GENDER FEATURES OF STRUCTURAL-GEOMETRIC REMODELING OF THE LEFT VENTRICLE IN PATIENTS WITH MYOCARDIAL INFARCTION WITHOUT ELEVATION OF ST SEGMENT

Recently, there has been a tendency to increase the incidence of myocardial infarction without elevation of the ST segment, which, according to some data, accounts for about half of all registered MI. The main problem with this type of infarction is that the long-term prognosis in these patients remains unsatisfactory, and mortality one year after the catastrophe is equal to or even higher than mortality from ST-segment elevation myocardial infarction, which encourages continued predictors of unfavorable prognosis. Objective: to determine the gender characteristics of the structural and geometric remodeling of the left ventricle in patients with myocardial infarction without ST segment elevation. Materials and methods. We conducted a comprehensive study of 200 patients with acute myocardial infarction without ST-segment elevation (NSTEMI) aged 38 to 80 (mean 62.0 ± 0.71, median 62 and interquartile range 55 and 70). The structural and functional state of the myocardium and types of left ventricular remodeling according to transthoracic echocardiography were studied. Results. Analysis of the obtained data shows that echocardiographic parameters in patients with NSTEMI depending on gender did not reveal significant differences between different groups. The exception was the size of the right atrium, which was significantly higher in the group of men compared to women with comparable values of the size of the right ventricle and the ratio of the size of the left to the right atrium. Analysis of the nature of structural and geometric remodeling of the left ventricle in general by groups showed that almost half of the subjects registered concentric hypertrophy of the left ventricle. Concentric left ventricle remodeling was observed in one third of patients and in other patients - normal geometry and eccentric left ventricle hypertrophy. Thus, it was found that concentric models of left ventricle – concentric hypertrophy and concentric remodeling – were registered in the vast majority of patients with NSTEMI. The latter can be explained by a significant proportion of hypertension which was identified by us in most patients and, of course, contributed to the development of concentric models of left ventricle. Analysis of the nature of structural and geometric remodeling of the left ventricle depending on gender showed that in the group of men, compared with women, there was a significant increase in the incidence of concentric remodeling. At the same time, in women, compared with men, there was a significant increase in cases of more severe types of structural remodeling - concentric and eccentric hypertrophy. Thus, we found that gender differences in echocardiographic parameters in patients with NSTEMI relate exclusively to indicators of structural and geometric remodeling of the left ventricle. Signs of concentric and eccentric left ventricular hypertrophy predominate in women, and indicators of normal geometry and concentric left ventricular remodeling in men. This distribution of types of remodeling indicates a more severe course and unfavorable prognosis of NSTEMI in women.

Effects of sodium–glucose cotransporter-2 inhibitors on cardiac structural and electrical remodeling: from myocardial cytology to cardiodiabetology

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have changed the clinical landscape of diabetes mellitus (DM) therapy through their favourable effects on cardiovascular outcomes. Notably, the use of SGLT2i has been linked to cardiovascular benefits regardless of DM status, while their pleiotropic actions remain to be fully elucidated. What we do know is that SGLT2i exert beneficial effects even at the level of the myocardial cell, and that these are linked to an improvement in the energy substrate, resulting in less inflammation and fibrosis. SGLT2i ameliorate myocardial extracellular matrix remodeling, cardiomyocyte stiffness and concentric hypertrophy, achieving beneficial remodeling of the left ventricle with significant implications for the pathogenesis and outcome of heart failure. Most studies show a significant improvement in markers of diastolic dysfunction along with a reduction in left ventricular hypertrophy. In addition to these effects there is electrophysiological remodeling, which explains initial data suggesting that SGLT2i have an antiarrhythmic action against both atrial and ventricular arrhythmias. However, future studies need to clarify not only the exact mechanisms of this beneficial functional, structural, and electrophysiological cardiac remodeling, but also its magnitude, and to determine whether this is a class or a drug effect.

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.

