Left ventricular geometry and diastolic function in the hypertensive heart: impact of age

Obesity-hyperlipidemia, Hypertension, and Left Atrial Enlargement During Stroke in Young Adults

BACKGROUND

This study investigated the association between left atrial enlargement and stroke severity in young adults. We also studied the differences between the normal and left atrial enlargement groups in clinical data.

METHODS

A total of 135 young stroke patients admitted to the Department of Neurology of the Taizhou People's Hospital were recruited from January 2018 to December 2021. The patients were divided into normal and enlarged groups by left atrial size. The relationship between the left atrial diameter and the National Institutes of Health Stroke Scale score was analyzed apart from the differences in clinical variables.

RESULTS

No relationship was observed between the left atrial diameter and the National Institutes of Health Stroke Scale score ( r =-0.045 P =0.603). The univariate analysis of both groups revealed that hypertension ( P =0.004), hyperlipidemia ( P =0.001), body mass index ( P =0.000), obesity ( P =0.015), and not stroke etiologic subtypes were associated with left atrial enlargement. In binary logistic regression analysis models, hyperlipidemia 3.384 (95% CI, 1.536 to 7.452), hypertension 2.661 (95% CI, 1.066 to 6.639), and obesity 2.858 (95% CI, 1.158 to 7.052) were significantly associated with the young stroke of left atrial enlargement.

CONCLUSIONS

In young adults, obesity-hyperlipidemia and hypertension were significantly associated with left atrial enlargement in stroke.

Elevated Plasma Homocysteine Level Associated with Further Left Ventricular Structure and Function Damages in Type 2 Diabetic Patients: A Three-Dimensional Speckle Tracking Echocardiography Study

Aims: The aims of this study were to explore the left ventricular (LV) structural remodeling and its risk factors in type 2 diabetes mellitus (T2DM) patients with or without hyperhomocysteinemia (hHcy) and to detect the accompanied LV dysfunction using three-dimensional speckle tracking echocardiography (3DSTE). Methods: There were totally 80 T2DM patients with undamaged LV ejection fraction (≥55%) in this study, 40 of whom were also diagnosed with hHcy as co-morbidity. Forty age- and gender-matched controls were also recruited. The risk factors and corresponding diagnostic values for LV remodeling (LVR) were, respectively, determined using logistic regression and area under the receiver operating characteristic curves (AUC). The 3DSTE was used to measure global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS). Results: The constituent ratio of LV geometry showed significant differences among the study populations (P = 0.01). Compared with the controls, three types of LVR accounted for larger proportion in the two T2DM groups, whereas LV hypertrophy was most prevalent in those with T2DM and hHcy. Glycosylated hemoglobin (HbA1c), total plasma homocysteine (tHcy), and HbA1c plus tHcy were all significant risk factors associated with LVR in T2DM patients (AUC values: 0.741, 0.746 and 0.851, respectively). The patients with T2DM alone had significantly lower GLS and GAS than the controls (both P < 0.05). The patients with T2DM and hHcy had significantly lower GLS, GCS, GAS, and GRS than the controls (all P < 0.001), and also had significantly lower GLS, GCS, and GRS than the patients with T2DM alone (all P < 0.05). Conclusions: The 3DSTE plus conventional echocardiography could be used as an effective supplement for detecting early and occult cardiac damages in T2DM patients with plasma homocysteine at normal or elevated levels.

Deep echocardiography: data-efficient supervised and semi-supervised deep learning towards automated diagnosis of cardiac disease

Deep learning and computer vision algorithms can deliver highly accurate and automated interpretation of medical imaging to augment and assist clinicians. However, medical imaging presents uniquely pertinent obstacles such as a lack of accessible data or a high-cost of annotation. To address this, we developed data-efficient deep learning classifiers for prediction tasks in cardiology. Using pipeline supervised models to focus relevant structures, we achieve an accuracy of 94.4% for 15-view still-image echocardiographic view classification and 91.2% accuracy for binary left ventricular hypertrophy classification. We then develop semi-supervised generative adversarial network models that can learn from both labeled and unlabeled data in a generalizable fashion. We achieve greater than 80% accuracy in view classification with only 4% of labeled data used in solely supervised techniques and achieve 92.3% accuracy for left ventricular hypertrophy classification. In exploring trade-offs between model type, resolution, data resources, and performance, we present a comprehensive analysis and improvements of efficient deep learning solutions for medical imaging assessment especially in cardiology.

Prevalence and distribution of left ventricular diastolic dysfunction in treated patients with long-lasting hypertension

BACKGROUND

Although the presence of sub-clinical left ventricular diastolic dysfunction (LVDD) increases cardiovascular risk, the current ESH/ESC guidelines do not include the presence of this condition in the list of target organ damage or cardiovascular risk charts dedicated to the hypertensive population. Several conditions may predict the LVDD occurrence, however, clustering of these factors with hypertension makes the relationship less clear. Therefore, the aim of this study was to evaluate both the occurrence and the severity of diastolic dysfunction in a large cohort of treated hypertensives.

