Hypertrophy ◽  
Preclinical Investigation ◽  
And Function ◽  
Invasive Hemodynamics

Heart failure with preserved ejection fraction (HFpEF) occurs in over 50% of total HF population today and is growing with no approved therapies today. A major challenge to the field is that truly representative experimental models of HFpEF do not exist and therefore, the advancement of the science and treatment is minimal. We have set out to develop a reliable and reproducible HFpEF rodent model to provide a platform for preclinical investigation of potential therapies. Diagnostic criteria to validate the model included (a) LVEDP > 15 mmHg, (b) left ventricular (LV) stiffness and impaired LV relaxation, (c) preserved ejection fraction (EF ≥ 55%), and (d) LV concentric hypertrophy. Adult SHR were given isoproterenol by subcutaneous mini pump infusion for 4-weeks. After first week of isoproterenol treatment initiated, L-NAME was added for 8-weeks to accelerate transition from concentric hypertrophy to HFpEF. Echocardiography and invasive hemodynamics were used to evaluate cardiac structure and function at baseline, immediately after stopping L-NAME and at 4 and 8 weeks. Treated SHR had significantly increased LVEDP, Tau and left ventricular hypertrophy with preserved EF. A follow-up study confirmed these initial data and demonstrated this HFpEF phenotype remained for at least 8-week after end of L-NAME/Iso treatment (see table). This rodent model mimics many characteristics of HFpEF patients, such as concentric cardiac hypertrophy, slow LV relaxation, and increased LV stiffness with a chronic hypertensive background and may provide a valuable platform for understanding the pathophysiology of HFpEF, as well as facilitating preclinical investigation of potential therapies.

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

2015 ◽  
Vol 25 (4) ◽  
pp. 65-72 ◽  
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.

scholarly journals Predictive values of multiple non-invasive markers for myocardial fibrosis in hypertrophic cardiomyopathy patients with preserved ejection fraction

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yumin Li ◽  
Jia Liu ◽  
Yukun Cao ◽  
Xiaoyu Han ◽  
Guozhu Shao ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Ejection Fraction ◽  
Myocardial Fibrosis ◽  
Troponin I ◽  
Myocardial Strain ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Predictive Values ◽  
Non Invasive ◽  
Potential Biomarker

AbstractMyocardial fibrosis assessed by late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) is associated with cardiovascular outcomes in hypertrophic cardiomyopathy (HCM) patients, but little is known about the utility of non-invasive markers for detecting LGE. This study aims to explore the association between cardiac-specific biomarkers, CMR myocardial strain, left ventricular (LV) hypertrophy and LGE in HCM patients with preserved ejection fraction (EF) and investigate the predictive values of these indexes for LGE. We recruited 33 healthy volunteers and 86 HCM patients with preserved EF to undergo contrast-enhanced CMR examinations. In total, 48 of 86 HCM patients had the presence of LGE. The LGE-positive patients had significant higher serum high-sensitivity cardiac troponin I (hs-cTnI) and N-terminal pro b-type natriuretic peptide (Nt-proBNP) levels and lower global longitudinal (GLS) and circumferential (GCS) strains than the LGE-negative group. The LGE% was independently associated with the Nt-proBNP levels, GCS, LV end-diastolic maximum wall thickness (MWT) and beta-blocker treatment. In the receiver operating characteristic curve analysis, the combined parameters of Nt-proBNP ≥ 108.00 pg/mL and MWT ≥ 17.30 mm had good diagnostic performance for LGE, with a specificity of 81.25% and sensitivity of 70.00%. These data indicate that serum Nt-proBNP is a potential biomarker associated with LGE% and, combined with MWT, were useful for identifying myocardial fibrosis in HCM patients with preserved EF. Additionally, LV GCS may be a more sensitive indicator for reflecting the presence of myocardial fibrosis than GLS.

scholarly journals Left ventricular fibrosis and hypertrophy are associated with mortality in heart failure with preserved ejection fraction

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Pankaj Garg ◽  
Hosamadin Assadi ◽  
Rachel Jones ◽  
Wei Bin Chan ◽  
Peter Metherall ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
T1 Mapping ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Native T1 ◽  
Lv Mass ◽  
All Cause Mortality ◽  
Ventricular Fibrosis