Utility of Three Adiposity Indices for Identifying Left Ventricular Hypertrophy and Geometric Remodeling in Chinese Children

BackgroundPrevious studies have shown that waist-to-height ratio (WHtR) performed similarly well when compared to body mass index (BMI) and waist circumference (WC) for identifying cardiovascular risk factors. However, to our knowledge, the performance of these three adiposity indices for identifying left ventricular hypertrophy (LVH) and left ventricular geometric (LVG) remodeling in youth has not been assessed. We aimed to determine the utility of BMI, WC and WHtR for identifying LVH and LVG in Chinese children.MethodsThis study included 1,492 Chinese children aged 6-11 years. Adiposity indices assessed were BMI, WC and WHtR. LVH and high relative wall thickness (RWT) were defined using sex- and age-specific 90th percentile values of left ventricular mass index and RWT, respectively, based on the current population. LVG remodeling included concentric remodeling (CR), eccentric hypertrophy (EH) and concentric hypertrophy (CH), which was defined based on the combination of LVH and high RWT.ResultsThe magnitude of association of central obesity defined by WHtR with LVH [odds ratio (OR) =10.09, 95% confidence interval (CI) =6.66-15.29] was similar with general obesity defined by BMI (OR=10.49, 95% CI=6.97-15.80), and both were higher than central obesity defined by WC (OR=6.87, 95% CI=4.57-10.33). Compared with BMI, WHtR had better or similar predictive utility for identifying LVH, EH, and CH [the area under the curve (AUC): 0.84 vs. 0.79; 0.84 vs. 0.77; 0.87 vs. 0.88, respectively]; WC had worse or similar discriminatory utility with AUCs of 0.73, 0.70, 0.83, respectively.ConclusionWHtR performed similarly or better than BMI or WC for identifying LVH and LVG remodeling among Chinese children. WHtR provides a simple and convenient measure of central obesity that might improve the discrimination of children with cardiac structural damage.

Serum Zinc and Selenium Concentrations in Patients with Hypertrophy and Remodelling of the Left Ventricle Secondary to Arterial Hypertension

The aim of the study was to assess the relationship between serum selenium and zinc concentrations (Se-S and Zn-S) and the left ventricle geometry in patients suffering from arterial hypertension. A total of 78 people with arterial hypertension (mean age: 53.72 ± 12.74 years) participated in the study. Se-S and Zn-S were determined in all patients. The type of left ventricular remodelling and hypertrophy was determined by the left ventricular mass index (LVMI) and relative wall thickness (RWT) measured by echocardiography. Se-S and Zn-S in the whole group were 89.84 ± 18.75 µg/L and 0.86 ± 0.13 mg/L. Normal left ventricular geometry was found in 28.2% of patients; left ventricular hypertrophy (LVH) in 71.8%, including concentric remodelling in 28.2%, concentric hypertrophy in 29.5%, and eccentric hypertrophy in 14.1%. LVH was statistically significantly more frequent in patients with Se-S < median compared to patients with Se-S ≥ median (87.2% vs. 56.4%, p < 0.05), as well as in patients with Zn-S < median compared to patients with Zn-S ≥ median (83.8% vs. 60.9%, p < 0.05). In hypertensive patients, older age, higher LDL cholesterol, higher fasting glucose, lower Se-S, and lower Zn-S were independently associated with LVH. In conclusion, in hypertensive patients, left ventricular hypertrophy may be associated with low levels of selenium and zinc in the serum.

Pathophysiological characteristics of the development of arterial hypertension in Yorkshire Terriers with alimentary obesity

Relevance. The study of the pathogenesis of obesity in domestic animals is an urgent problem in veterinary medicine, which is associated with the high prevalence of this pathological condition and a significant risk of complications from the cardiovascular system. The aim of the study was to present the pathophysiological characteristics of the development of arterial hypertension syndrome in obesity in Yorkshire Terrier dogs.Methods. In a comparative aspect, clinical, tonometric, electrocardiographic, echocardiographic and biochemical parameters were studied in obese patients (n = 13) and clinically healthy dogs (n = 7).Results. Our study shows the negative role of obesity in the development of arterial hypertension syndrome in Yorkshire Terrier dogs. It was also found that obesity in dogs is accompanied by impaired lipid metabolism, oxidative stress, the development of arterial hypertension and a tendency to the development of concentric hypertrophy of the left ventricular myocardium and hepatopathy.

