scholarly journals Echocardiographic Left Ventricular Mass Assessment: Correlation between 2D-Derived Linear Dimensions and 3-Dimensional Automated, Machine Learning-Based Methods in Unselected Patients

2021 ◽  
Vol 10 (6) ◽  
pp. 1279
Author(s):  
Andrea Barbieri ◽  
Francesca Bursi ◽  
Giovanni Camaioni ◽  
Anna Maisano ◽  
Jacopo Francesco Imberti ◽  
...  
Keyword(s):  
Machine Learning ◽  
Linear Method ◽  
Left Ventricular ◽  
Human Interaction ◽  
3D Analysis ◽  
3 Dimensional ◽  
Automated Algorithm ◽  
Linear Dimensions ◽  
Lv Mass ◽  
The Difference

A recently developed algorithm for 3D analysis based on machine learning (ML) principles detects left ventricular (LV) mass without any human interaction. We retrospectively studied the correlation between 2D-derived linear dimensions using the ASE/EACVI-recommended formula and 3D automated, ML-based methods (Philips HeartModel) regarding LV mass quantification in unselected patients undergoing echocardiography. We included 130 patients (mean age 60 ± 18 years; 45% women). There was only discrete agreement between 2D and 3D measurements of LV mass (r = 0.662, r2 = 0.348, p < 0.001). The automated algorithm yielded an overestimation of LV mass compared to the linear method (Bland–Altman positive bias of 13.1 g with 95% limits of the agreement at 4.5 to 21.6 g, p = 0.003, ICC 0.78 (95%CI 0.68−8.4). There was a significant proportional bias (Beta −0.22, t = −2.9) p = 0.005, the variance of the difference varied across the range of LV mass. When the published cut-offs for LV mass abnormality were used, the observed proportion of overall agreement was 77% (kappa = 0.32, p < 0.001). In consecutive patients undergoing echocardiography for any indications, LV mass assessment by 3D analysis using a novel ML-based algorithm showed systematic differences and wide limits of agreements compared with quantification by ASE/EACVI- recommended formula when the current cut-offs and partition values were applied.

Abstract 2292: Torsional Deformation Delay: a Novel Echocardiographic Index of Left Ventricular Peak Rotation Sequence Between Basal and Apical Level.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Lukasz Chrzanowski ◽  
Barbara Uznanska ◽  
Michal Plewka ◽  
Piotr Lipiec ◽  
Jaroslaw Drozdz ◽  
...  
Keyword(s):  
Systolic Function ◽  
Temporal Distribution ◽  
Left Ventricular ◽  
Torsional Deformation ◽  
Lv Mass ◽  
Echocardiographic Parameters ◽  
The Difference ◽  
Lv Systolic Function ◽  
Rotation Sequence

Purpose: left ventricular (LV) torsion (TOR) results from oppositely directed rotation (ROT) at the basal (BAS) and apical (AP) level. Speckle Tracking Echocardiography (STE) allows TOR assessment, but little is known of LV ROT temporal distribution. The aim was to evaluate the sequence of BAS and AP level ROT and to identify associated echocardiographic parameters. Methods: 48 patients (PTS) were studied (mean age 54±13 years, 23 men). LV systolic function was normal in 23 PTS (LVEF 60% or more), and various degrees of dysfunction were present in 25 PTS (mean LVEF 40±10%). Digital short axis loops at BAS and AP level were analyzed using STE algorithm to measure ROT in degrees (°). After adjustment for heart rate, Torsional Deformation Delay (TDD) was calculated as the difference between the time from the onset of QRS complex to the peak average systolic ROT at BAS and AP level (figure ). Results: mean TOR, BAS ROT and AP ROT was 14.3±7.3°, −6.8±4.7° and 7.5±6.1° respectively. Mean TDD was 19±107 ms (range from −285 to 248 ms); negative TDD indicated shorter time to BAS peak ROT. No difference of mean TDD was found between PTS with normal and decreased LVEF. TDD outside the range of −28 ms to 28 ms, derived by ROC analysis, was shown to have 96% specificity in detecting PTS with LVEF <60%. It was also associated with higher LV mass index as compared to TDD ranging from −28 to 28 ms (130 g/m2 vs 100 g/m2, p=0.025). Conclusions: a novel TDD index allows evaluation of LV ROT temporal distribution between BAS and AP level. TDD values outside the range of −28 ms to 28 ms are associated with decreased LVEF and presence of LV hypertrophy. Further studies are required to assess the role of TDD in cardiac imaging.

