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Introduction: Palpitation is a common complaint among patients presenting to emergency departments or cardiologists. Palpitation caused by organic heart diseases, such as coronary atherosclerotic heart disease and hypertensive heart disease, may be a sign of a life-threatening condition. In such cases, treatment with western medicines or surgeries is warranted. However, for patients with palpitation caused by non-cardiac factors, western medicine treatment is often ineffective, and traditional Chinese medicine has comparatively superior advantage. With the change in people's lifestyle and habits in the past decades, the time spent sitting and that with a forward head posture is increasing, which has accelerated the process of spinal aging and increased the incidence rate of spinal diseases. Case presentation: A 54-year-old female presented with paroxysmal palpitations, chest depression, and neck pain that had lasted for more than 2 months. Western medicine diagnosis was palpitations due to spinal disorders, while the traditional Chinese medicine diagnosis was palpitation (heart and spleen deficiency). The patient was treated with traditional Chinese massage, 30 min sessions, 5 times a week, 3 weeks totally. Subsequently, the patient's neck pain and numbness disappeared and the palpitations, chest tightness, and dizziness ameliorated. The patient resumed regular appetite, experienced better sleep, and had further improvement of spirit, enabling her to lead a normal life. Conclusions: Traditional Chinese massage therapy can relieve muscle spasm, regulate cervical facet joint disorder and dislocation, release adhesion, relieve synovial incarceration, restore the dynamic and static balance of the cervical spine, improve blood circulation of the cervical spine, increase the nutritional supply of the cervical spine and surrounding soft tissue, and promote metabolism and tissue repair. All these advantages make it a good complementary and alternative therapy for palpitation caused by spine disorders.

Acute myocarditis (AM) and hypertensive heart disease (HHD) have different pathophysiological backgrounds, thus potentially showing distinct patterns of altered myocardial deformation. Therefore, CMR left ventricular (LV) feature tracking (FT)- based strain parameters were indexed to myocardial mass index (LVMi) in order to evaluate potential additional value in the differentiation among AM, HHD, and healthy volunteers (HV) compared to non-indexed conventional strain.Patients with AM (n = 43) and HHD (n = 28) underwent CMR at 3T. 61 HV served as controls. Cine imaging-based FT-strain analysis was performed and natural strain (nStrain) values were evaluated for gender and age specific differences in HV. Strain parameters were indexed to LVMi yielding ratio Strain (rStrain). These were evaluated for their discriminatory accuracy compared to nStrain values.There were significant differences in nStrain between genders (p0.05), but not between age groups in HV. Circumferential strains differentiated best between HV and AM, reaching an area under the curve (AUC) of 0.86 (female) and 0.81 (male), yielding 93 (72) % sensitivity and 55 (75) % specificity. In discriminating between HV and HHD as well as AM and HHD, longitudinal strains outperformed all other parameters with AUCs of 1.00 (female)/ 0.92 (male) and 0.90 (female)/ 0.74 (male), respectively. Sensitivity and specificity levels of 100 %/ 100 % (female) and 91 %/ 72 % (male) for HV versus AM as well as 82 %/ 71 % (female) and 91%/ 57 % (male) for AM versus HHD could be demonstrated. The usage of rStrains significantly increased the AUC for circumferential and radial strains in male patients.rStrain provided additional value in the differentiation of diseases with increased LVM. As rStrain is derived from standard native cine imaging, such parameters can be time efficiently and reliably calculated, giving them the potential to be a powerful addition to the currently developing multiparametric native diagnostic approaches.

INTRODUCTION: The increasing prevalence of cardiovascular risk factors in South African rural communities is well reported. However, the prevalence of cardiovascular disease (CVD) leading to hospital admission and related in-hospital mortality in rural and semi-rural hospitals is unknown. METHODS: We conducted a retrospective review of hospital records for patients admitted to the Department of Internal Medicine at Dora Nginza Hospital in Port Elisabeth, South Africa between 1 April and 31 October 2016. The study focused on patients who received a primary diagnosis of CVD. RESULTS: During the seven-month study period, 4 884 patients were admitted to the unit, 1 325 of whom received a primary diagnosis of CVD, giving a prevalence of 27%. Patients with CVD had a mean (standard deviation) age of 60 (± 15) years, 32% of this patient population was younger than 55 years and 65% were female. Furthermore, 94% had a background medical history of systemic hypertension and 30% of diabetes mellitus. The three leading cardiovascular causes of hospital admission were stroke (38%), hypertensive heart disease plus heart failure (33%), and hypertensive emergency/urgency (18%). In-hospital outcome: 12.4% of patients admitted for CVD died during the index hospitalisation and strokes were responsible for 70% of the deaths. CONCLUSION: The prevalence of CVD in this cohort was high and accounted for significant morbidity and mortality. Systemic hypertension was a leading risk factor in our cohort and we need to intensify efforts to diagnose and treat systemic hypertension.

Background ‘Classical’ echocardiographic signs of Fabry cardiomyopathy (FC), such as left ventricular hypertrophy (LVH), posterolateral strain deficiency (PLSD) and papillary muscle hypertrophy may have a limited diagnostic accuracy in clinical practice. Our aim was to evaluate the diagnostic value of left atrial (LA) strain impairment compared to ‘classical’ echocardiographic findings to discriminate FC. Methods In standard echocardiographic assessments, we retrospectively analyzed the diagnostic value of the “classical” red flags of FC as well as LA strain in 20 FC patients and in 20 subjects with other causes of LVH. Receiver operating characteristic (ROC) curve analysis was performed to assess the respective diagnostic accuracy. Results FC was confirmed in 20 patients by genetic testing. In the LVH group, 12 patients were classified by biopsy to have hypertrophic cardiomyopathy, two had hypertensive heart disease, and six LVH combined with borderline myocarditis. Global and regional left ventricular (LV) strain was not significantly different between groups while LA strain was significantly impaired in FC (Left atrial reservoir strain (LASr) 19.1%±8.4 in FC and 25.6%±8.9 in LVH, p=0.009; left atrial conduction strain (LAScd) -8.4%±4.9 in FC and -15.9%±8.4 in LVH, p

BACKGROUND Left ventricular (LV) systolic impairment, particularly in the longitudinal direction, is considered an early and sensitive marker of hypertensive heart disease and increased cardiovascular risk. The evidence indicates that aortic stiffness and central hemodynamic factors are important determinants of LV performance, mediating the interaction between the heart and vascular load. Despite the existence of cross-sectional analyses linking central blood pressure (BP) parameters with LV mechanics, no longitudinal data are available which include serial measurements in the course of antihypertensive treatment. OBJECTIVES To investigate the associations between changes in LV longitudinal and circumferential function with alterations in arterial hemodynamics and ventricular-arterial coupling (VAC) in patients with uncomplicated hypertension during a 12-month follow-up. MATERIAL AND METHODS In this retrospective study, 216 patients (age 64.3 ±7.6 years) underwent echocardiography including left ventricular longitudinal (GLS) and circumferential strain (GCS) analysis, brachial BP measurements, VAC (combining echocardiography and brachial BP), and arterial hemodynamics using radial tonometry at baseline and after 12 months of antihypertensive therapy. Patients were grouped into 2 subsets: with improvement in GLS (n = 103) and with deterioration in GLS (n = 113). RESULTS No significant differences were observed in the majority of cardiovascular, demographic or clinical characteristics between the groups. The subset with improvement in GLS demonstrated more favorable changes over follow-up in pulse wave velocity (p = 0.03), central augmentation pressure (p = 0.01) and ventricular-arterial coupling (p = 0.04) compared to patients showing deterioration in GLS. In the multivariable analysis, independent determinants of changes in GLS were: GLS at baseline (-0.48; p < 0.001), changes from baseline to follow-up in central augmentation pressure (-0.29; p = 0.002) and ventricular-arterial coupling (-0.25; p = 0.004). Independent determinants of analogous changes in GCS were: GCS at baseline (-0.46; p < 0.001) and changes in central augmentation pressure (-0.22; p = 0.02). CONCLUSIONS Left ventricular longitudinal and circumferential functional remodeling over time in hypertensive patients is associated with arterial hemodynamics and ventricular-arterial coupling.