AbstractCardiac magnetic resonance (CMR) is emerging as an important tool in the assessment of heart failure with preserved ejection fraction (HFpEF). This study sought to investigate the prognostic value of multiparametric CMR, including left and right heart volumetric assessment, native T1-mapping and LGE in HFpEF. In this retrospective study, we identified patients with HFpEF who have undergone CMR. CMR protocol included: cines, native T1-mapping and late gadolinium enhancement (LGE). The mean follow-up period was 3.2 ± 2.4 years. We identified 86 patients with HFpEF who had CMR. Of the 86 patients (85% hypertensive; 61% males; 14% cardiac amyloidosis), 27 (31%) patients died during the follow up period. From all the CMR metrics, LV mass (area under curve [AUC] 0.66, SE 0.07, 95% CI 0.54–0.76, p = 0.02), LGE fibrosis (AUC 0.59, SE 0.15, 95% CI 0.41–0.75, p = 0.03) and native T1-values (AUC 0.76, SE 0.09, 95% CI 0.58–0.88, p < 0.01) were the strongest predictors of all-cause mortality. The optimum thresholds for these were: LV mass > 133.24 g (hazard ratio [HR] 1.58, 95% CI 1.1–2.2, p < 0.01); LGE-fibrosis > 34.86% (HR 1.77, 95% CI 1.1–2.8, p = 0.01) and native T1 > 1056.42 ms (HR 2.36, 95% CI 0.9–6.4, p = 0.07). In multivariate cox regression, CMR score model comprising these three variables independently predicted mortality in HFpEF when compared to NTproBNP (HR 4 vs HR 1.65). In non-amyloid HFpEF cases, only native T1 > 1056.42 ms demonstrated higher mortality (AUC 0.833, p < 0.01). In patients with HFpEF, multiparametric CMR aids prognostication. Our results show that left ventricular fibrosis and hypertrophy quantified by CMR are associated with all-cause mortality in patients with HFpEF.

Significance of the echocardiographic evaluation of left atrial myocardial strain for early diagnosis of heart failure with preserved ejection fraction

Kardiologiia ◽  
2021 ◽  
Vol 61 (8) ◽  
pp. 68-75
Author(s):  
E. K. Serezhina ◽  
A. G. Obrezan
Keyword(s):  
Heart Failure ◽  
Early Diagnosis ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Myocardial Dysfunction ◽  
Systolic Dysfunction ◽  
Myocardial Strain ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Echocardiographic Evaluation

This systematic review is based on 19 studies from Elsevier, PubMed, Embase, and Scopus databases, which were found by the following keywords: LA strain (left atrial strain), STE (speckle tracking echocardiography), HF (heart failure), and HFpEF (heart failure with preserved ejection fraction). The review focuses on results and conclusions of studies on using the 2D echocardiographic evaluation of left atrial (LA) myocardial strain for early diagnosis of HFpEF in routine clinical practice. Analysis of the studies included into this review showed a significant decline of all LA functions in patients with HFpEF. Also, multiple studies have reported associations between decreased indexes of LA strain and old age, atrial fibrillation, left ventricular hypertrophy, left and right ventricular systolic dysfunction, and LV diastolic dysfunction. Thus, the review indicates significant possibilities of using indexes of LA strain in evaluation of early stages of both systolic and diastolic myocardial dysfunction. Notably, LA functional systolic and diastolic indexes are not sufficiently studied despite their growing significance for diagnosis and prognosis of patients with HFpEF. For this reason, in addition to existing models for risk stratification in this disease, including clinical characteristics and/or echocardiographic data, future studies should focus on these parameters. 

Abstract 13497: Prognostic Value of the Combination of the Echocardiographic Derived Pulmonary Artery Wedge Pressure and Body Mass Index in Patients With Heart Failure With Preserved Ejection Fraction: Insights From PURSUIT-HFpEF Registry

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kumpei Ueda ◽  
Shungo Hikoso ◽  
Daisaku D Nakatani ◽  
Shunsuke Tamaki ◽  
Masamichi Yano ◽  
...  
Keyword(s):  
Heart Failure ◽  
Body Mass Index ◽  
Ejection Fraction ◽  
Prognostic Value ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Pulmonary Artery Wedge Pressure ◽  
Patients With Heart Failure ◽  
Wedge Pressure

Background: An elevated pulmonary artery wedge pressure (PAWP), a surrogate of left ventricular filling pressure, is associated with poor outcomes in patients with heart failure (HF). In addition, obesity paradox is well recognized in HF patients and body mass index (BMI) also provides a prognostic information. However, there is little information available on the prognostic value of the combination of the echocardiographic derived PAWP and BMI in patients with HF with preserved ejection fraction (HFpEF). Methods and Results: Patients data were extracted from The Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with Preserved Ejection Fraction (PURSUIT HFpEF) study, which is a prospective multicenter observational registry for acute decompensated heart failure (ADHF) patients with HFpEF. We analyzed 548 patients after exclusion of patients undergoing hemodialysis, patients with in-hospital death, missing follow-up data, or missing data to calculate PAWP or BMI. Body weight measurement and echocardiography were performed just before discharge. PAWP was calculated using the Nagueh formula [PAWP = 1.24* (E/e’) + 1.9] with e’ = [(e’ septal + e’ lateral ) /2]. During a mean follow up period of 1.5±0.8 years, 86 patients had all-cause death (ACD). Multivariate Cox analysis showed that both PAWP (p=0.020) and BMI (p=0.0001) were significantly associated with ACD, independently of age and previous history of HF hospitalization, after the adjustment with gender, left ventricular ejection fraction, NT-proBNP and estimated glomerular filtration rate. Kaplan-Meier curve analysis revealed that there was a significant difference in the risk of ACD when patients were stratified into 3 groups based on the median values of PAWP (17.3) and BMI (21.4). Conclusions: The combination of the echocardiographic derived PAWP and BMI might be useful for stratifying ADHF patients with HFpEF at risk for the total mortality.

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