751 Quantitative changes in intracardiac vortices between patients with different ventricular geometry

Aims Over the past decades growing evidence have demonstrated the promising role of intracardiac fluid-dynamics in evaluating cardiac performance. To investigate quantitative changes in vortices parameters in patients with different ventricular geometry. Methods and results We enrolled 50 consecutive patients with one of the following: LV concentric hypertrophy (CH), eccentric hypertrophy (EH), concentric remodelling, and normal LV geometry (CTRL). They underwent a complete echocardiographic examination with intracardiac fluid-dynamic analysis by Color Vector Flow Mapping (Hyperdoppler). The following parameters were obtained: vortex area (VA); vortex length (VL); and vortex depth (VD). Bland Altman Plot has been used to assess intra and inter-observer variability. Mean VD was higher in CR, CH, and EH compared to CTRL (P = 0.013, P = 0.001, and P = 0.022, respectively). Moreover, CH showed higher VL (P = 0.006) and larger VA (P = 0.012) compared to CTRL. A similar trend was noticed in EH patients, despite did not reach statistical significance (P = 0.21 and P = 0.07 for VA and VL, respectively). No significative differences in vortices parameters have been observed between CH and EH. Conclusions This is the first study providing quantitative echocardiographic parameters of vortex location and morphology in different LV geometries. Quantitative fluid-dynamic assessment was feasible and reliable in the whole population.

Assessment of intracardiac flow dynamics for the evaluation of patients with different ventricular geometry

Background Over the last decades growing evidence have demonstrated the promising role of intracardiac flow dynamic analysis in evaluating cardiac performance. Diastolic forces contribute to the formation of vortices, complex structures capable of kinetic energy storage and responsible of a smoother transition of blood from left ventricular (LV) inlet to outlet. Change in shape and location of these structures has been related with cardiovascular disease and prognosis. Purpose To investigate quantitative changes in vortices parameters in patients with different ventricular geometry. Methods We enrolled 72 consecutive patients (age 66±11 years, 49 male, 68%) with LV concentric hypertrophy (CH, n=15), eccentric hypertrophy (EH, n=13), concentric remodeling (CR, n=15) and normal LV geometry (CTRL, n=29). Each patient underwent a complete echocardiographic examination and a non-invasive intracardiac fluid dynamic analysis by Color Vector Flow Mapping. A 3-chamber apical view with a frame rate between 22 and 25 Hz has been acquired and subsequently analyzed offline by a semi-automatic software obtaining the following parameters: vortex area (VA) (the ratio between the total vortex area and the left ventricular (LV) area); vortex length (VL) (the longitudinal length of the vortex relative to the total LV length; vortex depth (VD) (the distance of the vortex center from the LV base relative to the total LV long axis). Bland Altman Plot has been used to assess intra and inter-observer variability. Results Mean VD was higher in CR, CH and EH compared to CTRL (p=0.013, p=0.001 and p=0.022, respectively). Moreover, CH showed higher VL (p=0.006) and larger VA (p=0.012) compared to CTRL. A similar trend was noticed in EH patients, despite did not reach statistical significance (p=0.21 and p=0.07 for VA and VL respectively). No significative differences in vortices parameters have been observed between CH and EH. Conclusion(s) This is the first study providing quantitative echocardiographic parameters of vortex location and morphology in different LV geometries. Higher values of VD were found in CR, CH and EG. Quantitative intra dynamic fluid assessment was feasible and reliable in the whole population and could provide additional information to the standard echocardiographic examination. FUNDunding Acknowledgement Type of funding sources: None.

Prediction of abnormal left ventricular geometry on the ECG through machine learning with a focus on obesity

