Relationship of left ventricular mass to coronary atherosclerosis and myocardial ischaemia: the CORE320 multicenter study

Vascular calcification in Takayasu arteritis: relationship with metabolic syndrome, left ventricular mass index, and intima-media thickness

OBJECTIVE

The present study aims to determine the frequency of vascular calcification in Takayasu arteritis (TA) and the risk factors for it and to evaluate its relation with atherosclerotic predictors such as metabolic syndrome (MS), left ventricular mass index (LVMI) and carotid intima-media thickness (CIMT).

METHODS

A cross-sectional study was conducted in patients with TA; MS was defined according to the US National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III) criteria. The study included 49 TA patients (22 with MS, 27 without MS) and 31 healthy controls (HCs). Non-contrast computed tomography measured calcification in coronary arteries, aorta, and branches.

RESULTS

Forty-seven patients (95.9%) were female and mean age was 33.45 ± 8.53 years. Total calcification score (mean ± SD; 5223.9 ± 18041.1 AU vs. 35.87 ± 72.70 AU (p = 0.05)), CIMT, and LVMI were found to be significantly higher in TA patients than HCs (p < 0.05). While there was no significant difference between the total calcification score of MS (+) TA patients and MS (-) TA patients, in both patient groups, the total calcification score was found to be significantly higher than HCs. MS (+) and MS (-) groups were found to have significantly higher CIMT and LVMI values than the control group, in addition, MS (+) patients were found to have significantly higher LVMI and CIMT values than MS (-) group (p < 0.05).

CONCLUSION

Vascular calcification, CIMT, and LVMI are elevated in all TA patients, with greater impact in the presence of MS.

Association of dietary fats with ischemic heart disease (IHD): a case-control study

BACKGROUND

This study aimed to investigate the association between different types of dietary fats with ischemic heart disease (IHD).

METHODS

This case-control study was conducted on 443 cases and 453 controls aged 40-80 years in Tehran, Iran. The semi-quantitative 237-item food frequency questionnaire (FFQ) was used to assess the amount of food intake. Nutritionist IV was applied to test the amount of consumption of dietary fats.

RESULTS

The case group had a lower intake of docosahexaenoic acid (DHA) (11.36 ± 12.58 vs. 14.19 ± 19.57, P = 0.01) than the control group. A negative association was found between IHD and DHA (OR 0.98, CI 95% 0.97-0.99, P = 0.01). No significant association was observed between IHD with the intake of cholesterol, trans fatty acids (TFA), saturated fatty acids (SFA), monounsaturated fatty acids (MUFA), polyunsaturated fatty acids (PUFA), eicosatetraenoic acid (EPA), and α-Linolenic acid (ALA).

CONCLUSION

It was found that DHA may reduce the risk of IHD, whereas there was no significant association between other types of dietary fats with the odds of IHD. If the results of this study are confirmed in future research, a higher intake of DHA in diet can be recommended as a strategy to prevent IHD events.

Association Between the Presence of Coronary Artery Disease or Peripheral Artery Disease and Left Ventricular Mass in Patients Who Have Undergone Coronary Computed Tomography Angiography

Background

Left ventricular mass (LVM) is a critical marker of future cardiovascular risk. We determined the association between LVM measured by coronary computed tomography angiography (CCTA) and the presence of coronary artery disease (CAD) or peripheral artery disease (PAD) in patients who had undergone CCTA for screening of CAD.

Methods

We enrolled 1,307 consecutive patients (66 ± 12 years old, 49% males) who underwent CCTA for screening of CAD at the Fukuoka University Hospital (FU-CCTA registry), and either were clinically suspected of having CAD or had at least one cardiovascular risk factor. Patients with coronary stenosis of ≥ 50% by CCTA were diagnosed as CAD. Patients with an ankle brachial pressure index < 0.9 or who had already been diagnosed with PAD were considered to have PAD. Left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF), end-diastolic volume (EDV) and end-systolic volume (ESV) were measured. The patients were divided into CAD (-) and CAD (+) or PAD (-) and PAD (+) groups.

