Abstract WP207: Ethnic Disparities in Hypertensive Heart Disease Among Young Adults with Ischemic Stroke in Hawaii

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Alap R Jani ◽  
Cherisse Ito ◽  
Todd Seto ◽  
Kazuma Nakagawa
Keyword(s):  
Young Adults ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
Diastolic Dysfunction ◽  
Ethnic Disparities ◽  
Hypertensive Heart Disease ◽  
Left Ventricular ◽  
Admission Diagnosis ◽  
Lv Mass ◽  
Echocardiographic Findings

A recent study showed that Native Hawaiians and Other Pacific Islanders (NHOPI) with ischemic stroke are younger and have a higher burden of cardiovascular risk factors compared to whites and Asians. However, a detailed assessment of the degree of hypertensive heart disease using echocardiogram data among this multi-ethnic young adult population has not been studied. The objective of this study was to assess ethnic differences in the echocardiographic findings of hypertensive heart disease among young adults who were hospitalized for ischemic stroke. We hypothesized that NHOPI young adults with ischemic stroke have a higher prevalence of echocardiographic findings of hypertensive heart disease compared to whites and Asians. We conducted a retrospective study of all young adults (age ≤ 55 years) who were hospitalized at the Queen’s Medical Center in Honolulu, HI between 2008 and 2012 with an admission diagnosis of ischemic stroke. Patients with an ethnicity other than white, Asian, or NHOPI were excluded. Echocardiograms for each patient were reviewed. Left ventricular mass was estimated by the Devereux formula. Early (E) and late (A) transmitral diastolic flow, and mitral medial annulus early diastolic velocities (E’) were recorded; and E/A and E/E’ were calculated as measures of diastolic dysfunction and LV filling pressures. A total of 259 patients (44% NHOPI, 36% Asians, and 19% whites) were included in the study. The overall mean age was 47.1 ± 7.7 years with 34% women. NHOPIs had a higher LV mass (248.9 ± 94.8 g), LV mass index (121.5 ± 41.4 g/m 2 ), and mitral E/E’ values (15.5 ± 9.3) compared to whites (218.6 ± 74.6 g, 107.9 ± 34.2 g/m 2 , 11.5 ± 4.6, all P <0.05) and Asians (191.3 ± 61.5 g, 106 ± 32.2 g/m 2 , 12.4 ± 5.8, all P <0.01). NHOPIs had more severe diastolic dysfunction and relative wall thickness (all P <0.05) compared to Asians but not whites. Overall, NHOPIs compared to whites and Asians had 8% compared to 10% and 10.6% with normal geometry, 39% compared to 50% and 47.9% with concentric remodeling, 53% compared to 40% and 41.5% with hypertrophy. Left atrial enlargement was seen in 24% of the total population. In conclusion, this study shows that among young adults with ischemic stroke, NHOPIs have a higher burden of hypertensive heart disease compared to whites and Asians.

scholarly journals Left ventricle geometry, echoreflectivity and CYP11B2 polymorphism C-344T in hypertensive males

2019 ◽  
Vol 6 (3) ◽  
pp. 3027-3033
Author(s):  
Lozinska Marina ◽  
Zhebel Vadym ◽  
Lozinsky Sergiy
Keyword(s):  
Heart Disease ◽  
Ventricular Hypertrophy ◽  
Blood Pressure Measurement ◽  
Interventricular Septum ◽  
Hypertensive Heart Disease ◽  
Posterior Wall ◽  
Left Ventricular ◽  
Distinct Cluster ◽  
Lv Mass