Background Cardiac remodeling, an important aspect of cardiovascular disease (CVD) progression, is emerging as a significant therapeutic target. However, the ECG is not a sensitive method of detecting left ventricular hypertrophy (LVH), and as far as we know, it cannot detect changes in left ventricular geometry (LVG) at early stages, especially before LVH is present. Its sensitivity is particularly low for obese patients. Purpose To use a machine learning (ML) classifier to detect abnormal LVG from EKG parameters/markers, even before it becomes LVH, and to propose some indicative markers useful for practitioners. We also looked at the results of our model for obese patients to test the markers in this population. Methods We enrolled 594 consecutive subjects, aged 30 years or older (mean age: 61.6±12 years old) with and without essential hypertension and no indications of CVD. We tried to build a “clean” dataset through which we can target the clinical, anthropometric, and electrocardiogram measurements indicative of abnormal LVG. All patients underwent a full echocardiographic evaluation and were classified into 2 groups; those with normal geometry (NG) vs. those with concentric remodeling (CR) or LVH. Abnormal LVG was identified as increased relative wall thickness (RWT) and/or left ventricular mass index (LVMi). We analyzed the EKG waveforms deduced to single beat averages for each lead using custom software and extracted 70 markers. We then trained a Random Forest machine learning model to classify subjects with abnormal LVG and calculated SHAP values to perform feature importance and interaction. Results The percentage of women was 56.5%, while 71.3% of all patients were hypertensive. Hypertension, age, body mass index divided by the Sokolow-Lyon voltage (BMI/S-L), QRS-T angle, and QTc duration were among the most important parameters (Figure, left panel) identified by the model as being predictive of abnormal LVG (AUC/ROC = 0.84, sensitivity = 0.94, specificity 0.61). Specifically for obese patients, whose prevalence in our population was 60.3%, our model performed well (sensitivity = 0.71, specificity = 0.92. When we tried our model without the the BMI/S-L parameter, the specificity dropped to 0.88. We also found that a cut-off point of 18 for the BMI/S-L marker predicted the patients who were more probable to have developed abnormal LVG (Figure 1). Conclusions This study is the first to demonstrate the promising potential of ML modeling for the efficient and cost-effective diagnostic screening of abnormal LVG through ECG. We found specific clinical and ECG parameters that can predict early pathological changes of LVG in patients without established CVD and detect the population who will benefit from a detailed echocardiographic evaluation. Our model contributes to the development of human-centered and autonomous technologies and can optimize patient-management and treatment. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

Abnormal left ventricular geometry in female collegiate swimmers

Background There is a paucity of data describing left ventricular geometry changes in female athletes. While some studies suggest that female athletes participating in dynamic sports exhibit higher prevalence of eccentric left ventricular hypertrophy (LVH) when compared to men, a recent study suggested more concentric geometry changes in female basketball athletes. We were unable to identify studies describing the left ventricular geometry of female collegiate swimmers. Objectives To describe LV geometry changes in a cohort of female collegiate swimmers. Methods We analyzed a cohort of female collegiate swimmers who had a pre-participation cardiac evaluation by 12-lead ECG and 2-dimensional echocardiography. Left ventricular (LV) geometry was assessed based on relative wall thickness (RWT) (defined as: 2 x posterior wall thickness (PWT) divided by LV end-diastolic diameter (LVEDD)) and LV mass (LVM) (Devereux's formula: LVM = [0.8 x 1.04 [(LVEDD + interventricular septum + posterior wall thickness)3 − (LVEDD)3]] + 0.6g) and was indexed to body surface area (BSA).LVH was defined as LV mass index >95 g and was defined as concentric when associated with a relative wall thickness (RWT) >0.42 and as eccentric when RWT was ≤0.42. Concentric remodeling was defined as normal LVM index and increased RWT. Results A total of 83 female collegiate swimmers were included. Their age was 18.5±0.5 years (mean ± standard deviation, SD), 74 (89.2%) were White, BSA was 1.78±0.11 m2, height 173±6.3 cm, weight 66.2±7.2 K. Their interventricular septum diameter was 0.89±0.14 cm, PWT 0.92±0.15 cm, LVEDD 4.9±0.5 cm and LV end-systolic diameter (LVESD) 3.2±0.4 cm. Left atrium diameter ranged from 2.6 to 4.3 cm (mean 3.4 cm ± 0.4 cm). Aortic root diameter ranged from 1.9 to 3.5 cm (mean 2.7±0.3 cm) (Figure 1). LVH was present in 27 swimmers (32.5%). Eccentric LVH was present in 17 athletes (20.5%), concentric hypertrophy in 10 athletes (12%), and concentric remodeling in 12 (14.5%) (Figure 2). No athletes with LVH or concentric remodeling had borderline or abnormal ECG findings based on international criteria. Only two women with normal LV geometry had abnormal ECG findings: prolonged QT interval and abnormal T wave inversion. There was a linear correlation between BSA with LVEDD, LVESD and LV mass (r=0.40, 0.35, and 0.48 with P<0.001,0.002 and <0.001, respectively). However, there was no statistically significant difference between LV geometry groups based on BSA or blood pressure. Conclusion Our data document a high incidence of eccentric hypertrophy among female collegiate swimmers. Concentric remodeling and hypertrophy were also relatively high. Differentiating physiologic from pathologic cardiac remodeling in these athletes is critical to prevent potential complications such as sudden cardiac death, arrhythmias, and other adverse outcomes. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): This work was supported in part by the American Medical Society for Sports Medicine (AMSSM) Foundation Research Grant 2016 awarded to KE, and the University of Florida REDCap uses the NIH National Center for Advancing Translational Sciences (NCATS) grant UL1 TR001427. Figure 1 Figure 2. LV geometry in female swimmers