scholarly journals Machine learning based automated dynamic quantification of left heart chamber volumes

2018 ◽  
Vol 20 (5) ◽  
pp. 541-549 ◽  
Author(s):  
Akhil Narang ◽  
Victor Mor-Avi ◽  
Aldo Prado ◽  
Valentina Volpato ◽  
David Prater ◽  
...  
Keyword(s):  
Machine Learning ◽  
Cardiac Cycle ◽  
Volumetric Analysis ◽  
Left Ventricular ◽  
Clinical Workflow ◽  
Limits Of Agreement ◽  
Heart Chamber ◽  
Automated Algorithm ◽  
Time Required ◽  
Manual Correction

Abstract Aims Studies have demonstrated the ability of a new automated algorithm for volumetric analysis of 3D echocardiographic (3DE) datasets to provide accurate and reproducible measurements of left ventricular and left atrial (LV, LA) volumes at end-systole and end-diastole. Recently, this methodology was expanded using a machine learning (ML) approach to automatically measure chamber volumes throughout the cardiac cycle, resulting in LV and LA volume–time curves. We aimed to validate ejection and filling parameters obtained from these curves by comparing them to independent well-validated reference techniques. Methods and results We studied 20 patients referred for cardiac magnetic resonance (CMR) examinations, who underwent 3DE imaging the same day. Volume–time curves were obtained for both LV and LA chambers using the ML algorithm (Philips HeartModel), and independently conventional 3DE volumetric analysis (TomTec), and CMR images (slice-by-slice, frame-by-frame manual tracing). Automatically derived LV and LA volumes and ejection/filling parameters were compared against both reference techniques. Minor manual correction of the automatically detected LV and LA borders was needed in 4/20 and 5/20 cases, respectively. Time required to generate volume–time curves was 35 ± 17 s using ML algorithm, 3.6 ± 0.9 min using conventional 3DE analysis, and 96 ± 14 min using CMR. Volume–time curves obtained by all three techniques were similar in shape and magnitude. In both comparisons, ejection/filling parameters showed no significant inter-technique differences. Bland–Altman analysis confirmed small biases, despite wide limits of agreement. Conclusion The automated ML algorithm can quickly measure dynamic LV and LA volumes and accurately analyse ejection/filling parameters. Incorporation of this algorithm into the clinical workflow may increase the utilization of 3DE imaging.

P2729NT-proBNP and high-sensitivity cardiac troponin T to diagnose cardiac amyloidosis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
V Castiglione ◽  
A Aimo ◽  
A Barison ◽  
D Genovesi ◽  
C Prontera ◽  
...  
Keyword(s):  
Cardiac Troponin ◽  
Cardiac Amyloidosis ◽  
Troponin T ◽  
High Sensitivity ◽  
Left Ventricular ◽  
Clinical Suspicion ◽  
Al Amyloidosis ◽  
Cardiac Troponin T ◽  
Lv Mass ◽  
The Difference