METHODS

We retrospectively analyzed records of 610 hypertensive participants of the CARE NORTH Study who consented to echocardiography and were free of overt cardiovascular disease. Mean age was 54.0 ± 13.9 years (mean ± SD), BMI 29.7 ± 4.8 kg/m². The exclusion criteria were: established heart failure, LVEF <45%, coronary revascularization, valvular defect, atrial fibrillation, or stroke. The staging of LVDD was based on comprehensive transthoracic echocardiographic measurements.

RESULTS

49.7% percent of the patients had normal diastolic function (38.8% vs. 59.0%, females (F) vs. males (M), respectively; p < .001). Grade 1 LVDD was documented in 24.4% (27.8% and 21.6%; F and M; p = .08) and grade 2 LVDD in 19.3% (24.9% and 14.6%; F and M; p = .001) of the patients. None were diagnosed with grade 3 LVDD. In the logistic regression model, female sex, advancing age, obesity status, established diabetes mellitus, higher 24-hour SBP, and increasing LVMI were identified as the independent variables increasing the odds for the presence of LVDD, whereas blood-lowering therapy attenuated the risk.

CONCLUSIONS

There is an unexpectedly high prevalence of different forms of diastolic dysfunction in treated hypertensive patients who are free of overt cardiovascular disease.

Activated protein C protects against pressure overload-induced hypertrophy through AMPK signaling

We found that the anticoagulant plasma protease, activated protein C (APC), stimulates the energy sensor kinase, AMPK, in the stressed heart by activating protease-activated receptor 1 (PAR1) on cardiomyocytes. Wild-type (WT) and AMPK-kinase dead (KD) transgenic mice were subjected to transverse aortic constriction (TAC) surgery. The results demonstrated that while no phenotypic differences can be observed between WT and AMPK-KD mice under normal physiological conditions, AMPK-KD mice exhibit significantly larger hearts after 4 weeks of TAC surgery. Analysis by echocardiography suggested that the impairment in the cardiac function of AMPK-KD hearts is significantly greater than that of WT hearts. Immunohistochemical staining revealed increased macrophage infiltration and ROS generation in AMPK-KD hearts after 4 weeks of TAC surgery. Immunoblotting results demonstrated that the redox markers, pShc⁶⁶, 4-hydroxynonenal and ERK, were all up-regulated at a higher extent in AMPK-KD hearts after 4 weeks of TAC surgery. Administration of APC-WT and the signaling selective APC-2Cys mutant, but not the anticoagulant selective APC-E170A mutant, significantly attenuated pressure overload-induced hypertrophy and fibrosis. Macrophage infiltration and pShc⁶⁶ activation caused by pressure overload were also inhibited by APC and APC-2Cys but not by APC-E170A. Therefore, the cardiac AMPK protects against pressure overload-induced hypertrophy and the signaling selective APC-2Cys may have therapeutic potential for treating hypertension-related hypertrophy without increasing the risk of bleeding.

Relationship between extent and complexity of coronary artery disease and different left ventricular geometric patterns in patients with coronary artery disease and hypertension

OBJECTIVE

The relationship between severity of coronary artery disease (CAD) and left ventricler (LV) hypertrophy in hypertensive patients is well known. However, the association between the extent and complexity of CAD assessed with SYNTAX score (SS) and different LV geometric patterns has not been investigated. We aimed to investigate the association between SYNTAX score and different LV geometric patterns in hypertensive patients.

METHODS

The study had been made in our clinic between January 2013 and August 2013. We studied 251 CAD patients who had hypertension and who underwent coronary angiography (147 males, 104 females; mean age 61.61±9.9 years). Coronary angiography was performed based on clinical indications. SS was determined in all patients. Echocardiographic examination was performed in all subjects. Four different geometric patterns were determined in patients according to LV mass index (LVMI) and relative wall thickness (RWT) (Groups: NG- normal geometry, CR- concentric remodeling, EH- eccentric hypertrophy, and CH- concentric hypertrophy). Biochemical markers were measured in all participants.

RESULTS

The highest SS values were observed in the CH group compared with the NG, CR, and EH groups (p<0.05 for all). Also, the SS values of the EH group were higher than in the NG and CR groups (p<0.05 for all). Multivariate linear regression analysis showed that SS was independently associated with LV geometry (β=0.316, p=0.001), as well as age (β=0.163, p=0.007) and diabetes (β=-0.134, p=0.022).

CONCLUSION

SYNTAX score is independently related with LV geometry in hypertensive patients. This result shows that LV remodeling is parallel to the increase in the extent and complexity of CAD in our study patients.