Myocardial infarction with non-obstructive coronary arteries (MINOCA) as a relatively new disease entity distinguished from the group of acute coronary syndromes (ACS) is not a rare clinical problem and it requires in-depth diagnostics. MINOCA accounts for 5–10% of all ACS cases. MINOCA is most common between the ages of 50–60 and predominates in females. Coronary microvascular dysfunction and coronary vasospasm are among the potential mechanisms. The latest guidelines for the treatment of ACS in patients presenting without persistent ST-segment elevation emphasize the importance of searching for the causes of angina in patients with insignificant lesions in the coronary arteries by extending invasive diagnostics (e.g., acetylcholine provocation test) and using noninvasive diagnostics (e.g., CMR or SPECT). In the context of MINOCA, among the typical risk factors for coronary artery disease, arterial hypertension (HTN) seems to be the most important by inducing coronary microcirculation remodeling (mostly hypertrophy) and hence the narrowing of the lumen. Studies comparing patients with MINOCA and obstructive coronary artery disease (MI-CAD) in the context of risk factors, in particular HTN, were analyzed. In five out of nine analyzed studies, HTN occurred significantly more often in patients with MINOCA compared to patients with MI-CAD. The current pharmacotherapy recommendations focus on slowing the progression of coronary microvascular dysfunction (CMD), i.e., adequate treatment of risk factors and comorbidities, such as HTN. Therefore, it seems reasonable to conduct studies directly analyzing the relationship between HTN and MINOCA in order to improve diagnostics and establish appropriate pharmacotherapy that will improve prognosis.

В статье изложены результаты анализа литературы, посвященные исследованию развития фиброза миокарда у больных артериальной гипертензией. В обзоре поданы современные представления о механизмах формирования миокардиального фиброза, включая влияние гуморального и клеточного компонентов. Проанализировано значение термина «гипертоническая болезнь сердца», а также патогенетических, морфологических и прогностических его составляющих.

This research is aimed at studying the effect of Angelica sinensis polysaccharide (ASP) extracted from the Lixinshui prescription on cardiac disease induced by hypertension in rats. Rat models of cardiovascular disease were established, and the associated factors were measured. The data showed that ASP treatment increased the ejection fraction and short axis shortening rate, while decreasing the LV end-diastolic diameter, LV end-systolic diameter, LV end-diastolic volume, and LV end-systolic volume in HHD rats. ASP downregulated the expression level of TGF-β1, alpha-smooth muscle actin (α-SMA), collagen I, fibronectin, vimentin, Bax, cleaved caspase-9, and cleaved caspase-3 and upregulated the expression level of Bcl-2 in LV of HHD rats. Meanwhile, ASP increased the activity of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) and decreased the level of malondialdehyde (MDA), tissue endogenous hydrogen peroxide (H2O2), and reactive oxygen species (ROS). Our findings indicated that ASP could prevent hypertensive heart disease by inhibiting myocardial fibrosis, suppressing the myocardial apoptosis, and alleviating oxidative stress.

AIM Evidence on systolic dysfunction, as assessed by left ventricular (LV) mechanics, in hypertensive heart disease phenotyped by abnormal LV geometric patterns is still limited. Thus, we performed a systematic meta-analysis of 2D/3D speckle-tracking studies in order to provide an updated comprehensive information on this topic. METHODS The PubMed, OVID-MEDLINE, and Cochrane library databases were analyzed to search for articles published from the inception up to 31 January 2021. Studies were identified by using MeSH terms and crossing the following search items: 'myocardial strain', 'left ventricular mechanics', 'speckle tracking echocardiography', 'systolic dysfunction', 'hypertensive heart disease', 'left ventricular hypertrophy', left ventricular remodeling", 'concentric hypertrophy', 'eccentric hypertrophy'. RESULTS Overall, data of 267 normotensive controls and 712 hypertensive patients (234 normal geometry, 97 LV concentric remodeling, 176 eccentric LVH, and 205 concentric LVH) from eight studies were considered. Pooled ejection fraction was similar in normotensives and in the whole group of hypertensive patients: (SMD 0.037 ± 0.05, confidence interval (CI): 0.14/0.07, P = 0.51) as well as in hypertensive subgroups. LVMI, and E/e' gradually increased from hypertensive patients with normal geometry and concentric remodeling, to patients with eccentric and concentric LVH. LV global longitudinal strain (GLS) was lower in all hypertensive groups compared with normotensive controls, in particular, in the eccentric (SMD 1.14 ± 0.22, CI: 0.69/1.59, P

The incidence of hypertension is continuously increasing. This study aimed to investigate the changes in clinical biochemical indexes of patients with heart failure with preserved ejection fraction (HFpEF), or patients with hypertensive heart disease (HHD) before and after treadmill exercise.Seventy-eight patients with HFpEF and 78 patients with HHD who were admitted to our hospital between February 2020 and February 2021 were selected to take a treadmill exercise test. All patients continued to exercise for 1 month. Clinical biochemical indexes [hemoglobin A1c (HbA1c), low-density lipoprotein (LDL-C), high-density lipoprotein (HDL-C), total cholesterol (TC), N-segment pro-brain natriuretic peptide (NT-proBNP), and cardiac troponin I (cTnI)] were measured before and after the treadmill exercise test and compared between the two groups. Receiver operating characteristic (ROC) curves were drawn to analyze the optimal cutoff values of the clinical biochemical indexes in the diagnosis of HFpEF. The positive diagnostic rates of the biochemical indicators for HFpEF before and after treadmill exercise were compared using the optimal cut-off value of ROC as the positive standard.Before exercise, there was no significant difference in HbA1c, LDL-C, HDL-C, or TC between the two groups (P0.05), but NT-proBNP and cTnI were significantly higher in the HFpEF group than in the HHD group (P0.05). ROC curve analysis showed that before exercise, the best cutoff values for plasma NT-proBNP and cTnI in the diagnosis of HFpEF were 2,248.24 pg/mL and 1.14 ng/mL, respectively. After exercise, no significant difference was found in HbA1c, LDL-C, HDL-C, or TC between the two groups (P0.05). However, the levels of NT-proBNP and cTnI in both groups were higher after exercise, with more significant increases seen in the HFPEF group (P0.05). The positive rates of plasma NT-proBNP and cTnI in HFpEF group were statistically higher after exercise than before exercise (P0.05).The changes in plasma NT-proBNP and cTnI in patient after treadmill exercise can be used as sensitive indicators for the diagnosis and differentiation of HFpEF and HHD.

Cardiovascular disease is the leading cause of mortality in hypertensives, and patients with true resistant hypertension have an increased risk for premature cardiovascular events. Electrocardiography (ECG) has an essential role in the monitoring of hypertensive heart disease; however, little is known about the importance of ECG parameters in patients with resistant hypertension. We aimed to investigate whether fragmented QRS (fQRS) and frontal plane QRS-T angle, which are novel ECG parameters indicating myocardial damage, predict true resistant hypertension in patients with uncontrolled blood pressure. Four hundred six hypertensive patients with resistant hypertension were prospectively enrolled for the study. Patients were divided into two groups as 'true resistant' or 'pseudo-resistant' hypertensives and compared regarding the ECG parameters. While 73 (18%) patients had true resistant hypertension, 333 (82%) patients had pseudo-resistant hypertension. The frequency of fQRS (47.9% vs. 20.1%, p 0.001) and average frontal plane QRS-T angle (93.0° ± 19.7° vs. 53.8° ± 10.2°, p 0.001) were significantly higher in patients with true resistant hypertension compared to those with pseudo-resistant hypertension. Also, fQRS in anterior leads was significantly more frequent in patients with true resistant hypertension (57.1% vs. 23.8%, p 0.001). Moreover, ROC curve analysis demonstrated that an increased frontal plane QRS-T angle 90.75° predicted true resistant hypertension with a sensitivity 96% and specificity 61% (AUC:0.874, p 0.001). Furthermore, multivariate analysis demonstrated that fQRS in anterior leads (OR: 1.251, 95% CI: 1.174-1.778, p = 0.002) and frontal plane QRS-T angle (OR: 1.388, 95% CI: 1.073-1.912, p 0.001) were independent predictors of true resistant hypertension. In conclusion, fQRS and frontal plane QRS-T angle may be useful to predict true resistant hypertension in patients with uncontrolled blood pressure.