Objectives: Hypertensive heart remodeling requires the assumption of different factors, including an increase of left ventricular mass (LVM) and myocardial fibrosis. It was shown that aldosterone stimulates cardiac collagen synthesis and fibroblast proliferation. CYP11B2 is one of the genes responsible for the effects of aldosterone. Therefore, hypertensive remodeling could be partially related to the polymorphism of this gene. The purpose of this study was to assess the association of CYP11B2 polymorphism with structural remodeling by changes in geometry and myocardial density to define their role and interaction in hypertensive heart disease. Methods: The study recruited 150 men aged 45-60 with and without essential hypertension (EH), who possessed no irreversible target organ damages. Fifty of them had normal BP, 58 had EH without left ventricular hypertrophy (LVH) and 42 had EH and LVH. Each participant underwent office blood pressure measurement, echocardiography with echo-reflectivity analysis, and determination of the C-344T polymorphism of the aldosterone synthase gene CYP11B2. Results: Patients with EH and LVH differed not only by LV mass but also by larger body mass, relative wall thickness, and wider echo-reflectivity spectrum. The associations of larger end diastolic diameter with C allele, and the larger thickness of the posterior wall and interventricular septum with T allele, were revealed only in patients with EH and LVH. Conclusions: Hypertensive patients with LVH are likely to be a distinct cluster with their own genetic predisposition to hypertensive heart disease.  

Abstract 705: The Difference in Left Ventricular Twisting Behavior Between Patients With Hypertensive Heart Disease and Hypertrophic Cardiomyopathy

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Kazuhisa Nishimura ◽  
Hideki Okayama ◽  
Makoto Saito ◽  
Katsuji Inoue ◽  
Toyofumi Yoshii ◽  
...  
Keyword(s):  
Heart Disease ◽  
Hypertrophic Cardiomyopathy ◽  
Diastolic Dysfunction ◽  
Systolic Function ◽  
Hypertensive Heart Disease ◽  
Left Ventricular ◽  
Control Group ◽  
Control Groups ◽  
The Difference ◽  
And Control

(Background) Left ventricular (LV) untwisting behavior is a novel index of LV diastolic function since it is a powerful determinant of LV diastolic suction. The LV of patients with hypertrophic cardiomyopathy (HCM) and hypertensive heart disease (HHD) has diastolic dysfunction despite normal systolic function. However, the role of untwisting behavior in HCM and HHD in the pathophysiology of diastolic dysfunction is unknown. The aim of this study was to investigate the difference of LV twisting behavior between patients with HCM and HHD. (Methods) Forty-four patients with HCM (mean age, 63+/−15 y, 34 males), 30 patients with HHD (mean age, 62+/−12 y, 20 males), and 20 age and sex-matched control subjects were evaluated. After a standard echocardiographic examination, LV twist and twisting velocity profiles from apical and basal short-axis images were analyzed using two-dimensional speckle tracking imaging. All temporal parameters were normalized by R-R intervals. (Results) LV diastolic and systolic dimensions, and ejection fraction were not significantly different among the groups. LV mass index and early diastolic mitral annular velocity were not significantly different between the HCM and HHD groups. The peak torsion in the HCM and HHD groups was significantly greater than that in the control group (Table ). The peak untwisting velocity in the HCM group was comparable to that in the control group. However, when the peak untwisting velocity was corrected by peak torsion, the value in the HCM group was significantly decreased compared with that in the HHD and control groups. The time to peak untwisting velocity from aortic valve closure in the HCM group was significantly longer than that in the HHD and control groups. (Conclusion) These results suggest that enhanced peak torsion in HCM might compensate for untwisting behavior, but this mechanism fails to fully compensate for untwisting behavior compared with HHD. Left ventricular twisting behavior

scholarly journals 2011 appropriate use criteria audit of an echocardiography lab in South Western Nigeria

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Opeyemi O. Oni ◽  
Moshood A. Adeoye ◽  
Adewole Adebiyi ◽  
Akinyemi Aje ◽  
Olaniyi Oyebowale ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Hypertensive Heart Disease ◽  
Clinical Information ◽  
Left Ventricular ◽  
Appropriate Use Criteria ◽  
Appropriate Use ◽  
Reduced Ejection Fraction ◽  
Lv Mass ◽  
And Function