Abstract Background Cardiac amyloidosis (CA) is characterized by the accumulation of misfolded proteins into amyloid fibrils, leading to cardiomyocyte toxicity, extracellular volume expansion and ventricular pseudohypertrophy. As a consequence of such processes, natriuretic peptides and cardiac troponins are chronically elevated in CA and hold significant prognostic value. The diagnostic yield of these biomarkers for CA has never been explored so far. Methods Plasma levels of N-terminal fraction of pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) were measured in 230 patients referred to a tertiary centre with the clinical suspicion of cardiac amyloidosis. The final diagnosis was established according to current protocols, which include clinical, electrocardiographic, biohumoral, instrumental (echocardiography, cardiac magnetic resonance, diphosphonate scintigraphy), and biopsy examinations. Results Patients were aged 79 (interquartile interval 73–83) years and were predominantly males (n=147, 64%). Mean left ventricular (LV) ejection fraction was 55% (48–62%), and mean LV mass indexed was 150 (120–178) g/m2. CA was confirmed in 86 patients (37%), who had either light chain (AL) amyloidosis (n=25, 29%) or transthyretin (ATTR) amyloidosis (n=61, 71%). Alternative diagnoses were hypertensive cardiopathy (n=69, 48%), valvular disease (n=27, 19%), hypertrophic cardiomyopathy (n=18, 13%), or left ventricular hypertrophy with unknown or multifactorial mechanisms. Patients with CA showed higher NT-proBNP (5507 ng/L [2348–10326] vs. 1332 [392–3752], p<0.001) and hs-cTnT (65 ng/L [48–114] vs. 35 [21–52], p<0.001) than those without CA. The area under the curve (AUC) values for NT-proBNP and hs-cTnT were 0.712 and 0.775 respectively (p=0.062 for the difference). The combination of the two biomarkers improved discrimination over NT-proBNP alone (p=0.011), but not over hs-cTnT (p=0.470) (Figure). A NT-proBNP level <600 ng/L or a hs-cTnT level <17 ng/L were optimal for ruling out amyloidosis, with a negative predictive value of 95% in both cases. Patients with AL amyloidosis had higher NT-proBNP and hs-cTnT than those with ATTR (10809 ng/L [6292–17483] vs. 3084 [1841–7624], p=0.014; 130 ng/L [64–211] vs. 61 [48–95], p=0.006). The difference was even more prominent when biomarker levels were normalized for LV mass (NT-proBNP/LV mass, 33.9 ng/L/g [20.4–53.8] vs. 10.0 [5.8–23.5], p=0.002; hs-cTnT/LV mass, 0.48 ng/L/g [0.25–0.71] vs. 0.19 [0.14–0.26], p=0.001). NT-proBNP and hs-cTnT could effectively discriminate patients with AL amyloidosis among subjects with clinical suspicion of CA (AUC values of 0.787 and 0.805 respectively) (Figure). Figure 1 Conclusions Plasma NT-proBNP and hs-cTnT have diagnostic value in patients with suspected CA. In the subgroup with CA, both biomarkers are higher in patients with AL amyloidosis even when normalizing for LV mass, possibly because of a greater cardiotoxic effect of light-chain fibrils.

Abstract 5734: Left Ventricular Torsion Reflects Degree of Myocardial Fibrosis in Hypertrophic Cardiomyopathy

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Ayumi Nakaboh ◽  
Akiko Goda ◽  
Shinji Nakao ◽  
Katsumi Oka ◽  
Takeshi Tsujino ◽  
...  
Keyword(s):  
Myocardial Fibrosis ◽  
Speckle Tracking ◽  
Recent Observation ◽  
Left Ventricular ◽  
List Type ◽  
Speckle Tracking Imaging ◽  
2D Echocardiography ◽  
Lv Mass ◽  
Ventricular Torsion ◽  
The Difference

Background : LV torsion (LVtor) is reduced in patients with impaired LV systolic function, e.g., dilated cardiomyophaty. It used to be thought that LVtor is reduced in patients with hypertrophic caridiomyopathy (HCM) because of the myocardial disarray; however, recent observation showed that LVtor assessed with tagged magnetic resonance imaging (MRI) even increased in patients with HCM. Recently LVtor is assessable with novel ultrasound speckle tracking imaging (STI) method. This technique may be used to assess intra-ventricular torsion in the LV muscle (intra-LVtor) that occurs due to the different fiber directions between the endocardium and epicardium. In this study, we analyzed LVtor and intra-LVtor in light of LV fibrosis in patients with HCM. Methods : MRI and echo studies were performed in 10 patients with HCM in whom any medication had not been given to HCM. MRI was used to determine LV mass index. In addition, %DEmass was determined as an MRI index of the extent of myocardial fibrosis by dividing the extent of late gadolinium enhancement by LV mass. We acquired basal and apical short-axis LV images with 2D echocardiography for off-line STI analysis to determine LVtor and intra-LVtor. We traced 18 points of the endcardium and epicardium, respectively, and averaged all regional rotation at the basal and apical plane, respectively. LVtor was defined as the difference of LV rotation between the basal and apical plane. Intra-LVtor was defined as the difference in the rotation between the endcardium and epicardium. Results : There was a significant correlation between %DEmass and LVtor(r=−0.72, p<0.05, indicating that LVtor is reduced in HCM patients with larger extent of LV myocardial fibrosis. There was no significant correlation between LVtor and LV mass index (r=−0.15, p=n.s.). %DEmass also correlated with intra-LVtor (r=−0.67, p<0.05, indicating that intra-LVtor is reduced in HCM patients with larger extent of LV myocardial fibrosis. Conclusions : Both LV torsion and intra-LV torsion are reduced in HCM patients with extended LV fibrosis. In other words, the extent of myocardial fibrosis may be assessed with LVtor and intra-LVtor by use of speckle tracking imaging in patients with HCM.