Dilated cardiomyopathy is a form of heart failure characterized by left ventricular dilation with impaired systolic function. Causes may include ischemic heart disease, hypertensive heart disease, valvular heart disease, endocrine disorders, substance use, and viral diseases. This case report describes a patient with new-onset heart failure, initially diagnosed as idiopathic dilated cardiomyopathy with pericarditis secondary to a virus but later found to be secondary to hyperthyroidism.

A sixty year old man presented to our health facility with a year history of severe erectile dysfunction (International Index of Erectile Function Score of 5 (IIEF-5)). He was also a known hypertensive and currently being managed for hypertensive heart disease by the Cardiologist. Colour Doppler interrogation of the Cavernosal Arteries showed multiple areas of narrowing in both arteries, giving beaded appearance. The peak systolic velocities of the arteries were less than 25cm/s, and there was persistent diastolic flow in the entire spectral recordings, prompting the diagnosis of arteriogenic erectile dysfunction (ED) secondary to atherosclerosis of the cavernosal arteries. He had medical treatment with PGE5-I, and intracavernosal injection of prostaglandin E1 (Caverjet), but all to no avail. He was counselled for penile implant and he is favourably disposed to that but largely being limited by funds.

Echocardiography and electrocardiogram (ECG) are the primary tools used by cardiologists to diagnose cardiovascular heart diseases. Contrary to the critical role of combining the echocardiography a...

Hypertensive heart disease refers to changes in the myocardium that result from hypertension. The relationship between hypertensive heart disease and sudden cardiac death is well established, but there are few pathological studies. We examined the clinical and pathological features of hypertensive heart disease in sudden cardiac death victims from a national cardiovascular pathology registry. We investigated 5239 cases of sudden cardiac death between 1994 and 2018. Hearts were examined by two expert cardiac pathologists. Diagnostic criteria included history of hypertension, increased heart weight and left ventricular wall thickness in the absence of other causes. Collagen was quantified using picrosirius red staining and imaging software. Of 75 sudden cardiac death cases due to hypertensive heart disease (age at death: 54 ± 16 years; 56% males), 56 (75%) reported no prior cardiac symptoms. Thirty-four (45%) recorded a BMI ≥ 30. Only two (2.7%) had hypertensive heart disease diagnosed antemortem. Four (5%) were diagnosed clinically with hypertrophic cardiomyopathy, but lacked myocyte disarray at autopsy. All hearts showed concentric left ventricular hypertrophy and myocyte hypertrophy. Fibrosis was identified microscopically in 59 cases (81%). The posterior left ventricular wall showed the greatest increase in the percentage of collagen in hypertensive diseased hearts compared to controls (25.2% vs 17.9%, p = 0.034). Most sudden deaths due to hypertensive heart disease occur without prior cardiac symptoms; thus, clinical risk stratification is challenging. Hypertensive heart disease can be misdiagnosed in life as hypertrophic cardiomyopathy which has major implications for relatives. Pathologists require a history of hypertension and histology for a definitive diagnosis of hypertensive heart disease.

Aims To provide the first systematic analysis of the burden and underlying causes of heart failure (HF) in 195 countries and territories from 1990 to 2017. Methods and results We collected detailed information on prevalence, years lived with disability (YLDs), and underlying causes of HF from the Global Burden of Disease study 2017. Numbers and age-standardized rates of HF prevalence and YLDs were compared by age, sex, socio-demographic index (SDI), and location. The proportions of HF age-standardized prevalence rates due to 23 underlying causes were also presented. Globally, the age-standardized prevalence and YLD rates of HF in 2017 were 831.0 and 128.2 per 100 000 people, a decrease of −7.2% and −0.9% from 1990, respectively. Nevertheless, the absolute numbers of HF prevalent cases and YLDs have increased by 91.9% and 106.0% from 1990, respectively. There is significant geographic and socio-demographic variation in the levels and trends of HF burden from 1990 to 2017. Among all causes of HF, ischaemic heart disease accounted for the highest proportion (26.5%) of age-standardized prevalence rate of HF in 2017, followed by hypertensive heart disease (26.2%), chronic obstructive pulmonary disease (23.4%). Conclusion HF remains a serious public health problem worldwide, with increasing age-standardized prevalence and YLD rates in countries with relatively low SDI. More geo-specific strategies aimed at preventing underlying causes and improving medical care for HF are warranted to reduce the future burden of this condition.

Aims Acutely decompensated heart failure (HF) (ADHF) is a common cause of hospitalization and mortality worldwide. This study explores the epidemiology and prognostic factors of ADHF in Cameroonian patients. Methods and results This was a retrospective study conducted between January 2003 and December 2013 from the medical files of patients followed at the intensive care and cardiovascular units of Douala General Hospital in Cameroon. Clinical, electrocardiographic, echocardiographic, and biological data were collected from 142 patients (58.5% men; mean age 58 ± 14 years) hospitalized for ADHF with reduced ejection fraction (HFrEF), whose left ventricular ejection fraction was 12 mg/L (87.5%, n = 124); hyperuricaemia >70 mg/L (84.9%, n = 121); elevated serum creatinine (65.6%, n = 93); anaemia (59.1%, n = 84); hyperglycaemia on admission >1.8 g/L (42.3%, n = 60); and hyponatraemia

Background: Heart disease in the developing world is mainly due to nonischemic causes-hypertensive heart disease, valvular and myocardial damage from rheumatic fever, and heart muscle diseases caused by certain infectious agents, for example, cardiomyopathy from HIV infection. Peripartum cardiomyopathy is also a well-recognized cause of heart disease in developing countries. However, there is evidence of epidemiological transition toward the increasing prevalence of atherosclerotic cardiovascular disease in Sub-Saharan Africa largely because of the increasing prevalence of traditional risk factors, such as hypertension, diabetes mellitus, dyslipidemia, obesity, and cigarette smoking. Aim: The aim of this study was to determine the pattern of heart diseases among patients undergoing transthoracic echocardiographic evaluation between February 2012 and February 2017 at the Cardiology Unit of the Department of Medicine, Federal Teaching Hospital, Gombe, Gombe State. Materials and Methods:Echocardiographic data of patients from February 2012 to February 2017 were retrieved. A total of 2265 patient records were analyzed. All patients had standard resting transthoracic echocardiography including Doppler modalities where appropriate. Descriptive statistics were used in assessing the distribution of different heart diseases.Results: The age range of the 2265 patients was 14–89 years, with a mean age of 47.3 ± 20.1 years and a female preponderance (58%). The most common heart disease among these patients was hypertensive heart disease (41.8%) followed by cardiomyopathies (15.4%). Ischemic heart disease remains rare (0.7%) probably due to the investigative modality used in this study (resting transthoracic echocardiography). Conclusion: Hypertensive heart disease remains the most common heart disease among men and women in Gombe and its environs. Cardiomyopathies, although rare in certain regions of Nigeria, are quite common in Northeast Nigeria.

Background: Heart failure (HF) is a major and growing public health problem across the world for both males and females in all ethnic groups. Therefore, this study aimed to evaluate the causes and associated risk factors of HF patients in Aljouf, Saudi Arabia. Methodology: Total 274 consecutive patients including 165 males and 109 females who were diagnosed with HF and admitted to Cardiac center of King Abdul Aziz Specialized Hospital (KAASH) over a period of January 2019 to December 2019, were enrolled in this retrospective study. All information was collected from the hospital records including medical history, age, causative factors and associated risk factors. Result: It was found that majority of female (31.1%) and male (45.4%) HF patients were over 65 years of age and between 55 to 64 years, respectively. The common causes were ischemic heart diseases (47.4%), hypertensive heart disease (30.2%), and dilated cardiomyopathy (22.2%) among HF patients. Furthermore, risk factors included diabetes (88%) and obesity (80.7%) which were higher in female as compared to males (p < 0.05). Besides, the family history of coronary artery disease and cardiovascular diseases (71.5%), and hypertension (32.7%) were significantly higher in male HF patients than female HF patients (p < 0.05). Smoking (58.39%) was considered as a major risk factor for male HF patient. Conclusion: The HF patient’s incidence as well as its complications might be reduced remarkably by early prevention with proper management of its associated risk factors and major causes.

