The value of the spatial QRS–T angle for assessing the severity of heart damage in patients with arterial hypertension

Kardiologiia ◽  
2021 ◽  
Vol 61 (11) ◽  
pp. 49-56
Author(s):  
T. A. Sakhnova ◽  
E. V. Blinova ◽  
M. A. Saidova
Keyword(s):  
Body Mass Index ◽  
Blood Glucose ◽  
High Risk ◽  
Arterial Hypertension ◽  
Body Mass ◽  
Wall Thickness ◽  
Posterior Wall ◽  
Left Ventricular ◽  
Septal Thickness ◽  
Grade 3

Aim      To study the relationship between clinical, echocardiographic, and laboratory indexes with increased QRS–T spatial angle (sQRS–T) in patients with arterial hypertension (AH).Material and methods  The study included 160 patients with AH, 61 (38 %) men and 99 (62 %) women aged 58 [49; 67] years. Patients with ischemic heart disease or His bundle blocks were not included. Echocardiography was used to determine the left ventricular end-diastolic dimension (LV EDD), left ventricular posterior wall thickness (LVPWT), interventricular septal thickness (IVST), relative wall thickness (RWT), left ventricular myocardial mass (LVMM), and LVMM index (LVMMI). Also, the following indexes were analyzed: office systolic and diastolic blood pressure (SBP, DBP), disease duration, body mass index, plasma levels of glucose, cholesterol, and creatinine, and glomerular filtration rate. The QRS-T spatial angle was calculated as an angle between the integral vectors QRS and T using a vectorcardiogram derived from a 12-lead digital electrocardiogram. Data are presented as median (25th percentile; 75th percentile].Results The QRS-T spatial angle for the group was 65 [43; 90]°. The QRS–T spatial angle increased with increases in the AH grade (grade 1 AH, 55 [37; 74]°; grade 2 AH, 60 [41; 82]°; grade 3 AH, 88 [62; 107]°; р<0.0001); the AH stage (stage 1, 50 [41; 77]°; stage 2, 68 [44; 93]°; stage 3, 78 [59; 110]°; р=0.0002), and the cardiovascular risk degree (low and moderate risk, 49 [37; 70]°, high risk, 62 [43; 88]° (р=0.005); very high risk, 88 [61; 117]° vs. high risk, 62 [43; 88]° (р=0.0002). The QRS–T spatial angle was greater with diabetes mellitus (78 [60; 117]°) than without it (63 [43; 89]°) (р=0.03). Weak but significant correlations were found between sQRS–T and body mass index (r=0.2; p<0.01), SBP (r=0.4; p<0.0001), DBP (r=0.2; p<0.01), LV EDD (r=0.2; p<0.01), LV PWT (r=0.3; p<0.001), IVST (r=0.3; p<0.001), LVMM (r=0.3; p<0.001), LVMMI (r=0.3; p<0.001), and blood glucose (r=0.2; p<0.01).Conclusion      In patients with AH, a large QRS-T spatial angle is related with significantly higher values of SBP and DBP, LV dimension, blood glucose, and body mass index. 

scholarly journals Features of structural and functional remodeling of the left ventricle in patients suffering from arterial hypertension with concomitant hypothyroidism

2019 ◽  
Vol 26 (5) ◽  
pp. 43-52
Author(s):  
V. I. Tseluyko ◽  
L. M. Yakovleva ◽  
D. A. Korchagina
Keyword(s):  
Body Mass Index ◽  
Left Ventricle ◽  
Arterial Hypertension ◽  
Diastolic Dysfunction ◽  
Body Mass ◽  
Mean Value ◽  
Left Ventricular ◽  
Control Group ◽  
Functional Remodeling ◽  
The Mean

