Abstract 17729: Ideal Cardiovascular Health is Associated With a Lower Prevalence of Adverse Left Ventricular Remodeling Patterns in the Framingham Offspring Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Matthew Nayor ◽  
Danielle Enserro ◽  
Ramachandran S Vasan ◽  
Vanessa Xanthakis
Keyword(s):  
Risk Factor ◽  
Cardiovascular Health ◽  
Left Ventricular ◽  
Lower Prevalence ◽  
Ideal Cardiovascular Health ◽  
Risk Factor Profile ◽  
Geometric Patterns ◽  
Concentric Hypertrophy ◽  
Unit Increase ◽  
Eccentric Hypertrophy

Introduction: The American Heart Association Heart Healthy score (AHA score or Life’s Simple 7™) is inversely associated with atherosclerotic vascular disease including heart failure (HF), but its relationship to adverse left ventricle (LV) geometric patterns (known precursors of HF) is unknown. LV geometry can be categorized into 4 distinct patterns: normal (normal LV mass [LVM] and relative wall thickness [RWT]), concentric remodeling (normal LVM with increased RWT), eccentric hypertrophy (increased LVM with normal RWT) and concentric hypertrophy (increased LVM and RWT). Hypothesis: We hypothesized that ideal cardiovascular health is inversely associated with adverse LV geometric patterns. Methods: We evaluated the cross-sectional relations between the AHA score (range 1-7, based on lifestyle and risk factor profile, 7 being healthiest) and the prevalence of echocardiographic LV geometric patterns in 2392 Framingham Offspring Study participants (mean age 58 years, 56% women). Using generalized logits models, we calculated odds ratios (OR) for each pattern of LV remodeling as compared to the normal pattern (that served as referent) for every unit-increase in AHA score, adjusting for age and sex. Results: Normal geometry was present in 1283 participants (54%), concentric remodeling in 486 (20%), eccentric hypertrophy in 352 (15%) and concentric hypertrophy in 271 (11%). Each unit- increase in the AHA score was associated with lower odds of concentric remodeling and hypertrophy, Table. We did not observe a significant association between the AHA score and the odds of eccentric hypertrophy. Conclusions: Our findings support the association between ideal cardiovascular health and a lower prevalence of adverse cardiac remodeling, consistent with the favorable impact of both a healthy lifestyle and optimal risk factor profile on HF risk.

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

2013 ◽  
Vol 7 ◽  
pp. CMC.S12727 ◽  
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.

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

2007 ◽  
Vol 292 (5) ◽  
pp. H2119-H2130 ◽  
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.

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 Left ventricular geometric patterns in hypertensive Nigerians: a systematic review

2015 ◽  
Vol 1 (2) ◽  
pp. 84 ◽  
Author(s):  
Kamilu Karaye
Keyword(s):  
Ventricular Hypertrophy ◽  
English Language ◽  
Left Ventricular ◽  
Geometric Patterns ◽  
Concentric Hypertrophy ◽  
Cardiovascular Morbidity And Mortality ◽  
Lv Mass ◽  
Eccentric Hypertrophy ◽  
On Line ◽  
Antihypertensive Treatments

Introduction: Several studies on left ventricular hypertrophy (LVH) and LV geometric patterns in hypertensive subjects<br />have been carried out in Nigeria, but the results vary widely. The present article aims to systematically review published<br />studies carried out in Nigeria on the prevalence and pattern of LV geometry in hypertensive subjects as determined using<br />echocardiography.<br />Methods: Relevant English language papers published up to 15th November 2012 were searched for in Medline, African<br />Journals on Line, Google Scholar and several other websites, and enquiries were made from colleagues. Study quality was<br />assessed using a condensed version of the Downs and Black checklist. LVH was defined in most of the studies as LV mass<br />index (LVMI) &gt;96g/m2 in women and &gt;116g/m2 in men, or LVMI &gt;125g/m2 for both sexes.<br />Results: A total of 148 records were initially obtained after excluding duplicates, but 138 articles had to be excluded (126 for<br />lack of relevance; 12 abstracts for lack of full length articles) while data in the remaining 10 were extracted, further analysed<br />and discussed. Out of a total of 1722 persons in all the included studies, 621 (36.1%) subjects had LVH, while 496 (28.8%)<br />had concentric remodelling and the remaining 605 (35.1%) subjects had normal geometry. Of those with LVH, 321 (51.7%) of<br />them had eccentric hypertrophy while the remaining 300 (48.3%) had concentric hypertrophy.<br />Conclusion: The findings in the present study have important clinical implications in the choice of antihypertensive treatments<br />to control the blood pressure, induce regression of LVH and reduce overall cardiovascular morbidity and mortality, as<br />recommended in standard guidelines.

Abstract 53: Biomarkers of Cardiovascular Stress and Left Ventricular Hypertrophic Patterns: Cross-sectional relations and prognostic significance

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Vanessa Xanthakis ◽  
Meredith Stevenson ◽  
Ramachandran S Vasan
Keyword(s):  
Troponin I ◽  
Prognostic Significance ◽  
High Sensitivity ◽  
Left Ventricular ◽  
Cross Sectional ◽  
Cardiac Stress ◽  
Concentric Hypertrophy ◽  
Hazard Ratios ◽  
Unit Increase ◽  
Eccentric Hypertrophy