Relationship between Plasma Aldosterone Levels and Left Ventricular Mass in Hypertensive Africans

Background. Hypertension is the most common cardiovascular disease worldwide and is a major cause of morbidity and mortality. Studies have suggested that the activity of the renin-angiotensin-aldosterone system play a major role in the target organ damage such as left ventricular hypertrophy occuring in hypertension. We sought to determine the relationship between plasma aldosterone and left ventricular mass in untreated African hypertensives. Methods. We recruited 82 newly diagnosed and untreated hypertensives and 51 normal controls. Measurements obtained included echocardiographic LV mass index, plasma aldosterone and renin. Results. The hypertensive subjects had lower renin levels (21.03[6.974] versus 26.66[7.592] ng.mL⁻¹, P = 0.0013), higher LV mass index (52.56[14.483] versus 42.02[8.315] g.m^−2.7P < 0.0001) when compared with the controls. There were no univariate associations between LV mass index and plasma aldosterone (r = 0.0179, P = 0.57) and between LV mass index and plasma renin (r = 0.0887, P = 0.61). In a multivariate model involving LV mass index and age, sex, body mass index (BMI), plasma aldosterone, plasma renin and systolic blood pressure (SBP), only age (P = 0.008), BMI (P = 0.046), and SBP (P = 0.001) were independently associated with the LV mass index. Conclusions. In this group of hypertensive Africans, there is no independent association of plasma aldosterone with LV mass. The height of the blood pressure, the body mass index and the age of the subjects determined the LV mass.

High-sensitivity cardiac troponin T levels in newly diagnosed hypertensive patients with different left ventricle geometry

BACKGROUND

The high-sensitivity cardiac troponin T (hs-cTnT) assay provides important prognostic information on cardiovascular diseases. Although hs-cTnT is associated with left ventricle (LV) hypertrophy (LVH), it has not been investigated in different LV geometric patterns incorporating normal LV structure and concentric remodeling in addition to LVH.

OBJECTIVES

We aimed to investigate the possible association between hs-cTnT and LV geometric patterns in newly diagnosed hypertensive patients.

METHODS

We studied 306 patients with newly diagnosed hypertension (HT; mean age 51.7 ± 5.6 years) and 44 healthy control subjects (mean age 51.3 ± 4.7 years). Echocardiographic examination was performed in all subjects. Four different geometric patterns were determined in hypertensive patients according to LV mass index (LVMI) and relative wall thickness (RWth). hs-cTnT and other biochemical markers were measured in all participants.

RESULTS

The highest hs-cTnT values were observed in the concentric hypertrophy group compared with the control, normal geometry, concentric remodeling and eccentric hypertrophy groups (p < 0.05, for all). Also, hs-cTnT values of the eccentric hypertrophy group were higher than the control, normal geometry and concentric remodeling groups (p < 0.05, for all). Multivariate regression analysis showed that hs-cTnT was independently associated with LV geometry (β = 0.326, p = 0.001) as well as LVMI (β = 0.228, p = 0.010) and creatinine level β = 0.132, p = 0.012).

CONCLUSION

hs-cTnT level is related not only to LVH but also to LV geometry in hypertensive patients. hs-cTnT levels may mediate poorer LV geometric patterns in hypertensive patients.

Myocardial performance index and aortic distensibility in patients with different left ventricle geometry in newly diagnosed essential hypertension

BACKGROUND

Abnormal left ventricular (LV) geometric patterns, particularly concentric LV hypertrophy, are associated with a greater risk of hypertensive complications. The aim of this study was to investigate the association between LV myocardial performance index (LVMPI) and aortic distensibility (AD) with different LV geometric patterns in patients with newly diagnosed hypertension (HT).

METHODS

We studied 181 patients with newly diagnosed HT (mean age 51.7 ± 5.4 years) and 39 healthy control subjects (mean age 51.2 ± 5.1 years). Echocardiographic examination was performed in all subjects. Four different geometric patterns were determined in hypertensive patients according to LV mass index (LVMI) and relative wall thickness (RWT). AD was calculated from the echocardiographically derived ascending aorta diameters and haemodynamic pressure measurements. LVMPI was calculated from the tissue Doppler-derived ejection time, isovolumic contraction and relaxation times.

RESULTS

The highest LVMPI and the lowest AD values were observed in concentric hypertrophy group compared with control, normal geometry, concentric remodelling and eccentric hypertrophy groups (p < 0.05, for all). LVMPI was associated with LVMI (r = 0.497, p < 0.001), RWT (r = 0.270, p < 0.001), AD (r = -0.316, p < 0.001) and E deceleration time (r = 0.171, p = 0.02) in bivariate analysis. In multiple linear regression analysis, LVMPI was independently related to LVMI (β = 0.381, p < 0.001) and AD (β = -0.263, p = 0.001).

CONCLUSIONS

The LVMPI was highest and AD was lowest in patients with concentric hypertrophy. The LVMPI was independently associated with LVMI and AD in hypertensive patients.