The aim – to study the features of structural and functional remodeling of the left ventricle in patients suffering from arterial hypertension with concomitant hypothyroidism and to determine clinical and past medical history and laboratory factors associated with their development. Materials and methods. 50 patients suffering from hypertension with concomitant hypothyroidism were enrolled into the study. Depending on the level of thyroid stimulating hormone in the serum the examined patients were distributed into two groups of 25 patients with the compensated and 25 with decompensated course of hypothyroidism. The control group consisted of 30 patients with hypertension in which the pathology of the thyroid gland was excluded. The comparison of the main parameters of the echocardiography study of the myocardium has been performed depending on hypothyroidism compensation. Assessment of parameters of transmitral diastolic blood flow has been performed. A regression analysis has been conducted to detect the relation of clinical and past medical history factors and echocardiographic parameters with the development of diastolic dysfunction by E/A ratio. The values of central hemodynamics have been studied for evaluation of the contractile function of the myocardium. Results and discussion. According to the results of the echocardiography of both examined groups it has been found that the final systolic and stroke volume exceeded the parameters of the control group. The mean value of the left ventricle ejection fraction was statistically significantly lower than in the control group (p=0.004). The left ventricle myocardial mass in patients with hypothyroidism was statistically significantly greater than in the control group. It was proved that in patients, who were diagnosed with decompensated hypothyroidism, the mean value of the left atrium size to growth by the degree of 2.7 was statistically significantly higher than in the control group (p=0.01), whereas the average value of the ratio of the size of the left atrium to the surface area of the body had no statistically significant differences between the groups. It has been found that in both groups the proportion of patients with diastolic dysfunction in which the E/A ratio was less than 1.0 was higher than in the control group (р=0.01 and p=0.03, respectively). The independent factors of diastolic dysfunction of the left ventricle in patients with hypertension in the presence of hypothyroidism have been found. Conclusions. In the presence of decompensated hypothyroidism in patients with arterial hypertension, both with obesity and with normal body mass index, left ventricular mass indexes were significantly higher in comparison with a control group. Regardless of the compensation of the thyroid state in patients with arterial hypertension, the ejection fraction was significantly lower. According to regression analysis, independent factors for the development of diastolic dysfunction in patients with arterial hypertension and hypothyroidism with a body mass index ≥ 30 kg/m2 is the index of mass of the left ventricular myocardium, determined by the degree of 2.7, the level of total cholesterol to statistical significance – the level of office systolic blood pressure and the duration of hormone replacement therapy for hypothyroidism; with body mass index < 30 kg/m2 – age and left atrial index, determined by body surface area. For patients with arterial hypertension and reduced thyroid gland function, violation of the left ventricular myocardial relaxation is typical as evidenced by a higher proportion of patients with a decrease in E/A to less than 0.8 in these patients.

Does obesity influence ventricular repolarisation in children?

2020 ◽  
pp. 1-9
Author(s):  
Nihan Yıldırım Yıldız ◽  
Tayfun Uçar ◽  
Mehmet G. Ramoğlu ◽  
Merih Berberoğlu ◽  
Zeynep Şıklar ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Body Mass Index ◽  
Body Mass ◽  
Wall Thickness ◽  
Left Ventricular ◽  
Normal Weight ◽  
Qtc Interval ◽  
Healthy Children ◽  
Obese Children ◽  
Ventricular Repolarisation

Abstract Objective: Ventricular repolarisation changes may lead to sudden cardiac death in obese individuals. We aimed to investigate the relationship between ventricular repolarisation changes, echocardiographic parameters, anthropometric measures, and metabolic syndrome laboratory parameters in obese children. Methods: The study involved 81 obese and 82 normal-weight healthy children with a mean age of 12.3 ± 2.7 years. Anthropometric measurements of participants were evaluated according to nomograms. Obese patients were subdivided into two groups; metabolic syndrome and non-metabolic syndrome obese. Fasting plasma glucose, fasting insulin, and lipid profile were measured. QT/QTc interval, QT/QTc dispersions were measured, and left ventricular systolic and diastolic measurements were performed. Results: Body weight, body mass index, relative body mass index, waist/hip circumference ratio, and systolic and diastolic blood pressures were significantly higher in obese children. QT and QTc dispersions were significantly higher in obese children and also obese children with metabolic syndrome had significantly higher QT and QTc dispersions compared to non-metabolic syndrome obese children (p < 0.001) and normal-weight healthy children (p < 0.001). Waist/hip circumference ratio, body mass index, and relative body mass index were the most important determinant of QT and QTc dispersions. Left ventricular wall thickness (left ventricular posterior wall thickness at end-diastole, left ventricular posterior wall thickness at end-systole, interventricular septal thickness at end-diastole) and left ventricular mass index were significantly higher and ejection fraction was lower in obese children. Left ventricular mass index and interventricular septal thickness at end-diastole were positively correlated with QT and QTc dispersions. Conclusions: Our study demonstrated that QT/ QTc interval prolongation and increase in QT and QTc dispersion on electrocardiogram may be found at an early age in obese children.