Background: Cardiac stress biomarkers (growth differentiation factor 15 [GDF-15], soluble ST-2 [ST2], high-sensitivity troponin I [hsTnI]) and B-type natriuretic peptide [BNP]) are associated with incident heart failure (HF) and left ventricular mass (LVM). It is unclear if biomarker levels and their prognostic significance vary according to LV hypertrophy (LVH) pattern and extent. We hypothesized that concentric & eccentric LVH would be associated with highest biomarker levels; presence of both LVH and higher biomarker levels would indicate high HF risk. Methods and Results: We evaluated 2,425 Framingham Study participants free of HF (57% women, mean age 58 years) attending a routine examination, with available biomarker and echocardiographic measurements. We defined 4 LVH patterns: a. normal (normal LVM and Relative Wall Thickness [RWT]); b. concentric remodeling (normal LVM, elevated RWT); c. eccentric hypertrophy (elevated LVM, normal RWT); and d. concentric hypertrophy (elevated LVM and RWT). Adjusting for age & sex, biomarker levels (except BNP) increased sequentially across LVH patterns a-d ( Figure ). BNP levels were lowest in concentric remodeling and highest in eccentric LVH. In multivariable models, all biomarkers were associated with incident HF (106 cases, 12 yrs follow-up). We observed a significant interaction only between BNP and LVM (p=0.02). In stratified analyses, higher LVM was associated with incident HF in both BNP strata (Hazard Ratios [HR] per SD increase in LVM = 2.24 [<median BNP] and 1.35 [≥median BNP]; p<0.01 for both). However, higher BNP was associated with incident HF only in the stratum with LVM<median (HR = 2.09 per unit-increase in logBNP, p=0.003). Conclusions: In our large community-based sample, cardiac stress biomarker levels varied by LVH pattern. Contrary to our hypothesis, BNP levels were more strongly associated with HF in individuals with lesser degree of LVH.

Abstract P439: Risk Factor Profile and Prevalence of Subclinical Disease in African Americans with Diabetes and Metabolic Syndrome: The Jackson Heart Study

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Kamel A Gharaibeh ◽  
Vanessa Xanthakis ◽  
Jung Hye Sung ◽  
Tandaw S Samdarshi ◽  
Herman A Taylor ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Risk Factor ◽  
African Americans ◽  
Left Ventricular ◽  
Jackson Heart Study ◽  
Cvd Risk ◽  
Metabolic Derangement ◽  
Risk Factor Profile ◽  
Subclinical Disease ◽  
Heart Study

Background . Metabolic derangements such as diabetes (DM) and metabolic syndrome (MetS) are common in African Americans (AA) and contribute to the higher cardiovascular disease (CVD) mortality in this group. A greater prevalence of subclinical disease (ScD) among those with DM and MetS in the AA community may be an explanatory factor. Objective . We assessed the CVD risk factor profile and distribution of ScD among AA with DM and MetS in the Jackson Heart Study (JHS). Methods . We evaluated 4,365 AA participants [mean age (SD) of 53.8 (12.3) years, 64.5% women] free of overt CVD who attended JHS Exam 1 (between 2000- 2004), when ScD assessment was routinely performed(with the exception of CT for coronary calcium that occurred in Exam2). SCD measures included 1) peripheral artery disease (PAD, defined as ankle-brachial index<0.9), 2) high coronary artery calcium (CAC, defined as score>100), 3) left ventricular (LV) hypertrophy (LVH defined as left ventricular mass index>51 g/m 2.7 , 4) low LV ejection fraction (low EF, defined as an EF<50%), and 5) microalbuminuria (MA, defined as an albumin-to-creatinine ratio>25 μg/mg in men and >35 μg/mg in women). We compared the distribution of standard CVD risk factors and ScD prevalence in 1) those without DM or MetS (referent), 2) those with MetS but no DM and 3) those with DM. Results . In our study sample, 1,089 (24.9%) had MetS with no DM and 752 (17.2%) had DM. Compared to the referent group, groups with metabolic derangement tended to be older, female, hypertensive, obese, and had lower HDL, higher fasting glucose, and higher triglycerides levels. Table 1 compares the distribution of ScD for the three groups, and demonstrates the greater odds of. CAC, LVH and microalbuminuria in participants with MetS or DM. Conclusion . In our large community-based sample of AAs, we observed a significantly high prevalence of ScD overall, especially so in participants with MetS and DM. These findings likely contribute to the high CVD rates in AA with MetS and DM. -->

scholarly journals Stroke Disparities: From Observations to Actions

Stroke ◽  
2020 ◽  
Vol 51 (11) ◽  
pp. 3392-3405 ◽  
Author(s):  
Ralph L. Sacco
Keyword(s):  
Risk Factor ◽  
Ethnic Groups ◽  
Cardiovascular Health ◽  
Disease Incidence ◽  
Human Populations ◽  
Stroke Incidence ◽  
Ideal Cardiovascular Health ◽  
Awareness Campaigns ◽  
Study Results ◽  
Improvement Programs

Numerous epidemiological studies have demonstrated stroke disparities across race and ethnic groups. The goal of the NOMAS (Northern Manhattan Study) was to evaluate race and ethnic differences in stroke within a community with 3 different race-ethnic groups. Starting as a population-based incidence and case-control study, the study evolved into a cohort study. Results from NOMAS have demonstrated differences in stroke incidence, subtypes, risk factors, and outcomes. Disparities in ideal cardiovascular health can help explain many differences in stroke incidence and call for tailored risk factor modification through innovative portals to shift more diverse subjects to ideal cardiovascular health. The results of NOMAS and multiple other studies have provided foundational data to support interventions. Conceptual models to address health disparities have called for moving from detecting disparities in disease incidence, to determining the underlying causes of disparities and developing interventions, and then to testing interventions in human populations. Further actions to address race and ethnic stroke disparities are needed including innovative risk factor interventions, stroke awareness campaigns, quality improvement programs, workforce diversification, and accelerating policy changes.

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.

Co-morbidity (HFrEF and HFpEF): hypertension

ESC CardioMed ◽  
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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