Discrepancies between echocardiographic measurements of left ventricular mass in a healthy adult population

1999 ◽  
Vol 97 (3) ◽  
pp. 377-383 ◽  
Author(s):  
Jenny A. DEAGUE ◽  
Catherine M. WILSON ◽  
Leeanne E. GRIGG ◽  
Stephen B. HARRAP
Keyword(s):  
Healthy Adult ◽  
Adult Population ◽  
Statistical Test ◽  
Left Ventricular ◽  
Altman Analysis ◽  
Cardiovascular Morbidity And Mortality ◽  
Lv Mass ◽  
Heart Size ◽  
The Difference ◽  
American Society

Increased left ventricular (LV) mass is associated with increased cardiovascular morbidity and mortality. LV mass is commonly estimated from echocardiography according to the Penn or ASE (American Society of Echocardiography) conventions. No formal statistical test of agreement between these methods has been published. Therefore we compared M-mode echocardiographic LV mass estimates by the Penn and ASE methods in a normal adult population. M-mode echocardiographic tracings were obtained in 169 healthy volunteers and used to calculate LV mass using the Penn and ASE methods. Median values of the estimates were similar [Penn, 126 g (interquartile range 96–170 g); ASE, 129 g (105–164 g); P = 0.08] and were highly intercorrelated (r = 0.98, P < 0.0001). However, the Bland–Altman analysis of agreement revealed significant inconsistencies between Penn and ASE LV mass values. The difference between Penn and ASE values was correlated significantly with heart size (P < 0.0001), such that, for small hearts, the Penn LV mass was lower than the ASE LV mass; in contrast, for large hearts, Penn estimates were greater than ASE values. In the upper 5% of the LV mass distribution, the median value for the Penn LV mass index was 132.4 g/m2, compared with 116.5 g/m2 for ASE values (2P = 0.017). Thus the two most common methods of echocardiographic estimation of LV mass differ significantly at the upper and lower ends of the heart size distribution. These results have important implications for both cardiac research and clinical evaluation.

Abstract 2938: Decrease in Endocardial Radial Strain Precedes Global Left Ventricular Dysfunction in Patients With Hypertension.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Kazuhisa Nishimura ◽  
Hideki Okayama ◽  
Makoto Saito ◽  
Toyofumi Yoshii ◽  
Katsuji Inoue ◽  
...  
Keyword(s):  
Myocardial Dysfunction ◽  
Radial Strain ◽  
Normal Subjects ◽  
Left Ventricular ◽  
Lv Dysfunction ◽  
Lv Mass ◽  
Significant Difference ◽  
The Difference ◽  
Independent Assessment ◽  
Axis View

Background: Recent studies have reported that endocardial radial strain was approximately two fold greater than epicardial strain in normal subjects. Hypertension is a major cause of myocardial dysfunction and heart failure, but the difference between endocardial and epicardial radial strain in patients with hypertension is unknown. Two-dimensional speckle tracking echocardiography is a novel echocardiographic method that enables angle-independent assessment. Aim: The aim of this study was to evaluate the difference between radial strain in endocardial and epicardial segments in hypertensive patients. Method: This study enrolled 37 patients with hypertension (H group, age 63±12years, 24men) and 17 sex- and age-matched normal subjects (N group, age 61±7 years, 9 men). Conventional echocardiography was performed by a Vivid 7 dimension (GE). Endocardial and epicardial radial strains were calculated from the left ventricular (LV) short axis view at the papillary muscle level using custom software (EchoPAC (GE)). Results: There were no significant differences in LV diastolic dimension (47±5 mm vs. 48±4 mm), LV systolic dimension (29±4 mm vs. 29±4 mm), LV ejection fraction (65±9% vs. 67±6%) and fractional shortening (38±5% vs. 39±5%) between the H and N group. LV mass index (LVMI) in the H group was significantly greater than in the N group (109±33g/m2 vs. 90±22g/m2, P<0.05). Global radial strain including endocardium and epicardium were not significantly different between the H and N group (59±20% vs. 62±17%). However, endocardial radial strain in the H group was significantly less than in the N group (48±24% vs. 62±15%, P=0.03), whereas there was no significant difference in epicardial radial strain between the two groups (38±16% vs. 28±10%). The ratio of endocardial to epicardial radial strain (Endo/Epi ratio) in the H group was significantly smaller than in the N group (1.5±1.1 vs. 2.4±1.1, P<0.01). There were significant correlations between End/Epi ratio and LVMI (r=-0.33, P<0.05), and relative wall thickness (r=-0.43, P<0.01). Conclusion: A decrease in endocardial radial strain precedes global LV dysfunction in patients with hypertension.