Cardiovascular diseases are the major cause of death worldwide. Since its discovery in the 20th century, Echocardiography (ECHO) has become one of the pivotal tools in assessing cardiac structure and function. With the increase in requests for ECHO, there has risen an unwanted problem - inappropriate requests for ECHO. There has therefore arisen the need to audit ECHO labs for the appropriateness of ECHO requests. The patients referred from the outpatient clinics and in-patient wards for ECHO from June 1st, 2015 till September 30th, 2016 were recruited. Their request form data, clinical information, and ECHO results were analyzed as appropriate. The 2011 appropriate use criteria for Transthoracic ECHO was utilized. The most common indication out of the 2174 ECHOs reviewed was hypertension (16%), closely followed by hypertensive heart disease (12.4%). The percentage of appropriate, inappropriate, and uncertain indications according to the 2011 appropriate use criteria (AUC) for transthoracic echocardiography were 41.4%, 31.1%, and 0.1% respectively. Less than ten percent (9.3%) of the indications could not be classified by the 2011 AUC while 18.1% of the ECHOs had no indication. When indications of Hypertension, Hypertensive Heart Disease (HHD) and heart failure were compared, heart failure was significantly associated with eccentric Left Ventricular Hypertrophy (LVH), larger LV mass, lower BMI, larger cardiac dimensions, reduced ejection fraction, lower trans mitral A velocities than the other two indications. Concentric LVH was showed a trend towards being most in those with HHD (p= 0.072). The percentage of appropriate indications was low in this study as compared to others, largely because of large inappropriate indications. There is a need to ensure appropriate indications are filled for ECHO request forms. The 2011 AUC may need to be reviewed to expand the appropriate group of indications.

scholarly journals Severe Left Ventricular Hypertrophy, Small Pericardial Effusion, and Diffuse Late Gadolinium Enhancement by Cardiac Magnetic Resonance Suspecting Cardiac Amyloidosis: Endomyocardial Biopsy Reveals an Unexpected Diagnosis

2016 ◽  
Vol 2016 ◽  
pp. 1-7
Author(s):  
Nina P. Hofmann ◽  
Sorin Giusca ◽  
Karin Klingel ◽  
Peter Nunninger ◽  
Grigorios Korosoglou
Keyword(s):  
Heart Disease ◽  
Cardiac Magnetic Resonance ◽  
Late Gadolinium Enhancement ◽  
Endomyocardial Biopsy ◽  
Cardiac Amyloidosis ◽  
Hypertensive Heart Disease ◽  
Left Ventricular ◽  
Gadolinium Enhancement ◽  
Lv Mass ◽  
Small Pericardial Effusion

Left ventricular (LV) hypertrophy can be related to a multitude of cardiac disorders, such as hypertrophic cardiomyopathy (HCM), cardiac amyloidosis, and hypertensive heart disease. Although the presence of LV hypertrophy is generally associated with poorer cardiac outcomes, the early differentiation between these pathologies is crucial due to the presence of specific treatment options. The diagnostic process with LV hypertrophy requires the integration of clinical evaluation, electrocardiography (ECG), echocardiography, biochemical markers, and if required CMR and endomyocardial biopsy in order to reach the correct diagnosis. Here, we present a case of a patient with severe LV hypertrophy (septal wall thickness of 23 mm, LV mass of 264 g, and LV mass index of 147 g/m2), severely impaired longitudinal function, and preserved radial contractility (ejection fraction = 55%), accompanied by small pericardial effusion and diffuse late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR). Due to the imaging findings, an infiltrative cardiomyopathy, such as cardiac amyloidosis, was suspected. However, amyloid accumulation was excluded by endomyocardial biopsy, which revealed the presence of diffuse myocardial fibrosis in an advanced hypertensive heart disease.

scholarly journals Bone marrow mononuclear cells induce beneficial remodeling and reduce diastolic dysfunction in the left ventricle of hypertensive SS/MCWi rats

2012 ◽  
Vol 44 (19) ◽  
pp. 925-933 ◽  
Author(s):  
Sarah J. Parker ◽  
Daniela N. Didier ◽  
Jamie R. Karcher ◽  
Timothy J. Stodola ◽  
Bradley Endres ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Heart Disease ◽  
Diastolic Dysfunction ◽  
Mononuclear Cells ◽  
Diastolic Pressure ◽  
Interstitial Fibrosis ◽  
Hypertensive Heart Disease ◽  
Left Ventricular ◽  
Lower Percentage ◽  
Bone Marrow Mononuclear Cells