scholarly journals Diagnostic Utility of Electrocardiogram and Transthoracic Echocardiography in Diagnosis of Left Ventricular Hypertrophy among Known Hypertensive Patients

2020 ◽  
pp. 28-32
Author(s):  
Amit C. Botre ◽  
U. T. Mane ◽  
Dilip P. Patil ◽  
A. T. Pardesi ◽  
Anil Bhattad
Keyword(s):  
Wall Thickness ◽  
Ventricular Hypertrophy ◽  
Posterior Wall ◽  
Left Ventricular ◽  
Age Group ◽  
Hypertensive Patients ◽  
Septal Thickness ◽  
Posterior Wall Thickness ◽  
Males And Females ◽  
The Mean

The purpose of the study is to find out presence of LVH by 2D Echo in all cases of hypertension in relation to their duration and severity. In this study it was observed that 59% subjects were males and 41% were females and the mean age of males and females was 64 yrs. Majority of them 36.5% were in the age group of 61-70 yrs, out of them majority of females 48.6% were from age group 71-80 yrs and majority of males 76.5% were from age group of >80 yrs. Study showed that occurrence of LVH by Interventricular septal thickness criteria and Left ventricular posterior wall thickness criteria of 2D Echo in relation to duration of hypertension was statistically not significant. Occurrence of LVH by interventricular septal thickness criteria and Left ventricular posterior wall thickness criteria of 2D Echo in relation to severity of hypertension was statistically not significant.

scholarly journals Evaluation of LVEF with Changing left Ventricular Morphology in Hypertrophic Cardiomyopathy

2019 ◽  
Vol 15 (1) ◽  
pp. 12-15
Author(s):  
Md Mohiuddin Masum ◽  
Rayhan Shahrear ◽  
Zinnat Ara Yesmin ◽  
Latifa Nishat ◽  
Laila Anjuman Banu
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Wall Thickness ◽  
Posterior Wall ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Septal Thickness ◽  
Posterior Wall Thickness

Background:Hypertrophic cardiomyopathy (HCM) is the most frequent type of cardiomyopathy. HCM is a disease of changing cardiac morphology that causes various form of cardiac dysfunction. HCM patients may remain asymptomatic and undiagnosed for a long time. If they become symptomatic, they commonly present with breathlessness, chest discomfort, and exertion. It is also responsible for the sudden cardiac death.Proper assessment of the functional status of the heart is required for proper management strategies of HCM. Objective: The objective of the study was to assess the IVS, PWT and LVEF in different cardiac phenotypes as well as to draw correlation among them. Materials and method:A descriptive cross-sectional study was undertaken on thirty-four adult Bangladeshi hypertrophic cardiomyopathy patients (thirty-one male, three female). The study was carried out in the Department of Anatomy, BSMMU. Diagnoses adult HCM patients were selected as study patients. Transthoracic echocardiography was done to assess the interventricular septal thickness (IVS), left ventricular posterior wall thickness (PWT) and left ventricular ejection fraction (LVEF). Result: The changes in the value of the left ventricular ejection fraction shows significant correlation with left ventricular posterior wall thickness,rather than the interventricular septal thickness. Conclusion:Though significant correlation between left ventricular ejection fraction and left ventricular posterior wall thickness was found, a large cohort study could be done to see the long term outcome of such correlation. University Heart Journal Vol. 15, No. 1, Jan 2019; 12-15

scholarly journals Cardiac remodeling indicators in adolescent athletes

2017 ◽  
Vol 63 (5) ◽  
pp. 427-434 ◽  
Author(s):  
Joaquim Castanheira ◽  
João Valente-dos-Santos ◽  
Daniela Costa ◽  
Diogo Martinho ◽  
Jorge Fernandes ◽  
...  
Keyword(s):  
Wall Thickness ◽  
Posterior Wall ◽  
Left Ventricular ◽  
Basketball Players ◽  
Mean Values ◽  
Septal Thickness ◽  
Posterior Wall Thickness ◽  
Comparison Results ◽  
Hockey Players ◽  
Judo Athletes