Introduction: Left ventricular hypertrophy (LVH) is an important predictor of mortality and morbidity in hypertension, leading to hypertensive heart disease (HHD). Left ventricular mass (LVM), therefore, chiefly determines the geometrical reorientation of LV in hypertensives and these geometrical patterns are useful determinant of severity and prognosis of congestive heart failure (CHF). Studies on the geometrical assessment of LV in hypertensive patients involving large number of patients are limited in India. 2-D Echocardiography, is a non-invasive, cost effective, and a gold standard technique in the early detection of LV hypertrophy in hypertensive patients. Aims and Objectives: To determines the structural and functional integrity of LV in accordance with the variability of the LV geometry and function in recently detected hypertensive patients by 2D- Echocardiography and Colour Doppler. Material and Methods: 2D-Echocardiography and colour Doppler was done in 1000 randomly selected patients in OPD with accidently detected hypertension. LV geometrical patterns were determined by using Echocardiographic parameters chiefly left ventricular mass (LVM), left ventricular mass index to the power 2.7 of ht. (LVMI) and relative wall thickness (RWT) were recorded according to American society of Echocardiography convention (ACE). Results and Observations: Four patterns of LV geometry were noted i.e. concentric hypertrophy (CH) (22.9%), eccentric hypertrophy (EH) (9.7%), and concentric remodeling (CR) (50%) and normal geometry (NG) (17.4%). In this study, we observed that patients with concentric hypertrophy were significantly ( LV systolic function was significantly lower in patients with eccentric hypertrophy and some degree of diastolic dysfunction was present in abnormal geometry. Conclusion: The study determines that if there are regular screenings of the high blood pressure, then early steps can be taken to detect the establishment of LV hypertrophy. Keywords: LV hypertrophy, 2D-Echocardiography, LV mass, Hypertension.

In humans, females live longer than males but experience a worse longevity, as genome-wide autosomal DNA methylation differences between males and females have been reported. So far, few studies have investigated if DNA methylation is differently affected by aging in males and females. We performed a meta-analysis of 4 large whole blood datasets, comparing 4 aspects of epigenetic age-dependent remodeling between the two sexes: differential methylation, variability, epimutations and entropy. We reported that a large fraction (43%) of sex-associated probes undergoes age-associated DNA methylation changes, and that a limited number of probes shows age-by-sex interaction. We experimentally validated 2 regions mapping inFIGNandPRR4genes, and showed sex-specific deviations of their methylation patterns in models of decelerated (centenarians) and accelerated (Down syndrome) aging. While we did not find sex differences in the age-associated increase in epimutations and in entropy, we showed that the number of probes showing age-related increase in methylation variability is 15 times higher in males compared to females. Our results can offer new epigenetic tools to study the interaction between aging and sex and can pave the way to the identification of molecular triggers of sex differences in longevity and age-related diseases prevalence.

Aims Amyloid cardiomyopathy is an underappreciated cause of morbidity and mortality. Recent evidence suggests that ATTR wild‐type cardiomyopathy (ATTRwt‐CM) is probably much more common than widely appreciated. So far, no data are available on comparison of mortality from ATTRwt‐CM and other heart failure aetiologies. Methods and results This was a retrospective, observational, cohort study of 2251 patients and their data collected prospectively from May 2000 to June 2018. Long‐term mortality was the main outcome measure. Underlying cardiomyopathies were classified as amyloid CM (6.1%) [ATTRwt 3.0%; light‐chain amyloidosis (AL) 3.1%], dilated CM (dCMP) (46.4%), ischaemic heart disease (IHD) (24.4%), hypertensive heart disease (HHD) (14.6%), hypertrophic CM (HCM) (5.1%), and valvular heart disease (VHD) (3.4%). Median duration of follow‐up was 7.1 years (interquartile range 3.4–11.3). Five‐year overall survival in the whole cohort was 80.1%. In multivariate analysis, individuals with amyloid CM were 3.74 times [95% confidence interval (CI) 2.72–5.14; P

Aims Hypertension is a significant risk for the development of left ventricular hypertrophy, diastolic dysfunction, followed by heart failure and sudden cardiac death. While therapy with sacubitril/valsartan (SV) reduces the risk of sudden cardiac death in patients with heart failure and systolic dysfunction, the effect on those with diastolic dysfunction remains unclear. We hypothesized that, in the animal model of hypertensive heart disease, treatment with SV reduces the susceptibility to ventricular arrhythmia. Methods and results Young adult female spontaneous hypertensive rats (SHRs) were randomly separated into three groups, which were SHRs, SHRs treated with valsartan, and SHRs treated with SV. In addition, the age‐matched and weight‐matched Wistar Kyoto rats were considered as controls, and there were 12 rats in each group. In vivo ventricular tachyarrhythmia induction and in vitro optical mapping were used to measure the inducibility of ventricular arrhythmias and to characterize the dynamic properties of electrical propagation. The level of small‐conductance Ca2+‐activated potassium channel type 2 (KCNN2) was analysed in cardiac tissue. Compared with SHR with left ventricular hypertrophy, treatment with SV significantly improved cardiac geometry (relative wall thickness, 0.68 ± 0.11 vs. 0.76 ± 0.13, P

Echocardiography is a useful noninvasive tool for the diagnosis and evaluation of cardiac diseases. This study aims to share our 3 months’ experience in our echo lab as well as the scope of clinical cases diagnosed at our institute.

Hypertensive heart disease (HHD) includes left ventricular (LV) functional and structural remodeling. For a long time, this involved only LV diastolic dysfunction and LV hypertrophy. However, development of imaging technique enabled more detailed insights into LV mechanics. Its impairment seems to be the first step in the cascade of HHD. Tissue characterization, obtained by cardiac magnetic resonance, opened a completely new chapter in the assessment of HHD. We report a case of a 47-year-old man who was referred to our department for a newly detected heart failure. CT angiography excluded relevant coronary disease and cardiac magnetic resonance revealed focuses of fibrosis in interventricular septum, in addition severely dilated LV with severely reduced ejection fraction. Considering the fact that the patient had longstanding uncontrolled arterial hypertension and that other causes of cardiac remodeling and dysfunction were excluded, we hypothesized that the multimodality imaging approach enabled prompt diagnosis of HHD.

Background Transthyretin amyloid cardiomyopathy (ATTR-CM) is a commonly misdiagnosed cardiac condition due to low disease awareness and perceived rarity, which frequently results in incorrect management and poor outcomes. Early and prompt diagnosis has become critical with emerging therapies that improve patient survival. Case summary A 68-year-old woman presented to a tertiary care centre with acute decompensated heart failure following recurrent hospitalizations for the same issue over the past several months. Transthoracic echocardiography revealed severe concentric left ventricular hypertrophy with grade III diastolic dysfunction. However, QRS voltage by 12-lead electrocardiogram (ECG) was discordant with the degree of left ventricular hypertrophy seen by echocardiography, and the patient had recurrent non-sustained ventricular tachycardia that necessitated implantable cardioverter-defibrillator implantation a few months prior. After aggressive diuresis, the patient completed cardiac magnetic resonance imaging that raised concern for cardiac amyloidosis. Subsequent serum and urine protein electrophoresis with associated immunofixation were within normal limits. Finally, ATTR-CM was confirmed by technetium-99m pyrophosphate scintigraphy with plans to initiate tafamidis after genetic testing. Discussion Patients >60 years of age with diastolic heart failure phenotypically similar to hypertrophic cardiomyopathy and/or hypertensive heart disease should always be evaluated for ATTR-CM. Features that increase suspicion include discordance between left ventricular wall thickness and ECG voltage, and signs/symptoms of a primary peripheral and autonomic neuropathy. Useful non-invasive diagnostic testing has also made the diagnosis of ATTR-CM inexpensive and possible without the need for an endomyocardial biopsy. Unfortunately, this patient’s diagnosis of ATTR-CM came late in her disease course, which delayed the onset of definitive therapy.