Gestational diabetes triggers postpartum cardiac hypertrophy via activation of calcineurin/NFAT signaling

Population-based studies identified an association between a prior pregnancy complicated by gestational diabetes mellitus (GDM) and cardiac hypertrophy and dysfunction later in life. It is however unclear whether GDM initiates this phenotype and what are the underlying mechanisms. We addressed these questions by using female rats that express human amylin (HIP rats) as a GDM model and their wild-type (WT) littermates as the normal pregnancy model. Pregnant and two months postpartum HIP females had increased left-ventricular mass and wall thickness compared to non-pregnant HIP females, which indicates the presence of concentric hypertrophy. These parameters were unchanged in WT females during both pregnancy and postpartum periods. Hypertrophic Ca2+-dependent calcineurin/NFAT signaling was stimulated two months after giving birth in HIP females but not in the WT. In contrast, the CaMKII/HDAC hypertrophy pathway was active immediately after giving birth and returned to the baseline by two months postpartum in both WT and HIP females. Myocytes from two months postpartum HIP females exhibited slower Ca2+ transient relaxation and higher diastolic Ca2+ levels, which may explain calcineurin activation. No such effects occurred in the WT. These results suggest that a GDM-complicated pregnancy accelerates the development of pathological cardiac remodeling likely through activation of calcineurin/NFAT signaling.

Identification and Characterization of Circulating MicroRNAs as Novel Biomarkers in Dogs With Heart Diseases

Background: Previous studies in humans have confirmed dysregulations of circulating microRNAs (miRNAs) in patients with various cardiovascular diseases. However, studies on circulating miRNAs in dogs with various heart diseases are limited in number. This study aimed to identify significantly dysregulated circulating miRNAs and characterize them as novel biomarkers in dogs with heart diseases.Materials and Methods: Circulating levels of 11 miRNAs were investigated in serum samples of 82 dogs (72 with heart diseases and 10 healthy dogs) using quantitative reverse transcription-polymerase chain reaction. The results were correlated to clinical data including echocardiographic results and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels.Results: Upregulation of cfa-miR-130b was observed in dogs with myxomatous mitral valve degeneration (MMVD) stage B, patent ductus arteriosus, and pulmonic stenosis. In dogs with MMVD stage B, cfa-miR-130b was upregulated and correlated with clinical indices. In receiver operating characteristic (ROC) analysis, cfa-miR-130b accurately distinguished dogs with diseases from healthy dogs. We also observed that cfa-miR-375 and cfa-let-7b were upregulated in dogs with concentric cardiac hypertrophy. The cfa-miR-375 was correlated with concentric hypertrophy indices and was an accurate indicator of concentric hypertrophy in ROC analysis.Conclusions: The miRNAs identified in this study may be used as novel biomarkers and possible candidates for therapeutic targets in various canine heart diseases.

Sex differences in left ventricular remodeling in patients with severe aortic valve stenosis

Background Women with severe aortic valve stenosis (AS) have better long-term outcomes after transcatheter aortic valve implantation (TAVI) but worse survival after surgical aortic valve replacement compared to men. Whether this is related to sex differences in left ventricular (LV) remodeling is unknown. Purpose To examine sex differences in LV remodeling and outcomes in patients with severe AS undergoing TAVI. Methods Patients with severe AS who underwent TAVI between 2007 and 2018 with a pre-procedural multidetector row computed tomography (MDCT) scan were included. LV volumes, mass and function were analyzed with MDCT. Patients were classified into 4 LV remodeling patterns based on LV mass index and LV mass-to-volume ratio: 1) normal geometry, 2) concentric remodeling, 3) concentric hypertrophy and 4) eccentric hypertrophy. The primary endpoint was all-cause mortality after TAVI. Results A total of 289 patients (age 80±6 years, 54% male) were included. Women showed smaller LV volumes and mass compared to men. Concentric hypertrophy (50%) was the most frequent pattern of LV remodeling followed by eccentric hypertrophy (33%), normal geometry (13%) and concentric remodeling (4%). Concentric remodeling was more frequently observed in men compared to women (91% vs. 9% respectively, p=0.011). However, no sex differences were observed in the remaining LV remodeling patterns (Figure 1). During a median follow-up of 3.8 (IQR 2.2–5.1) years after TAVI, 87 patients died. Women demonstrated better outcome after TAVI compared to men (log-rank χ2=4.29, p=0.038). The survival benefit of women over men was mainly present among patients with concentric hypertrophy (log-rank χ2=4.91, p=0.027, Figure 2). Conclusion LV concentric and eccentric hypertrophy are similarly observed in men and women with severe AS. Women demonstrated better outcome after TAVI as compared to men, particularly among those with LV concentric hypertrophy. However, the outcome benefit of females after TAVI seems not to be related to sex-differences in LV remodeling. FUNDunding Acknowledgement Type of funding sources: None. Distribution of sex in LV remodeling All-cause mortality after TAVI