Summary Objective: The idea that different sports and physical training type results in different cardiac adaptations has been widely accepted. However, this remodelling process among different sport modalities is still not fully understood. Thus, the current study aims to investigate the heart morphology variation associated with a set of different modalities characterized by distinct models of preparation and different methods and demands of training and completion. Method: The sample comprises 42 basketball players, 73 roller hockey players, 28 judo athletes and 21 swimmers. Anthropometry was assessed by a single and experienced anthropometrist and the same technician performed the echocardiographic exams. Analysis of variance was used to study age, body size and echocardiograph parameters as well as different sport athlete's comparison. Results: Basketball players are taller (F=23.448; p<0.001; ES-r=0.553), heavier (F=6.702; p<0.001; ES-r=0.334) and have a greater body surface area (F=11.896; p<0.001; ES-r=0.427). Basketball and hockey players have larger left auricle diameters compared with judo athletes (F=3.865; p=0.011; ES-r=0.316). Interventricular end-diastolic septal thickness (F=7.287; p<0.001; ES-r=0.347) and left ventricular posterior wall thickness (F=8.038; p<0.001; ES-r=0.362) of the judokas are smaller compared to the mean values of other sports participants. In addition, relative left parietal ventricular wall thickness is lower among swimmers compared with judokas (F=4.127; p=0.008; ES-r=0.268). Conclusion: The major contributors to changes in heart morphology are for the most part associated with sport-specific training and competition and the specific dynamics and adaptive mechanisms imposed by each sport.

scholarly journals Investigating Insulin Resistance in Pediatric Cardiomyopathy - A Pilot Study

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A660-A661
Author(s):  
Daniel Mak ◽  
Kaitlin A Ryan ◽  
Joan C Han
Keyword(s):  
Insulin Resistance ◽  
Dilated Cardiomyopathy ◽  
Wall Thickness ◽  
Cardiac Dysfunction ◽  
Posterior Wall ◽  
Left Ventricular ◽  
Inverse Association ◽  
Septal Thickness ◽  
Posterior Wall Thickness ◽  
Pediatric Cardiomyopathy

Abstract Children with cardiomyopathy are a vulnerable population and understanding the factors that contribute to cardiac dysfunction are of great importance. At the biochemical level, energy utilization by cardiomyocytes during stress may provide insight into the progression of cardiomyopathy. There is a large body of literature that describes insulin resistance in adults with cardiomyopathy (1,2). Extensive literature on the topic in adult individuals exists however investigation in the pediatric population is sparse. The pathophysiology of disease in children and adolescents is unique. To study the role of insulin resistance in pediatric cardiomyopathy, we measured the homeostasis model assessment-estimated insulin resistance (HOMA-IR) at baseline in pre-pubertal patients (age 13-18 years old; mean 16 years old; n = 8) with either hypertrophic cardiomyopathy (HCM) or dilated cardiomyopathy (DCM). In patients with HCM, greater insulin resistance was positively correlated with greater left ventricular (LV) septal thickness (r = 0.55; p = 0.33; n = 5) and LV posterior wall thickness (r = 0.7; p = 0.19; n = 5) during diastole. As expected, insulin resistance was strongly correlated with BMI (r = 0.84; p = 0.08; n = 5) though greater BMI was not as strongly associated with LV septal thickness (r = 0.59; p = 0.3; n = 5) or posterior wall thickness (r = 0.59; p = 0.3; n = 5). In patients with DCM, insulin resistance was positively correlated with LV end diastolic volume (r = 0.59; p = 0.59; n = 3). Interestingly, there was an observed inverse association between insulin resistance and BMI in DCM (r = -0.85; p = 0.34; n =3). Though our sample population is limited, thus affecting statistical significance, results showed that there was a trend towards greater insulin resistance in patients with poorer cardiac measurements. These findings are consistent with adult literature and the proposition that cardiac dysfunction is an insulin resistant state. References: (1) Riehle C, Abel ED. Insulin Signaling and Heart Failure. Circulation research. 2016;118(7):1151-1169. (2) Shah A, Shannon RP. Insulin resistance in dilated cardiomyopathy. Reviews in cardiovascular medicine. 2003;4 Suppl 6:S50-57

Combination of Huangqi Granule and Rosuvastatin Improves the Cardiac Function in Heart Failure