Background Biphasic waveform shock has been established as the standard method for cardioversion of atrial fibrillation (AF). Depending on various factors, standard electrical cardioversion for AF may be unsuccessful in some cases, even with biphasic shocks. Case summary We report the safety and efficacy of orthogonal electrical cardioversion (OECV) as an alternative in patients with paroxysmal AF refractory to standard biphasic electrical cardioversion after up to three subsequent shocks of increasing energy and/or two or three initial shocks with maximum energy of 200-Joules. Shocks were delivered with two external defibrillators via two sets of adhesive electrode pads to apply two perpendicular electrical vectors in a simultaneous-sequential mode in antero-lateral and antero-posterior configuration. Five patients, mean age 54.4 ± 11, three with hypertensive heart disease and a body mass index 27.2 ± 2 kg/m2. All individual mean impedance before OECV was 79 ± 5 Ω with a mean peak current applied of 22 ± 4.5 A. Restoration of sinus rhythm with OECV was achieved acutely and sustained in all five patients. No patients developed haemodynamic instability or thromboembolic events. Discussion Double simultaneous shocks in an orthogonal configuration could theoretically decrease the defibrillation threshold through the ability of sequential pulses applying a more efficient and uniform current density. OECV using lower/medium energy may be another useful rescue strategy in AF refractory to standard biphasic shocks.

Based on scientific literature and own data, the article discusses the problem of hypertensive heart disease in real outpatient practice and especially in conducting preventive examinations in the working population. It is shown that the use of modern diagnostic methods, in particular electrocardiography with dopplerography, including pulse-wave tissue mode, should be an integral study included in the professional examination, as well as medical examination, which covers an increasing number of the population of our country. Echocardiography should be performed to clarify the cardiovascular risk and confirm the electrocardiographic diagnosis of left ventricular hypertrophy (LVH), left atrial dilatation, or suspected heart diseases (coronary heart disease, atrial fibrillation, other rhythm disorders). It has been shown that concentric LVH is the strongest predictor of an increased risk of heart failure, although the degree of LVH is not always directly related to the degree of hypertension and the duration of the disease.

Background: Patients diagnosed with hypertension will deteriorate into hypertensive heart disease which is characterized by diastolic dysfunction first followed by systolic dysfunction later in the course of the disease. Diastolic dysfunction of the left ventricle causes an increase in LVEDP as well as in the dimension of the left atrium. P-Wave Terminal Force V1 (PTFV1) which is derived from 12 lead ECG could help diagnose diastolic dysfunction in centers where echocardiography is not available. The purpose of this study was to determine the correlation of PTFV1 on the 12-lead Electrocardiography with diastolic dysfunction in patients diagnosed with hypertension in the outpatient clinic of Cardiac Center Adam Malik General Hospital in Medan. Methods: This is a cross-sectional study conducted from March 2019 until August 2019. Patients with hypertension who met the inclusion criteria were examined electrocardiographically to obtain PTFV1 value. Then echocardiography examination was then performed to assess the grades of diastolic dysfunction and other parameters. Analysis of correlation between PTFV1 values and diastolic dysfunction was then conducted. Results: From the clinical characteristics, there is no difference regarding age, sex , and risk factorsbetween the three diastolic dysfunction groups, while echocardiography characteristic shows more reduced EF in grade III diastolic dysfunction (36.5±7.7). Significant differences in PTFV1 are found among diastolic dysfunction groups. Grade I diastolic dysfunction has PTFV1 value of 23.8 mm.ms, grade II diastolic dysfunction has PTFV1 value of 34.1 mm.ms, and grade III diastolic dysfunction has PTFV1 value of 52.1 mm.ms, Significance of p value is 29.8 mm.ms can discriminate patients who have increased LAP with a sensitivity of 84% and specificity of 71%. Conclusions: PTFV1 is a simple screening tool which is widely available and correlate well with left ventricular diastolic dysfunction in patients with hypertension, which makes it a good alternative tool especially in areas where echocardiography is not readily available.

Hypertension is a leading cause of cardiovascular mortality and morbidity. The development of left ventricular hypertrophy (LVH) in hypertension is an independent predictor of adverse cardiovascular outcomes. Conversely, regression of LVH is associated with better prognosis. Lowering of blood pressure in patients with hypertension is the unequivocal determinant of regression of LVH. Unless otherwise contraindicated, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) are drugs of first choice in patients with essential hypertension with LVH. In this article, we summarise the preclinical and clinical evidence of the last 3 decades that established the preferential use of ACEIs/ARBs in hypertensive heart disease.

Background: Cardiac remodeling underpinning progressive hypertensive heart disease alters the three-dimensional structure of the extracellular matrix, as well as the laminar organization of myocardial sheetlets. The effect of pharmacological intervention on microstructural remodeling is not known. Objective: To examine the changes in myocardial microstructure that occur as a result of hypertensive heart disease, and the effect of pharmacological treatment. Methods: The spontaneously hypertensive rat (SHR) model of hypertensive heart disease was studied, and compared with the normotensive Wistar Kyoto (WKY) rat, and SHRs treated with angiotensin converting enzyme inhibitors (TSHR). Cardiac magnetic resonance was used to assess cardiac function and ventricular geometry. Excised myocardium was stained (picrosirius red) for collagen and extended volume confocal microscopy used to produce high-resolution image stacks. Results: At 24 months, TSHRs had significantly greater ejection fraction (P

Aims Myocardial fibrosis is a relevant component of hypertensive heart disease (HHD). Novel cardiovascular magnetic resonance (CMR) imaging techniques have shown potential in quantification of diffuse cardiac fibrosis, with T1 mapping, and estimating preclinical cardiac dysfunction, with strain analysis. Molecular biomarkers of fibrosis have been related with clinical outcomes and histologically proven myocardial fibrosis. The relationship between these CMR-imaging techniques and circulating biomarkers is not fully understood. Methods and results CMR was performed on a 3T scanner in 36 individuals with HHD. Extracellular volume fraction (ECV) and the partition coefficient were assessed using the T1 mapping technique shMOLLI. Longitudinal, circumferential and radial strain was assessed using CMR-Feature Tracking. Molecular biomarkers of collagen synthesis (PICP and PIIINP) and collagen degradation (CITP and MMP-1) were measured in blood using commercial kits. Correlation models showed a significant relationship of T1 mapping measures with left atrial diameter, LV mass, LV posterior wall thickness, LV end-diastolic volume and longitudinal strain. In fully adjusted regression models, ECV was associated with left atrial diameter (β=0.75, P = 0.005) and longitudinal strain (β = 0.43, P = 0.030); the partition coefficient was associated with LV posterior wall thickness (β = 0.53, P = 0.046). Strain measures were associated with cardiac geometry, and longitudinal strain was marginally associated with CITP. Conclusion In individuals with HHD, CMR-derived measures of myocardial fibrosis and function are related and might be useful tools for the identification and characterization of preclinical cardiac dysfunction and diffuse myocardial fibrosis. Molecular biomarkers of fibrosis were marginally associated with myocardial strain, but not with the extension of CMR-measured cardiac fibrosis.

Cardiac hypertrophy and renal damage associated with hypertension are independent predictors of morbidity and mortality. In a model of hypertensive heart disease and renal damage, we tested the actions of continuous administration of Vastiras, a novel compound derived from the linear fragment of ANP (atrial natriuretic peptide), namely pro-ANP 31–67 , on blood pressure and associated renal and cardiac function and remodeling. Of note, this peptide, unlike the ring structured forms, does not bind to the classic natriuretic peptide receptors. Dahl/Salt–Sensitive rats fed a 4% NaCl diet for 6 weeks developed hypertension, cardiac hypertrophy, and renal damage. Four weeks of treatment with 50 to 100 ng/kg per day of Vastiras exhibited positive effects on renal function, independent of blood pressure regulation. Treated rats had increased urine excretion, natriuresis, and enhanced glomerular filtration rate. Importantly, these favorable renal effects were accompanied by improved cardiac structure and function, including attenuated cardiac hypertrophy, as indicated by decreased heart weight to body weight ratio, relative wall thickness, and left atrial diameter, as well as reduced fibrosis and normalized ratio of the diastolic mitral inflow E wave to A wave. A renal subtherapeutic dose of Vastiras (25 ng/kg per day) induced similar protective effects on the heart. At the cellular level, cardiomyocyte size and t-tubule density were preserved in Vastiras-treated compared with untreated animals. In conclusion, these data demonstrate the cardiorenal protective actions of chronic supplementation of a first-in-class compound, Vastiras, in a preclinical model of maladaptive cardiac hypertrophy and renal damage induced by hypertension.