Results

The prevalences of CAD and PAD in all patients were 50% and 4.8%, respectively. Age, %males, %hypertension (HTN), %dyslipidemia (DL), %diabetes mellitus (DM), %smoking and %chronic kidney disease in the CAD (+) group were significantly higher than those in the CAD (-) group. Age, %males, %HTN, %DM and %smoking in the PAD (+) group were significantly higher than those in the PAD (-) group. CAD was independently associated with LVMI (odds ratio (OR): 1.01, 95% confidence interval (CI): 1.01 - 1.02, P < 0.01) in addition to age, male, HTN, DL, DM, and smoking. PAD was also independently associated with LVMI (OR: 1.01, 95% CI: 1.0 - 1.02, P = 0.018) in addition to age, DM, and smoking.

Conclusions

LVMI determined by CCTA may be useful for predicting atherosclerotic cardiovascular diseases including both CAD and PAD, although there were considerable differences between %CAD and %PAD in all patients.

Electrocardiographic and echocardiographic predictors of greater carotid intima-media thickness in tactical athletes: The CHIEF atherosclerosis study

OBJECTIVE

Both electrocardiographic and echocardiographic left ventricular hypertrophy (LVH) have been reported with an association with greater carotid intima-media thickness (cIMT), a marker of subclinical atherosclerosis in patients with hypertension, while the associations are unclear in physically fit young adults.

METHODS

A total of 1822 Taiwanese military personnel, aged 18-40 years, received an annual health examination including electrocardiography (ECG) and echocardiography in 2018-2020. Left carotid bulb cIMT was measured by high-resolution ultrasonography. Multiple logistic regression analysis with adjustments for age, sex, smoking, alcohol consumption, body mass index, mean blood pressure, and physical fitness was used to determine the associations between echocardiographic and ECG parameters and the highest quintile of cIMT (≥0.8 mm).

RESULTS

Cornell-based LVH, Myers et al.-based RVH and heart rate ≥75/min were associated with cIMT ≥0.8 mm [odds ratios (ORs) and 95% confidence intervals: 1.54 (1.01, 2.35), 1.66 (1.18, 2.33), and 1.39 (1.06, 1.83), respectively], while echocardiographic LVH defined as ≥46.0 g/m^2.7 for men and ≥38.0 g/m^2.7 for women was inversely associated with cIMT ≥0.8 mm [OR: 0.45 (0.24, 0.86)].

CONCLUSION

In tactical athletes of military, the associations of ECG and echocardiographic LVH with cIMT were in opposite directions. Higher physical fitness may cause cardiac muscle hypertrophy and reduce the atherosclerosis severity, possibly leading to the paradoxical echocardiographic finding. This study suggests that ECG-based LVH remains a good marker of subclinical atherosclerosis in our military population.

Cyclothymic affective temperament is independently associated with left ventricular hypertrophy in chronic hypertensive patients

OBJECTIVE

Affective temperaments (depressive, anxious, irritable, hyperthymic, and cyclothymic) are regarded as the stable core of personality and when present in their dominant form, are considered subclinical manifestations and high-risk states for various affective disorders. Furthermore, cumulating evidence supports their relationship with cardiovascular diseases. Our aim was to assess the association between affective temperaments and left ventricular hypertrophy (LVH) in chronic hypertensive patients.

METHODS

In the present cross-sectional study, 296 patients referred to coronary computed tomography angiography (CCTA) due to suspected coronary artery disease were analyzed. All patients completed the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A). Left ventricular mass was quantified by CCTA and indexed to the body surface area (LVMi). Logistic regression analysis was used to identify predictors of LVH (men: ≥67.2 g/m² and women: ≥54.7 g/m²).

RESULTS

Among our patient cohort (mean age: 59.4 ± 10.6, 44.9% female), the median LVM and LVMi were 115.5 [88.4-140.7] g and 58.4 [47.4-64.2] g/m², respectively. Elevated BMI (OR = 1.04 CI: 1.01-1.10, p = 0.04) and cyclothymic affective temperament scores (OR = 1.06 CI: 1.00-1.12, p = 0.04) significantly increased the odds of LVH in multivariate logistic regression analysis.

CONCLUSION

Assessment of affective temperaments may allow for the identification of chronic hypertensive patients with elevated risk for LVH as a potential target for earlier primary intervention.