scholarly journals Sex and regional differences in myocardial plasticity in aortic stenosis are revealed by 3D model machine learning

2019 ◽  
Author(s):  
Anish N Bhuva ◽  
Thomas A Treibel ◽  
Antonio De Marvao ◽  
Carlo Biffi ◽  
Timothy J W Dawes ◽  
...  
Keyword(s):  
Machine Learning ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Risk Stratification ◽  
Valve Replacement ◽  
Wall Thickness ◽  
Left Ventricular ◽  
Inferior Wall ◽  
Lv Mass

Abstract Aims Left ventricular hypertrophy (LVH) in aortic stenosis (AS) varies widely before and after aortic valve replacement (AVR), and deeper phenotyping beyond traditional global measures may improve risk stratification. We hypothesized that machine learning derived 3D LV models may provide a more sensitive assessment of remodelling and sex-related differences in AS than conventional measurements. Methods and results One hundred and sixteen patients with severe, symptomatic AS (54% male, 70 ± 10 years) underwent cardiovascular magnetic resonance pre-AVR and 1 year post-AVR. Computational analysis produced co-registered 3D models of wall thickness, which were compared with 40 propensity-matched healthy controls. Preoperative regional wall thickness and post-operative percentage wall thickness regression were analysed, stratified by sex. AS hypertrophy and regression post-AVR was non-uniform—greatest in the septum with more pronounced changes in males than females (wall thickness regression: −13 ± 3.6 vs. −6 ± 1.9%, respectively, P < 0.05). Even patients without LVH (16% with normal indexed LV mass, 79% female) had greater septal and inferior wall thickness compared with controls (8.8 ± 1.6 vs. 6.6 ± 1.2 mm, P < 0.05), which regressed post-AVR. These differences were not detectable by global measures of remodelling. Changes to clinical parameters post-AVR were also greater in males: N-terminal pro-brain natriuretic peptide (NT-proBNP) [−37 (interquartile range −88 to −2) vs. −1 (−24 to 11) ng/L, P = 0.008], and systolic blood pressure (12.9 ± 23 vs. 2.1 ± 17 mmHg, P = 0.009), with changes in NT-proBNP correlating with percentage LV mass regression in males only (ß 0.32, P = 0.02). Conclusion In patients with severe AS, including those without overt LVH, LV remodelling is most plastic in the septum, and greater in males, both pre-AVR and post-AVR. Three-dimensional machine learning is more sensitive than conventional analysis to these changes, potentially enhancing risk stratification. Clinical trial registration Regression of myocardial fibrosis after aortic valve replacement (RELIEF-AS); NCT02174471. https://clinicaltrials.gov/ct2/show/NCT02174471.

scholarly journals Predictors of left ventricular reverse remodelling after coarctation of aorta intervention

2020 ◽  
Author(s):  
Alexander C Egbe ◽  
William R Miranda ◽  
Heidi M Connolly
Keyword(s):  
Systolic Dysfunction ◽  
Global Longitudinal Strain ◽  
Pressure Overload ◽  
Left Ventricular ◽  
Coarctation Of Aorta ◽  
Post Intervention ◽  
Aortic Isthmus ◽  
Lv Mass ◽  
Reverse Remodelling ◽  
The Difference