Basal septal hypertrophy (BSH) is commonly seen in patients with systemic hypertension and has been associated with increased afterload. The impact of localized hypertrophy on left ventricular (LV) and left atrial (LA) function is still unclear. Our aim is to investigate if BSH is a marker of a more pronounced impact of hypertension on cardiac function in the early stages of hypertensive heart disease. An echocardiogram was performed in 163 well-controlled hypertensive patients and 22 healthy individuals. BSH was defined by a basal-to-mid septal thickness ratio ≥1.4. LV dimensions and mass were evaluated. LV global and regional deformation was assessed by 2-dimensional (2D) speckle tracking echocardiography, and LV diastolic function by 2D and Doppler imaging. LA function was evaluated with phasic volume indices calculated from 2D and 3-dimensional volumes, as well as speckle tracking echocardiography. The population was 54% men, mean age 57 (53 to 60) years. BSH was seen in 20% (n = 32) of the hypertensive cohort. Patients with BSH showed decreased regional LV systolic deformation, impaired LV relaxation with a higher proportion of indeterminate LV diastolic function, and LA functional impairment defined by a reduction of reservoir strain and a change in LA functional dynamics. In conclusion, in well-controlled hypertension impairment of LV and LA function is present in patients with early LV remodeling and localized hypertrophy. BSH might be useful as an early marker of the burden of hypertensive heart disease. This work was supported by Horizon 2020 European Commission Project H2020-MSCA-ITN- 2016 (764738), Grant from Fundacio La Marato de TV3 (040310, Exp 2015.40.30), and from Fondo de Investigaciones Sanitarias - Instituto de Salud Carlos III (PI17/ 01131).

Objective: To analyze the percentage of collagen fibers and mast cell density in the left ventricular myocardium of autopsied patients with and without hypertensive heart disease. Methods: Thirty fragments of left ventricular myocardium were obtained from individuals autopsied at the Clinical Hospital of the Federal University of Triângulo Mineiro (UFTM) in the period from 1987 to 2017. Individuals were divided into two groups: those with hypertensive heart disease (HD) and those with no heart disease (ND). Subjects were also assessed according to age, gender and race (white and non-white). Collagen fibers were quantified by computed morphometry and mast cell density was assessed by immunohistochemical methods. Results: There were significantly more collagen fibers in the left ventricle in the HD group than in the ND group (p

Angiotensin‐converting enzyme inhibitors (ACEi) are part of the indicated treatment in hypertensive African Americans. ACEi have blood pressure‐independent effects that may make them preferred for certain patients. We aimed to evaluate the impact of ACEi on anti‐fibrotic biomarkers in African American hypertensive patients with left ventricular hypertrophy (LVH). We conducted a post hoc analysis of a randomized controlled trial in which hypertensive African American patients with LVH and vitamin D deficiency were randomized to receive intensive antihypertensive therapy plus vitamin D supplementation or placebo. We selected patients who had detectable lisinopril (lisinopril group) in plasma using liquid‐chromatography/mass spectrometry analysis and compared them to subjects who did not (comparison group) at the one‐year follow‐up. The pro‐fibrotic marker type 1 procollagen C‐terminal propeptide (PICP) and the anti‐fibrotic markers matrix metalloproteinase‐1 (MMP‐1), tissue inhibitor of metalloproteinases 1 (TIMP‐1), telopeptide of collagen type I (CITP), and N‐acetyl‐seryl‐aspartyl‐lysyl‐proline (Ac‐SDKP) peptide were measured. Sixty‐six patients were included, and the mean age was 46.2 ± 8 years. No difference was observed in the number and intensity of antihypertensive medications prescribed in each group. Patients with detectable lisinopril had lower blood pressure than those in the comparison group. The anti‐fibrotic markers Ac‐SDKP, MMP‐1, and MMP‐1/TIMP‐1 ratio were higher in patients with detectable ACEi (all p

Aim: Information on systolic dysfunction, as assessed by left ventricular (LV) mechanics in secondary hypertension is still largely limited. We performed a systematic meta- analysis of 2D/3D speckle tracking studies in order to provide an updated comprehensive information on this topic. Methods: The PubMed, OVID-MEDLINE, and Cochrane library databases were analysed to search for articles published from the inception up to March 31st 2021. Studies were identified by using MeSH terms and crossing the following search items: “myocardial strain” “left ventricular mechanics”, “speckle tracking echocardiography”, “systolic dysfunction”, “hypertensive heart disease”, “left ventricular hypertrophy”, “secondary hypertension”, “primary aldosteronism”, “pheochromocytoma”, “Cushing disease”, “renal artery stenosis”. Results: On the whole, 515 patients with secondary hypertension (169 pheochromocytoma, 165 primary aldosteronism, 144 renal artery stenosis and 37 Cushing's syndrome) and 601 essential hypertensive patients from 11 studies were considered. Pooled ejection fraction (EF) was similar in essential hypertensive controls and in patients with secondary hypertension (SMD 0.12±0.06, CI: 0.001/0.25, p=0.05). Of note, EF was higher in patients with pheochromocytoma than in essential hypertensives (0.50±0.11, CI: 0.27/0.73, p

Backgroud Heart responds to physiologic and pathologic conditions and sympathetic drive plays an important role. It has been documented that LV base is more dominantly affected by sympathetic drive compared to the other regions. LV base is more dominantly exposed to wall stress in the initial period of remodeling due to pressure-overload, since LV cavity is the largest at base. Basal septal hypertrophy (BSH) in cross-sectional data is associated with the early phase of hypertensive heart disease. BSH was confirmed by 3rd generation microscopic ultrasound in small animals. BSH as the closest location to increased afterload could be detected in variety of stress stimuli and result in a huge septal hypertrophy in advance cases possibly related to earlier exposure of hemodynamic stress to septal wall. Conclusion Effective geometric and functional evaluation of initial remodeling due to hemodynamic stress is important according to both human and animal data. These findings possibly contribute to early recognition of adaptive phase of hypertensive remodeling and more effective management in a timely fashion., Highlights • Microimaging provides the documentation of regional evolution of left ventricular remodeling due to hemodynamic stress prospectively beyond cross-sectional clinical findings. • Both human and animal data show that novel quantitative imaging methods provide documentation of geometric and functional details of adaptive phase during hemodynamic stress-mediated remodeling. • Basal septal hypertrophy and hyperdynamic tissue response to hemodynamic stress could improve the clinical assessment of individuals with adaptive phase.

Background: The clinical manifestations of amyloid cardiomyopathy (AC) are not specific; therefore, AC is often misdiagnosed as hypertrophic cardiomyopathy (HCM) or hypertensive heart disease (HHD). A differential diagnosis of these three conditions is often necessary in the clinical setting. Objectives: To investigate the differential diagnostic performance of radiomic analysis, based on cardiac magnetic resonance (CMR) native T1 mapping images for the left ventricular hypertrophy (LVH) etiologies. Patients and Methods: This retrospective, case-control study was conducted on 91 participants (68 males and 23 females; mean age: 48 ± 13 years), including 22 patients with HHD, 27 patients with AC, 28 patients with HCM, and 14 controls in Tongji Hospital (Wuhan, China). All participants underwent 3.0T CMR imaging. Besides, radiomic analyses were performed using T1 mapping images. The cases were divided into training and test datasets using a random seed. Next, the models were constructed with the training dataset and evaluated with the test dataset. Results: A total of 1,033 radiomic features were extracted in this study. Overall, 11, 28, 19, and eight features were selected to construct the basal T1 mapping, mid-chamber T1 mapping, apical T1 mapping, and multi-module conjoint models, respectively. Optimal performance was reported in the mid-chamber and basal T1 mapping models. The area under the curve (AUC), precision, recall, and F1 score were 0.96, 0.84, 0.82, and 0.83 for the mid-chamber T1 mapping model and 0.96, 0.90, 0.89, and 0.88 for the basal T1 mapping model in the independent test dataset, respectively. The lowest diagnostic performance was observed in the apical T1 mapping model. The AUC, precision, recall, and F1 score of the apical T1 mapping model were 0.86, 0.71, 0.70, and 0.70 in the independent test dataset, respectively. Conclusion: The radiomic analysis of T1 mapping could accurately distinguish the three causes of myocardial hypertrophy, including HCM, HHD, and AC. It may be also a suitable alternative to late gadolinium enhancement-CMR.