Multiphoton microscopy providing pathological-level quantification of myocardial fibrosis in transplanted human heart

Multiphoton microscopy (MPM), a high-resolution laser scanning technique, has been shown to provide detailed real-time information on fibrosis assessment in animal models. But the value of MPM in human histology, especially in heart tissue, has not been fully explored. We aimed to evaluate the association between myocardial fibrosis measured by MPM and that measured by histological staining in the transplanted human heart. One hundred and twenty samples of heart tissue were obtained from 20 patients consisting of 10 dilated cardiomyopathies (DCM) and 10 ischemic cardiomyopathies (ICM). MPM and picrosirius red staining were performed to quantify collagen volume fraction (CVF) in explanted hearts postoperatively. Cardiomyocyte and myocardial fibrosis could be clearly visualized by MPM. Although patients with ICM had significantly greater MPM-derived CVF than patients with DCM (25.33  ± 12.65 % vs. 19.82  ± 8.62 %, p = 0.006), there was a substantial overlap of CVF values between them. MPM-derived CVF was comparable to that derived from picrosirius red staining based on all samples (22.58 ± 11.13% vs. 21.19 ± 11.79%, p = 0.348), as well as in DCM samples and ICM samples. MPM-derived CVF was correlated strongly with the magnitude of staining-derived CVF in both all samples and DCM samples and ICM samples (r = 0.972, r = 0.963, r = 0.973, respectively; all p < 0.001). Intra- and inter-observer reproducibility for MPM-derived CVF and staining-derived CVF were 0.995, 0.989, 0.995, and 0.985, respectively. Our data demonstrated that MPM can provide a pathological-level assessment of myocardial microstructure in transplanted human heart.

Relationship between vascular ageing and left ventricular geometry in patients with newly diagnosed primary aldosteronism

BACKGROUND

Changes in left ventricular (LV) geometry are early manifestations of cardiac damage. The relationship between vascular aging and LV geometry has been reported. However, in newly diagnosed primary aldosteronism (PA), with more severe target organ damage than essential hypertension, the relationship between vascular aging and LV geometry has never been described.

METHODS

We conducted a retrospective study among newly diagnosed PA from 1 January 2017 to 30 September 2021 at the Third Xiangya Hospital. The data of vascular aging parameters were collected, including ankle-brachial index (ABI), brachial-ankle pulse wave velocity (baPWV), and carotid intima-media thickness (cIMT). Echocardiography data were collected to assess LV geometry patterns.

RESULTS

A total of 146 patients with newly diagnosed PA were included. The mean age was 44.77 ± 9.79 years, and 46.58% participants were women. Linear regression analysis adjusting all potential confounders showed that cIMT was significantly associated with LV mass index (LVMI) (β=0.164, P=0.028) and baPWV was significantly associated with relative wall thickness (RWT) (β= 0.00005, P=0.025). Multifactorial adjusted logistic regression analysis demonstrated that cIMT was significantly associated with LV hypertrophy (LVH) (OR=7.421, 95%CI: 1.717-815.688, P=0.021) and baPWV was significantly associated with LV concentric geometry (LVCG) (OR=1.003, 95%CI: 1.001-1.006, P=0.017).

CONCLUSION

baPWV was significantly associated with LVCG and cIMT was significantly associated with LVH in newly diagnosed PA. This study provides insights on the importance of baPWV measurement and cIMT measurement in early assessment of cardiac damage in newly diagnosed PA.

Association between Coronary Artery Disease and Left Ventricle Remodeling Parameters in Hypertensive Patients: A Cross-Sectional Study in a Limited Resource Setting