Abstract P190: Antihypertensive Treatment Improves Left Ventricular Geometry After 10 Years Even In Elderly Hypertensive Patients

Introduction: Both ageing and high blood pressure (BP) is associated with a risk of left ventricular hypertrophy; therefore, it is unclear whether antihypertensive treatment for 10 years period reduce cardiac hypertrophy and concentricity beyond the impact of ageing. We assessed the hypothesis that even in elderly patients, BP reduction is effective for left ventricular remodeling. Methods: Among 558 hypertensive patients without concurrent heart disease referred to a cardiology clinic who underwent echocardiography and ambulatory blood pressure monitoring, 151 patients’ data of echocardiography was available after 10 years of follow up period. We evaluated the relation among BP at baseline, antihypertensive medications, and change in echocardiographic parameters of left ventricular geometry. Results: Mean age was 70.8±8.2 years at baseline. 24-hour BP was 127.4±16.4/71.4±9.6mmHg, awake BP was 129.9±17.1/72.4±10.2mmHg, and asleep BP was 122.5±16.9/67.1±9.1 mmHg. After 10 years (mean age 81.0±9.0 years), number of antihypertensive increased from 1.3±1.2 to 2.0±1.1. Left ventricular mass index (LVMI) insignificantly decreased from 115.7 to 98.7mg/m 2 (p=0.167)and relative wall thickness (RWT) significantly decreased from 0.51 to 0.47(p<0.001). There were 12% of patients with normal left ventricular geometry (N), 52% with concentric remodeling (CR), 9% with eccentric hypertrophy (EH), and 27% with concentric hypertrophy (CH) at baseline. Among patients with N or CR at baseline, those who developed to CH or EH had higher night time systolic BP (126.5±17.0 vs 118.9 ±15.4, p=0.037) than those who did not. Neither number nor type of antihypertensive was related to this geometry change. In logistic regression analysis, night time systolic BP was significantly related to the progression of hypertrophy adjusting for age, sex, BMI, LVMI, RWT, and clinic systolic BP at baseline (p=0.04). Conclusions: Even in elderly hypertensive patients, antihypertensive treatment for 10 years improved LV geometry in spite of ageing. Nighttime BP at baseline predicted worsening of LV geometry after 10 years beyond clinic BP.

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

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.

Reliability of Cardiac Percussion Technique to Determine Left Ventricular Geometry in Comparison with Transthoracic Echocardiography

Background: Cardiac percussion (CP) is a bedside technique to evaluate cardiac borders and chamber size. Although advanced cardiac imaging has revolutionized the methods to detect cardiomegaly, art of CP remains the most convenient option, especially in emergent situations. Although transthoracic echocardiography (TTE) is considered the gold standard to determine left ventricular (LV) size, CP can estimate LV size with equal accuracy as TTE in appropriate clinical setting. The aim of this study was to investigate the correlation of LV size assessed by CP technique versus standard TTE, as well as cardiothoracic ratio (CTR) on chest roentgenography (CXR). Methods: This descriptive study was conducted on Telemetry units. Patients were positioned in supine position at Gatch angle of 30-45 degrees. Cardiac dullness was measured in cm by percussing from mid clavicular line towards gladiolus of sternal body. Subsequently, findings were correlated with TTE dimensions of left ventricular end-diastolic diameter (LVEDD). Results: In 200 patients, mean age was 63+15.8 years, with 51% females. The LV diameter (LVD) measured by CP technique was observed to be similar to LVEDD measured by TTE (Mean- 4.65+0.67 cm versus 4.69+0.76 cm, COV 7.6%). The BlandAltman comparison of CP technique and TTE measurements indicated significant differences in variances between the two measures (r=0.270, p=<0.001). The LVD measured by CXR did not show correlation with LVEDD (5.79+1.21 cm, COV 14.3%) with significant differences in the variances between the two measures (r=-0.475, p<0.001). The LV volumes measured by CP technique were observed to have correlation with LV volumes measured by TTE (COV 14.9%). Conclusion: CP technique is a convenient bedside method that can be utilized to assess LVD and volume. It is shown to have a precise correlation with LVEDD measured by TTE. The study emphasizes role of bedside estimation of LV size by using the art of physical examination.