Currently, diabetes mellitus (DM) is a complex global problem, which is increasing every year. So, in 2019, diabetes mellitus was detected in 463 million adults (from 20 to 79 years old) in the world. And the main cause of death in patients with diabetes mellitus is cardiovascular complications. The study was aimed investigate the features of functional and structural changes in the heart in patients with type 2 diabetes mellitus and nephropathy. A total of 98 patients with type 2 diabetes mellitus were examined, out of which 78 patients had diabetic nephropathy (DN) of varying severity. The control group consisted of 20 healthy patients. After a clinical examination, depending on the state of renal function, all patients were divided into the following groups: group I — patients with type 2 diabetes mellitus without signs of nephropathy (n = 36), group II — patients with type 2 diabetes mellitus with normal glomerular filtration rate (GFR) and albuminuria (n = 33), group III — patients with type 2 diabetes mellitus with decreased GFR and albuminuria (n = 29). To study changes in hemodynamics and structural parameters of the heart, patients underwent transthoracic echocardiography on an ULTIMA PA ultrasound machine (Radmir, Ukraine) using a sectoral phased transducer with a frequency range of 2–3 MHz according to the standard technique based on the recommendations of the American Echocardiographic Society. To determine indexing indicators, the patients underwent anthropometric measurements. Patients with DN and albuminuria and decreased GFR showed an increase in the linear dimensions of the heart in comparison with controls and patients without signs of nephropathy. With DN, patients have a significant increase in left ventricular mass and a significant increase in the detection rate of left ventricular hypertrophy up to 91.3 % in patients with albuminuria and preserved renal function and up to 100 % with a decrease in GFR., У наш час цукровий діабет (ЦД) є складною світовою проблемою, вплив якої збільшується щороку. Так, у 2019 році ЦД у світі був виявлений у 463 млн дорослих людей (від 20 до 79 років). А основною причиною смертей у хворих на ЦД є серцево-судинні ускладнення. Метою дослідження було вивчення особливостей структурних і функціональних змін у серці у хворих на ЦД 2-го типу з порушенням функції нирок. Були обстежені 98 хворих із ЦД 2-го типу, із них 78 пацієнтів були з діабетичною нефропатією (ДН) різного ступеня тяжкості. Контрольну групу становили 20 здорових пацієнтів. Після клінічного обстеження залежно від стану функції нирок усі пацієнти були розділені на групи: I група — хворі на ЦД 2-го типу без ознак нефропатії (n = 36), II група — хворі на ЦД 2-го типу з нормальною швидкістю клубочкової фільтрації (ШКФ) та альбумінурією (n = 33), III група — хворі на ЦД 2-го типу зі зниженою ШКФ й альбумінурією (n = 29). Для дослідження змін гемодинаміки і структурних параметрів серця пацієнтам проводили трансторакальну ехокардіографію на ультразвуковому апараті «Ultima PA» (Radmir, Україна) з використанням секторального фазованого датчика з діапазоном частот 2–3 МГц за стандартною методикою згідно з рекомендаціями Американського ехокардіографічного товариства. Для отримання індексованих показників хворим проводили антропометричні виміри. У хворих із ДН та альбумінурією і зниженою ШКФ виявлене збільшення лінійних розмірів серця порівняно з контролем і хворими без ознак нефропатії. При ДН у хворих відзначається вірогідне збільшення маси міокарда лівого шлуночка й істотне збільшення частоти виявлення гіпертрофії лівого шлуночка до 91,3 % у хворих з альбумінурією й збереженою функцією нирок і до 100 % — при зниженні ШКФ.

We present a case of a middle-aged patient followed up at the medical outpatient’s department routinely over two years for hypertensive heart disease and tobacco-induced chronic obstructive pulmonary disease. The patient was found to have an additional problem of congenital absence of the left main pulmonary artery.

Background Black African/African-Caribbean individuals with hypertension (BH) are at greater risk of heart failure than those of white European ethnicity (WH). The mechanisms underlying this dissimilarity remain poorly understood. Purpose To investigate the influence of ethnicity on left ventricular (LV) remodelling using multi-parametric cardiovascular magnetic resonance (CMR). Methods BH (n=44), WH (n=38) and healthy-volunteers (HV; n=25, 5 of black ethnicity) underwent comprehensive CMR. The exam included: i) Arterial Stiffness/Afterload pulse-wave-velocity (PWV), aortic elastance (Ea) and systemic vascular resistance (SVR) by phase-contrast velocity-encoding imaging; ii) Ventricular remodelling/Function LV and right ventricular (RV) volumes, mass, ejection fraction (EF), LV peak-filling rate by short-axis cine images; myocardial strains were measured by feature tracking; iii) Left atrial (LA) remodelling/Function volumes and functions by long-axis cine images; iv) Tissue characterisation: extracellular volume by pre/post-contrast T1-mapping and late gadolinium enhancement (LGE) for interstitial and replacement myocardial fibrosis, respectively. Multivariate linear regression models were developed to investigate how LV remodelling associates with ethnicity, arterial afterload, including elastance (Ea) and stiffness [PW], and SVR. Models were adjusted for age, gender, body-mass-index, LV volumes or function and LA volumes. Results Subject characteristics are summarised in the Table. PWV and Ea and SVR were greater in hypertensives, particularly in BH, than HV; this was paralleled by higher LV mass, interventricular septum thickness (IVS), LA volumes but lower LV-EF. These findings were confirmed after adjusting for age. On the Model-1, IVS was associated with Ea (β=0.335, P=0.008) and black ethnicity (β=0.226, P=0.019) but not with SVR or PWV. For each increment of Ea there was a similar increase of IVS in BH and WH (P=0.602 for interaction), however BH had greater IVS than WH at each Ea value (Figure, fully-adjusted Model-1). On Model-2, LV end-diastolic volume was associated with Ea (β=−0.268, P=0.001), SVR (β=−0.319, P=0.019) but not with PWV or ethnicity. However, the inverse relation between LV size and Ea was significantly attenuated in BH (P=0.039 for interaction), (Figure, fully-adjusted Model-2). On model-3, LV-EF was associated with Ea (β=0.223, P=0.009) but not with ethnicity, PWV or SVR. LV-EF reduction for each Ea increment was similar for BH and WH (P=0.597 for interaction). Conclusion BH and WH show a distinctive LV remodelling phenotype. BH had a greater susceptibility to hypertrophy and an attenuated reduction of chamber size in response to arterial afterload. Further research to disentangle the genetic and environmental factors underlying these ethnic group-specific differences is utterly required. Funding Acknowledgement Type of funding sources: None. Figure 1Table 1

Objective To investigate a mechanistic determinant of left atrial (LA) reservoir function in patients presenting left ventricular (LV) hypertrophy, and clarify diagnostic and prognostic values of LA reservoir strain in patients with cardiac amyloidosis (CA). Methods Three-hundred sixty patients (median age: 68 years, male gender: 65%) with left ventricular hypertrophy (LVH) assessed by echocardiography were retrospectively included. The LVH etiologies were diagnosed by any of biopsy, cardiac magnetic resonance imaging or 99mTc-PYP scintigraphy. LV segmental longitudinal strain was estimated from apical three views, and LA reservoir strain was measured from an apical 4-chamber view. Results The LVH etiologies were confirmed with CA in 81 patients, hypertensive heart disease in 87 patients, hypertrophic cardiomyopathy in 143 patients, and miscellaneous disorders in 49 patients. The median (25th, 75th percentile) value of LV ejection fraction was 59% (48–67). LV basal longitudinal strain and LA reservoir strain were significantly reduced in patients with CA compared with those with other etiologies; LV basal strain: 5.4% (3.9–8.7) vs. 11.9% (9.3–14.6), LA reservoir strain: 9.2% (6.3–12.3) vs. 17.5% (11.3–24.1), p Conclusions The decrease of LV longitudinal shortening at cardiac base could worsen LA reservoir function especially in patients with CA. LA reservoir strain might be an alternative measure to identify CA etiology and have a predictive value of heart failure hospitalization in patients with LV hypertrophy. Funding Acknowledgement Type of funding sources: None.