BACKGROUND: Coronary artery disease (CAD) and hypertension are related with left ventricle (LV) remodeling, however evidence about association between CAD and remodeling in hypertensive patient is still limited, especially in limited resource setting like Indonesia. AIM: Evaluating impact of CAD on LV remodeling within hypertensive patients at tertiary referral hospital, Hasan Sadikin General Hospital Bandung, Indonesia. METHOD: Cross-sectional study involving 120 hypertensive patients who visited cardiology outpatient clinic from September-December 2019 and underwent transthoracic echocardiography examination for any medical indications. LV remodeling parameters, such as mass (LV Mass Index [LVMi]), volume (end-diastolic volume/body surface area [BSA]), and relative wall thickness (RWT), were compared between CAD and non-CAD groups. RESULTS: There were 108 patients to be analyzed, 12 patients were excluded due to technical difficulty (n = 9) and non-cooperative during interview (n = 3). Mean (standard deviation) age of patients was 56.9 (±11.8) years, 50 (46.3%) patients were male, and median (interquartile range) hypertension duration was 3 (±4.40) years. CAD was found in 40 (37.0%) patients. In the adjusted analysis, patients with CAD had average 27.75 g/m2 higher LVMi (95% confined interval [CI] 2.03; 53.47; p = 0.035) and 16.20 ml/m2 higher LV end-diastolic volume/BSA (95% CI 4.14; 28.25; p = 0.009) compared to those without. This was independent of age, duration of hypertension, consumption of antihypertensive therapy, and type-2 diabetes mellitus, but disappeared after heart failure (HF) was included in the study. CAD and non-CAD groups were not different, respectively, to RWT. CONCLUSION: In hypertensive patients, CAD was independently associated with higher LV mass and volume. These associations, however, were largely explained by the presence of HF. CAD did not associate with RWT.

Relationship Between Vascular Aging and Left Ventricular Concentric Geometry in Community-Dwelling Elderly: The Northern Shanghai Study

Purpose

There have been few recent studies regarding vascular aging and its relationship with left ventricular (LV) geometry. Moreover, the association of abnormal LV geometry with various kinds of vascular aging has not yet been systematically analyzed. Thus, this study aimed to further elucidate this relationship.

Materials and Methods

In this study, 3363 older participants (43.6% male, aged 71.1±5.9 years; 56.4% female, aged 71.1±6.1 years) derived from the Northern Shanghai Study were enrolled. Vascular aging criteria included arteriosclerosis, defined as carotid-femoral pulse wave velocity >10 m/s or brachial-ankle pulse wave velocity >1800 cm/s, and peripheral atherosclerosis, defined as ankle-brachial index <0.9, carotid artery intima-media thickness (cIMT) greater than 0.9 mm, or carotid plaque indicating carotid artery abnormality. Micro-albuminuria was defined as urinary albumin-to-creatinine ratio >30 mg/g. Decreased estimated glomerular filtration rate (eGFR) was defined as eGFR <60 mL/min/1.73 m².

Results

When vascular aging parameters were respectively adjusted for age and sex, arteriosclerosis, micro-albuminuria, and peripheral atherosclerosis were significantly associated with concentric remodeling, eccentric LV hypertrophy (LVH), and concentric LVH (P<0.045) but not with decreased eGFR or abnormal cIMT and presence of plaque. Peripheral atherosclerosis was strongly associated with LV concentric geometry (LVCG) when considering other covariates (risk factors, diseases, and treatments) (P<0.012).

Conclusion

Vascular aging parameters such as arteriosclerosis, micro-albuminuria, and peripheral atherosclerosis are significantly and independently associated with LVCG in community-dwelling older Chinese population, suggesting the importance of vascular aging during early clinical assessment of abnormal LV geometry change and serious cardiovascular events.

Relationship between vascular damage and left ventricular concentric geometry in patients undergoing coronary angiography: a multicenter prospective study

BACKGROUND

Vascular structural (intima-media thickness) and functional (carotid pulse wave velocity, cPWV) alterations are related to different patterns of left ventricular (LV) geometry in general population samples and in hypertensive patients. The relationship between vascular damage, evaluated by both echotracking ultrasound and coronary angiography, and LV geometry has not been prospectively analyzed.

METHODS

In eight Italian centers, 399 consecutive patients, without history of prior coronary artery disease and with clinical indication to coronary angiography, prospectively underwent cardiac standard ultrasound examination for the evaluation of LV mass, indexed by height to 2.7 power (LVMi g/m) and relative wall thickness (RWT), the measurement of Doppler flow in the left anterior descending artery (LAD) and the echocardiographic calcium score (eCS). In all patients measurement of common carotid intima-media thickness (cIMT) and cPWV by carotid ultrasound, with the realtime echotracking system was performed. The noninvasive evaluations were performed blindly to clinical information, before coronary angiography.