Abstract Aims Several coarctation of aorta (COA) severity indices are used for timing of COA intervention, and to define severity of residual coarctation post-intervention. However, it is unclear how many of these COA indices are required in order to recommend intervention, and what degree of residual coarctation results in suboptimal recovery of the left ventricle (LV). Our aim was to assess the correlation between different COA indices and effects of chronic LV pressure overload (LV hypertrophy, diastolic, and systolic dysfunction), and to determine the effect of residual coarctation on LV reverse remodelling after COA intervention. Methods and results COA severity indices were defined as Doppler COA gradient, systolic blood pressure (SBP, upper-to-lower-extremity SBP gradient, aortic isthmus ratio. LV remodelling indices were defined as LV mass index (LVMI), LV global longitudinal strain (LVGLS), e′ and E/e′. LV reverse remodelling was defined as the difference between indices obtained pre-intervention and 5-year post-intervention (delta LVMI, e′, E/e′, LVGLS). Of the COA indices analysed in 546 adult COA patients, aortic isthmus ratio had the strongest correlation with LVMI (β ± standard error −28.3 ± 14.1, P &lt; 0.001), LVGLS (1.51 ± 0.42, P = 0.005), e′ (3.11 ± 1.10, P = 0.014), and E/e′ (−13.4 ± 6.67, P = 0.008). Residual aortic isthmus ratio also had the strongest correlation with LV reverse remodelling, and residual aortic isthmus ratio &lt;0.7 was predictive of suboptimal LV reverse remodelling post-intervention. Conclusion Considering the known prognostic implications of LV remodelling and reverse remodelling in response to pressure overload, these results support the use of aortic isthmus ratio for timing of COA intervention, and for prognostication post-intervention.

Urine Albumin to Creatinine Ratio and Echocardiographic Left Ventricular Structure and Function in Patients with Essential Hypertension

2011 ◽  
Vol 9 (2) ◽  
pp. 90 ◽  
Author(s):  
Rohola Hemmati ◽  
Mojgan Gharipour ◽  
Hasan Shemirani ◽  
Alireza Khosravi ◽  
Elham Khosravi ◽  
...  
Keyword(s):  
Essential Hypertension ◽  
Peak Velocity ◽  
Left Ventricular ◽  
Lv Function ◽  
Creatinine Ratio ◽  
Uncomplicated Hypertension ◽  
Urine Albumin ◽  
Lv Dysfunction ◽  
Mitral Annulus Velocity ◽  
Lv Mass

Background:Appearance of microalbuminuria, particularly in patients with hypertension, might be associated with a higher prevalence of left ventricular (LV) dysfunction and geometric abnormalities. This study was undertaken to determine whether high urine albumin to creatinine ratio (UACR) as a sensitive marker for microalbuminuria can be associated with LV hypertrophy (LVH) and systolic and diastolic LV dysfunction.Methods:The study population consisted of 125 consecutive patients with essential uncomplicated hypertension. Urine albumin and creatinine concentration was determined by standard methods. LVH was defined as a LV mass index >100 g/m2 of body surface area in women and >130 g/m2 in men. Echocardiographic LV systolic and diastolic parameters were measured.Results:The prevalence of microalbuminuria in patients with essential hypertension was 5.6 %. UACR was significantly no different in patients with LVH than in patients with normal LV geometry (21.26 ± 31.55 versus 17.80 ± 24.52 mg/mmol). No significant correlation was found between UACR measurement and systolic and diastolic function parameters, including early to late diastolic peak velocity (E/A) ratio (R=-0.192, p=0.038), early diastolic peak velocity to early mitral annulus velocity (E/E') ratio (R=-0.025, p=0.794), LV ejection fraction (R=0.008, p=0.929), and LV mass (R=-0.132, p=0.154). According to the receiver operator characteristic (ROC) curve analysis, UACR measurement was not an acceptable indicator of LVH with areas under the ROC curves 0.514 (95 % confidence interval 0.394–0.634). The optimal cut-off value for UACR for predicting LVH was identified at 9.4, yielding a sensitivity of 51.6 % and a specificity of 48.3 %.Conclusion:In patients with uncomplicated essential hypertension, abnormal systolic and diastolic LV function and geometry cannot be effectively predicted by the appearance of microalbuminuria.

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