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.

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.

scholarly journals Left Ventricular Remodeling and Myocardial Work: Results From the Population-Based STAAB Cohort Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Floran Sahiti ◽  
Caroline Morbach ◽  
Vladimir Cejka ◽  
Judith Albert ◽  
Felizitas A. Eichner ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cohort Study ◽  
General Population ◽  
Myocardial Function ◽  
Myocardial Dysfunction ◽  
Blood Pressure Level ◽  
Hypertensive Heart Disease ◽  
Left Ventricular ◽  
Work Efficiency ◽  
Lv Mass

Introduction: Left ventricular (LV) dilatation and LV hypertrophy are acknowledged precursors of myocardial dysfunction and ultimately of heart failure, but the implications of abnormal LV geometry on myocardial function are not well-understood. Non-invasive LV myocardial work (MyW) assessment based on echocardiography-derived pressure-strain loops offers the opportunity to study detailed myocardial function in larger cohorts. We aimed to assess the relationship of LV geometry with MyW indices in general population free from heart failure.Methods and Results: We report cross-sectional baseline data from the Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) cohort study investigating a representative sample of the general population of Würzburg, Germany, aged 30–79 years. MyW analysis was performed in 1,926 individuals who were in sinus rhythm and free from valvular disease (49.3% female, 54 ± 12 years). In multivariable regression, higher LV volume was associated with higher global wasted work (GWW) (+0.5 mmHg% per mL/m2, p &lt; 0.001) and lower global work efficiency (GWE) (−0.02% per mL/m2, p &lt; 0.01), while higher LV mass was associated with higher GWW (+0.45 mmHg% per g/m2, p &lt; 0.001) and global constructive work (GCW) (+2.05 mmHg% per g/m2, p &lt; 0.01) and lower GWE (−0.015% per g/m2, p &lt; 0.001). This was dominated by the blood pressure level and also observed in participants with normal LV geometry and concomitant hypertension.Conclusion: Abnormal LV geometric profiles were associated with a higher amount of wasted work, which translated into reduced work efficiency. The pattern of a disproportionate increase in GWW with higher LV mass might be an early sign of hypertensive heart disease.

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.  

Left ventricular size, mass, and function in relation to angiotensin-converting enzyme gene polymorphism in humans

1994 ◽  
Vol 267 (3) ◽  
pp. H1107-H1111 ◽  
Author(s):  
M. Kupari ◽  
M. Perola ◽  
P. Koskinen ◽  
J. Virolainen ◽  
P. J. Karhunen
Keyword(s):  
Heart Disease ◽  
Gene Polymorphism ◽  
Angiotensin Converting Enzyme ◽  
Body Height ◽  
Left Ventricular ◽  
Major Influence ◽  
Converting Enzyme ◽  
Ace Gene ◽  
Lv Mass ◽  
And Function

Angiotensin-converting enzyme (ACE) exhibits genetic variation related to insertion/deletion (I/D) polymorphism in intron 16 of the ACE gene. The DD genotype results in high ACE activity and is overrepresented in diseases characterized by left ventricular (LV) hypertrophy and dysfunction. We studied whether the ACE gene polymorphism predicts LV mass or function in the absence of heart disease. Polymerase chain reaction of leukocyte DNA was used to determine the I/D genotype, and M-mode and Doppler echocardiography were used to quantify LV mass and function in 86 human subjects, 36-37 yr of age. All were free of clinical heart disease. The LV mass-to-body height ratio averaged 99 +/- 19 (SD) g/m in subjects with the II genotype (n = 25), 99 +/- 30 g/m in those with the ID genotype (n = 35), and 94 +/- 24 g/m in those with the DD genotype (n = 26; P = 0.790). The indexes of LV systolic and diastolic function were also unrelated to the ACE genotype. We conclude that in the absence of heart disease the ACE gene variation has no major influence on LV mass or function that is detectable at echocardiography.

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.

Left ventricular hypertrophy in athletes: How to differentiate between hypertensive heart disease and athlete’s heart

2020 ◽  
pp. 204748732091185 ◽  
Author(s):  
Flavio D’Ascenzi ◽  
Caterina Fiorentini ◽  
Francesca Anselmi ◽  
Sergio Mondillo
Keyword(s):  
Heart Disease ◽  
Left Ventricular Mass ◽  
Wall Thickness ◽  
Hypertensive Heart Disease ◽  
Clinical Information ◽  
Left Ventricular ◽  
Athlete’S Heart ◽  
Ventricular Mass ◽  
Competitive Athletes ◽  
Athlete's Heart

Athlete’s heart is typically accompanied by a remodelling of the cardiac chambers induced by exercise. However, although competitive athletes are commonly considered healthy, they can be affected by cardiac disorders characterised by an increase in left ventricular mass and wall thickness, such as hypertension. Unfortunately, training-induced increase in left ventricular mass, wall thickness, and atrial and ventricular dilatation observed in competitive athletes may mimic the pathological remodelling of pathological hypertrophy. As a consequence, distinguishing between athlete’s heart and hypertension can sometimes be challenging. The present review aimed to focus on the differential diagnosis between hypertensive heart disease and athlete’s heart, providing clinical information useful to distinguish between physiological and pathological remodelling.

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