RESULTS

cIMT and cPWV were higher in patients with concentric LV hypertrophy (LVH) (LVMi ≥ 49 g/m in men and ≥47 g/m in women and RWT ≥ 0.42) as compared with those with normal LVMi and geometry (N: LVMi < 49 g/m in men and <47 g/m in women and RWT < 0.42) and to those with concentric remodeling (normal LVMi and RWT ≥ 0.42). Distal LAD velocity and eCS were greater in patients with concentric LVH than in others groups. At coronary angiography the prevalence of coronary stenosis (>50%) was greater in patients with concentric LVH and concentric remodeling, as compared with N. Patients with both concentric LVH and concentric remodeling showed higher values of cIMT and cPWV and distal LAD velocity and a greater prevalence of coronary stenosis (>50%) than patients with RWT less than 0.42.

CONCLUSION

Our results further reinforced the observation that in patients undergoing elective coronary angiography, concentric geometry is associated with structural and functional carotid alterations, with higher distal LAD flow velocity and eCS. In this large group of patients, concentric geometry is associated with a greater prevalence of coronary stenosis, as assessed by coronary angiography. These results might contribute to explain the greater cardiovascular risk associated with concentric remodeling and LVH.

Dietary Docosahexaenoic Acid Reduces Oscillatory Wall Shear Stress, Atherosclerosis, and Hypertension, Most Likely Mediated via an IL-1-Mediated Mechanism

BACKGROUND

Hypertension is a complex condition and a common cardiovascular risk factor. Dietary docosahexaenoic acid (DHA) modulates atherosclerosis and hypertension, possibly via an inflammatory mechanism. IL-1 (interleukin 1) has an established role in atherosclerosis and inflammation, although whether IL-1 inhibition modulates blood pressure is unclear.

METHODS AND RESULTS

Male apoE-/- (apolipoprotein E-null) mice were fed either a high fat diet or a high fat diet plus DHA (300 mg/kg per day) for 12 weeks. Blood pressure and cardiac function were assessed, and effects of DHA on wall shear stress and atherosclerosis were determined. DHA supplementation improved left ventricular function, reduced wall shear stress and oscillatory shear at ostia in the descending aorta, and significantly lowered blood pressure compared with controls (119.5±7 versus 159.7±3 mm Hg, P<0.001, n=4 per group). Analysis of atheroma following DHA feeding in mice demonstrated a 4-fold reduction in lesion burden in distal aortas and in brachiocephalic arteries (P<0.001, n=12 per group). In addition, DHA treatment selectively decreased plaque endothelial IL-1β (P<0.01).

CONCLUSIONS

Our findings revealed that raised blood pressure can be reduced by inhibiting IL-1 indirectly by administration of DHA in the diet through a mechanism that involves a reduction in wall shear stress and local expression of the proinflammatory cytokine IL-1β.

Myocardial perfusion at rest in uncomplicated type 2 diabetes patients without coronary artery disease evaluated by 320-multidetector computed tomography: A pilot study

Using computed tomography myocardial perfusion imaging (CTP) to investigate resting myocardial perfusion alterations in uncomplicated type 2 diabetes mellitus (T2DM) patients without obstructive coronary artery disease (CAD).A total of 34 participants with 544 myocardial segments were included prospectively: 17 uncomplicated T2DM patients with no significant coronary artery stenosis on coronary computed tomography angiography and 17 healthy controls. Myocardial perfusion was evaluated by transmural perfusion ratio (TPR). Parameters of cardiac structure and function were measured for cardiac comprehensive assessment. Analyses included descriptive statistics and group comparisons.TPR of segments 5, 7, 9, 10 to 14 were significantly reduced in T2DM group compared with controls (P < .05). When 16 myocardial segments were localized into different areas according to the wall orientations, axial levels of left ventricle and coronary artery territories, respectively, TPR of each area in T2DM group were significantly lower than those in the control group (P < .05). No significant differences were found in cardiac anatomy and function analyses between 2 groups.In uncomplicated T2DM patients without obstructive CAD, myocardial perfusion impairments were present and may develop prior to cardiac morphological and functional abnormalities, which can be early detected by CTP.