2020 ◽  
Vol 19 (2) ◽  
pp. 181-187
Author(s):  
Jing Li ◽  
Yun Zhang ◽  
Weizhong Huangfu ◽  
Yuhong Ma
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Wall Thickness ◽  
Posterior Wall ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Model Group ◽  
Ventricular Ejection Fraction ◽  
Posterior Wall Thickness

Using rat models of heart failure, we evaluated the effects of rosuvastatin and Huangqi granule alone and in combination on left ventricular end-diastolic dimension, left ventricular end-systolic dimension, left ventricular ejection fraction, left ventricular posterior wall thickness at end-diastole, and left ventricular posterior wall thickness at end-systole. Results showed that left ventricular end-diastolic dimension, left ventricular end-systolic dimension in the rosuvastatin + Huangqi granule group were significantly decreased (P ‹ 0.01), while left ventricular ejection fraction, left ventricular posterior wall thickness at end-diastole and left ventricular posterior wall thickness at end-systole were significantly increased (P ‹ 0.05). The serum IL-2, IFN-β, and TNF-α in rosuvastatin + Huangqi granule group were significantly lower than those in model group (P ‹ 0.05). However, the levels of S-methylglutathione and superoxide dismutase in rosuvastatin + Huangqi granule group were significantly higher, while nitric oxide was significantly lower than that in the model group (P ‹ 0.05). Also, compared to the model group, the apoptosis rate, and the autophagy protein LC3-II in the cardiomyocytes of rosuvastatin + Huangqi granule group was significantly decreased (P ‹ 0.01), while the level of p62 protein was significantly increased (P ‹ 0.01). The levels of AMPK and p-AMPK in cardiomyocytes were significantly lower in rosuvastatin + Huangqi granule group; however, the levels of mTOR and p-mTOR showed an opposite trend (P ‹ 0.05). To sum up, rosuvastatin + Huangqi granule could improve the cardiac function, decrease the level of oxidative stress, and inflammatory cytokines in rats with HF. The possible underlying mechanism might be inhibition of autophagy and reduced apoptosis in cardiomyocytes by regulating AMPK-mTOR signaling pathway.

scholarly journals BASAN index (Body mass index, Age, Sex, Arterial hypertension and Neck circumference) predicts severe apnoea in adults living at high altitude

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e044228
Author(s):  
Henry Oliveros ◽  
Rafael Lobelo ◽  
Luis Fernando Giraldo-Cadavid ◽  
Alirio Bastidas ◽  
Constanza Ballesteros ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Arterial Hypertension ◽  
High Altitude ◽  
Body Mass ◽  
Sleep Apnoea ◽  
Neck Circumference ◽  
Binary Logistic Regression Model ◽  
Cross Sectional ◽  
Derivation Cohort ◽  
Obstructive Sleep

ObjectivesObstructive sleep apnoea (OSA)/hypopnoea syndrome is associated with serious and major multiorgan morbidities, particularly in its most severe forms. However, no severe OSA screening instruments are available for high altitude residents that enable adequate identification and clinical prioritisation of such patients. We aimed at developing a severe OSA prediction tool based on the clinical characteristics and anthropometric measurements of a clinical referral cohort living at 2640 m.a.s.l.DesignCohort-nested cross-sectional study.SettingSleep laboratory for standard polysomnography (PSG) in Colombia.ParticipantsA predictive model was generated from 8718 participants referred to the PSG laboratory. Results were subsequently validated in a second cohort of 1898 participants.Primary outcomeTo identify clinical and anthropometric variables associated with severe OSA (>30 events/hour) and to include them in a binary logistic regression model.ResultsThe significant variables that were retained with the presence of severe OSA included Body mass index (BMI), Age, Sex, Arterial hypertension and Neck circumference (BASAN). The area under the receiver operating characteristic curvefor the BASAN index was 0.69 (95% CI: 0.68 to 0.70) in the derivation cohort and 0.67 (95% CI: 0.65 to 0.69) in the validation cohort, whereby a BASAN index ≥2 had a sensitivity of 95% and a specificity of 17% to detect severe OSA.ConclusionAn objectively based approach to screen for the presence of severe OSA, the BASAN index, exhibits favourable sensitivity characteristics that should enable its operational use as a screening tool in a Hispanic population with a clinical suspicion of OSA and living at high altitude.

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