Bone marrow mononuclear cells (BMMNCs) increase capillary density and reduce fibrosis in rodents after myocardial infarction, resulting in an overall improvement in left ventricular function. Little is known about the effectiveness of BMMNC therapy in hypertensive heart disease. In the current study, we show that delivery of BMMNCs from hypertension protected SS-13BN/MCWi donor rats, but not BMMNC from hypertension susceptible SS/MCWi donor rats, resulted in 57.2 and 83.4% reductions in perivascular and interstitial fibrosis, respectively, as well as a 60% increase in capillary-to-myocyte count in the left ventricles (LV) of hypertensive SS/MCWi recipients. These histological changes were associated with improvements in LV compliance and relaxation (103 and 46.4% improvements, respectively). Furthermore, improved diastolic function in hypertensive SS/MCWi rats receiving SS-13BN/MCWi derived BMMNCs was associated with lower clinical indicators of heart failure, including reductions in end diastolic pressure (65%) and serum brain natriuretic peptide levels (49.9%) with no improvements observed in rats receiving SS/MCWi BMMNCs. SS/MCWi rats had a lower percentage of endothelial progenitor cells in their bone marrow relative to SS-13BN/MCWi rats. These results suggest that administration of BMMNCs can prevent or reverse pathological remodeling in hypertensive heart disease, which contributes to ameliorating diastolic dysfunction and associated symptomology. Furthermore, the health and hypertension susceptibility of the BMMNC donor are important factors influencing therapeutic efficacy, possibly via differences in the cellular composition of bone marrow.

Abstract 13834: Low Coronary Microvascular Vasodilator Capacity Relative to Myocardial Mass Predicts Cardiovascular Risk in Hypertensive Heart Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jenifer Brown ◽  
Wunan Zhou ◽  
Brittany Weber ◽  
Sanjay Divakaran ◽  
Jon Hainer ◽  
...  
Keyword(s):  
Heart Disease ◽  
Hypertensive Heart Disease ◽  
Left Ventricular ◽  
Structure And Function ◽  
Volume Index ◽  
Myocardial Mass ◽  
Flow Reserve ◽  
Increased Risk ◽  
Lv Mass ◽  
And Function

Introduction: Increased left ventricular (LV) mass and coronary microvascular disease (CMD) have been independently associated with risk of heart failure (HF) and mortality in hypertensive heart disease. Inability to match increased LV mass and corresponding metabolic demand with adequate perfusion may be important in the development of HF. Hypothesis: PET-derived coronary microvascular vasodilator capacity indexed to LV mass (stress P/M) is associated with LV structure (end-diastolic volume index, EDVi, and end-systolic volume index, ESVi), LV function (LVEF) and identifies patients at elevated risk for HF hospitalization and death. Methods: We studied a retrospective cohort of consecutive symptomatic patients with hypertension presenting for rest/stress myocardial perfusion PET with LVEF ≥ 40%, normal perfusion (summed stress score < 3), and no prior CAD, cardiomyopathy, or HF. Stress P/M was defined as stress myocardial blood flow (MBF) divided by LV mass. CMD was defined by myocardial flow reserve (MFR = stress/rest MBF) ≤ 1.8. Associations between stress P/M and LV structure and function were assessed, and prognostic value for HF hospitalization and all-cause mortality was evaluated. Results: We studied 358 patients: mean age 62.7±12.3y, 72.4% female. Global stress MBF was negatively associated with LV mass (β=-0.023, P<0.001). Lower stress P/M was independently associated with greater EDVi (β=-0.557, p<0.001), greater ESVi (β=-0.943, p<0.001), and lower LVEF (β=0.819, p<0.001). A below-median stress P/M conferred increased risk of mortality or incident HF hospitalization (adjusted HR=1.73 [95% CI: 1.10-2.73], p=0.02) (Figure 1A) and conferred comparable risk to CMD in those with preserved MFR (Figure 1B). Conclusions: Coronary microvascular vasodilator capacity relative to myocardial mass integrates microvascular physiology with LV structure and function and refines risk of HF and all-cause death in hypertensive heart disease.

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