OBJECTIVES High-sensitivity troponin T (hsTnT) testing was approved in the United States to better facilitate diagnosis of acute coronary syndrome (ACS). Although hsTnT has been widely studied internationally, the impact of hsTnT on discharge diagnoses and health care utilization within the United States is less known. We sought to evaluate the effects of implementing hsTnT on diagnosis patterns and stress testing utilization. STUDY DESIGN We performed a retrospective cohort analysis consisting of patients with suspected ACS undergoing either conventional troponin I (n = 14,631) or hsTnT (n = 7237) testing between January 2016 and February 2019. METHODS Log-binomial regression with interrupted time series modeled diagnosis patterns, and logistic regression with segmented time trends modeled stress testing rates. Observed trends were compared with expected trends using average marginal effect (AME). RESULTS Rates of acute myocardial infarction-related diagnoses were similar in the post-hsTnT period (AME, -0.6%; P = .065). Post hsTnT introduction, patients were more likely to receive a diagnosis of heart failure (2.1%; P

Aims The transition from hypertension to heart failure (HF) remains poorly understood. We hypothesized that insufficient perfusion to match global metabolic demand, reflected by a low ratio of myocardial blood flow to global myocardial mass, may be a HF risk marker. Methods and results A retrospective cohort (n = 346) of patients with hypertension who underwent clinical positron emission tomography (PET) myocardial perfusion imaging for chest pain and/or dyspnoea at Brigham and Women’s Hospital (Boston, MA, USA) were studied. Patients without obstructive coronary artery disease by history or PET perfusion (summed stress score Conclusion An integrated physiological measure of insufficient myocardial perfusion to match global metabolic demand identifies subclinical hypertensive heart disease and elevated risk of HF and death in symptomatic patients with hypertension but without flow-limiting coronary artery disease.

Fibrosis is the hallmark of hypertensive heart disease and heart failure with preserved ejection fraction. Perivascular fibrosis impairs vascular function while interstitial fibrosis leads to compromised cardiac contractility. How these fibrosis types are represented in mouse models of hypertensive heart disease and to what extent the transcriptional signatures of cardiac fibrosis are defined by their location is unknown. Mice were dosed over 4 weeks with angiotensin II (AngII) alone or together with α 1 -adrenergic agonist phenylephrine (PE) and were characterized by echocardiography, light sheet imaging and fibrosis histology. While both groups developed systolic and diastolic dysfunction, hypertrophy and perivascular fibrosis, co-administration of PE resulted in a more severe disease phenotype and prevalent interstitial fibrosis, highlighting the benefits of this model in preclinical research. High-precision spatial transcriptomics based on laser capture microdissected perivascular and interstitial fibrotic areas revealed activation of distinct pro-fibrotic as well as cardioprotective pathways in the AngII+PE infusion model. Perivascular and interstitial fibrosis showed remarkable differences in global gene expression signatures, as demonstrated by high expression of osteochondrogenic genes and markers of secretory fibroblasts in perivascular fibrosis. A limited number of upregulated genes is shared between the fibrosis locations. These data collectively show the suitability of mouse models of hypertensive heart disease to study cardiac fibrosis and demonstrate how progression of fibrosis in mice is closely coupled to deteriorating cardiac dysfunction associated with highly distinct molecular signatures of perivascular and interstitial fibrosis.

Background Dementia is commonly associated with co-morbidities and non-specific presentations. Individualised dementia care should ideally be provided within the context of these co-morbidities and presentations. To provide systematic insights, we described the dynamic changes of 20 commonest healthcare visits prior to the diagnosis dementia in Taiwan. Methods We adopted a nested case-control approach. From the Taiwanese healthcare records, which covers >99% of Taiwanese population, we identified 491,000 case individuals first diagnosed to have dementia after age 50 years during 2002–2015, and control individuals matched at 1:1 ratio by age, sex, year of birth, and region at the time of first diagnosis. By 3-digit codes according to the International Classification of Diseases, 9th Edition (ICD-9), we identified 20 commonest causes of healthcare visits in case individuals between 2000 and 2015. Using stratified Poisson regression, we estimated cause-specific rates of healthcare visits between cases and controls within a compatible person-year, and observed the change of relative rates over the 8-year span leading to the diagnosis of dementia. With the large sample size, confidence of intervals of these relative rates for common events were almost negligible. Results There was gradual increase in average numbers of all-cause healthcare visits prior to the diagnosis of dementia. However, we observed various decline of 15 of 20 cause-specific care prior to the diagnosis of dementia compared to controls, including diabetes mellitus (ICD-9 250), disorders of lipid metabolism (ICD-9 272), cataract (ICD-9 366), disorders of conjunctiva (ICD-9 372), essential hypertension (ICD-9 401), other form of chronic ischaemic heart disease (ICD-9 414), acute nasopharyngitis (ICD-9 460), acute upper respiratory infections of multiple or unspecific sites (ICD-9 465), acute bronchitis and bronchiolitis (ICD-9 466), diseases of hard tissues of teeth (ICD-9 521), and gingival and periodontal diseases (ICD-9 522), gastritis and duodenitis (ICD-9 535), osteo-arthrosis and allied disorders (ICD-9 715), other and unspecified disorders of back (ICD-9 724), and other disorders of soft tissues (ICD-9 729). Four causes of healthcare visits that increased prior to the diagnosis of dementia included neurotic disorders (ICD-9 300), disorders of function of stomach (ICD-9 536) functional digestive disorders, not elsewhere specified (ICD-9 564), and possibly contact dermatitis and other eczema (ICD-9 692). There was little change in hypertensive heart disease (ICD-9 401 prior to the diagnosis of dementia) Conclusion Paradoxical to the increase in all-cause healthcare visits prior to the diagnosis of dementia, there was decline of commonest care prior to the diagnosis of dementia. The few increasing exceptions could be common presentations prior to the diagnosis of dementia. These time-dependent findings provide systematic insights into dementia care and diagnosis.

The course of hypertension is often complicated by left ventricular hypertrophy (or hypertensive heart disease, HHD). The main “corridor” of natural HHD is development of heart failure with preserved ejection fraction (HFpEF). With HFpEF, the bioavailability of natriuretic peptides (NP) is significantly reduced, as a result of which the activity of cGMP-PKG signaling pathway, which plays a key role in maintaining normal diastolic function, weakens. It is possible to increase the activity of this pathway using the neprilysin inhibitor sacubitril. In case of HFpEF, the greatest efficacy from valsartan+sacubitril therapy should be expected in patients with severe concentric LVH, who have the most pronounced natriuretic peptide deficiency. Valsartan+sacubitril therapy has a clear hypotensive effect, causes a reversal of left ventricular hypertrophy and fibrosis. Since no effective treatment has yet been found for HFpEF, the main way for HHD treatment should be to prevent the diastolic dysfunction progression, which justifies valsartan+sacubitril therapy starting from the early/ asymptomatic stages.

Background Left ventricular hypertrophy (LVH) is an independent prognostic factor for cardiovascular events and it can be detected by echocardiography in the early stage. In this study, we aim to develop a semi-automatic diagnostic network based on deep learning algorithms to detect LVH. Methods We retrospectively collected 1610 transthoracic echocardiograms, included 724 patients [189 hypertensive heart disease (HHD), 218 hypertrophic cardiomyopathy (HCM), and 58 cardiac amyloidosis (CA), along with 259 controls]. The diagnosis of LVH was defined by two experienced clinicians. For the deep learning architecture, we introduced ResNet and U-net++ to complete classification and segmentation tasks respectively. The models were trained and validated independently. Then, we connected the best-performing models to form the final framework and tested its capabilities. Results In terms of individual networks, the view classification model produced AUC = 1.0. The AUC of the LVH detection model was 0.98 (95% CI 0.94–0.99), with corresponding sensitivity and specificity of 94.0% (95% CI 85.3–98.7%) and 91.6% (95% CI 84.6–96.1%) respectively. For etiology identification, the independent model yielded good results with AUC = 0.90 (95% CI 0.82–0.95) for HCM, AUC = 0.94 (95% CI 0.88–0.98) for CA, and AUC = 0.88 (95% CI 0.80–0.93) for HHD. Finally, our final integrated framework automatically classified four conditions (Normal, HCM, CA, and HHD), which achieved an average of AUC 0.91, with an average sensitivity and specificity of 83.7% and 90.0%. Conclusion Deep learning architecture has the ability to detect LVH and even distinguish the latent etiology of LVH.