Heart remodeling in patients with predialysis phase of chronic renal failure

AIM: To investigate remodeling of the heart in patients with predialysis phase of chronic renal failure (CRF). MATERIAL AND METHODS: Patients with predialysis phase of CRF (n = 61; serum creatinine 412.4 +/- 242.69 mumol/l), essential hypertension (EH) (n = 35) and healthy volunteers (n = 20) were assessed with echocardiography. The patients were not significantly different by the level of systolic and diastolic blood pressure, age and gender. RESULTS: Left ventricular mass index (LVMI) was increased in 53(86.9%) patients with CRF. LVMI was not different in patients with CRF and EH (189.9 +/- 71.35 vs. 165.0 +/- 41.83 g/m2; p = 0.3). Relative wall thickness was similar in patients with serum creatinine < 200 mumol/l and patients with more elevated serum creatinine (57.2 +/- 10.33 vs 58.31 +/- 13.33; p = 0.9). The ejection fraction lower than 50% was detected in 14(22.9%) patients with CRF. Multivariate regression analysis showed that LVMI was independently related to systolic blood pressure (p = 0.004) and level of hemoglobin (p = 0.004). Diastolic dysfunction (early and atrial peak filling velocities ratio < 1.0) was detected in 13(50%) from 26 investigated patients with CRF. The independent influence of hemoglobin on isovolumic relaxation time (p = 0.04) and early and atrial peak filling velocities ratio (p = 0.02) are shown. CONCLUSION: In patients with predialysis phase of CRF left ventricular hypertrophy (LVH) is extremely common including patients with mildly elevated serum creatinine. The treatment of patients with renal pathology and normal function must include measures not only to correct renal process but also to prevent development of LVH.     

Risk factors and pathogenetic mechanisms of left ventricular hypertrophy in progressive chronic kidney disease and after transplantation of the kidney

AIM: To specify the trend in the incidence of left ventricular hypertrophy (LVH) at a predialysis stage of chronic kidney disease (CKD) in the course of its progression from stage III to stage V and after transplantation of the kidney (TK); to study correlations between homeostatic disorders caused by CKD progression and myocardial remodeling; to define the role of some hemodynamic and nonhemodynamic factors in formation of LVH. MATERIAL AND METHODS: The study enrolled 128 patients (58 males and 70 females, age 18-55 years, mean age 42 +/- 11 years) at a predialysis stage of CKD (group 1) and 225 recipients of renal allotransplant--RRA (group 2, 140 males and 85 females, age 18-69 years, mean age 43 +/- 12 years). General clinical examination, biochemical and immunological blood tests, echocardiography were made. RESULTS: At a predialysis stage of CKD, LVH was diagnosed in 56% patients. Incidence of LVH was directly related with age of the patients (p = 0.001), blood pressure (p < 0.001), duration of arterial hypertension (p = 0.004), severity of anemia (p = 0.017), the level of C-reactive protein (p = 0.003), blood phosphorus concentration and inversely correlated with glomerular filtration rate--GFR (p = < 0.001), albumin level (p = 0.023) and blood Ca (p < 0.001). LVH was followed up for 12 months in 35 patients with predialysis CKD. Factors of LVH progression and factors hindering its regression were systolic blood pressure, Hb and Ca in the blood. In group 2 of RRA incidence of LVH was 53%. Significant factors of LVH risk after transplantation were age (p = 0.002), hypertension (p = 0.005) and anemia (p = 0.04). Moreover, LVH closely correlated with proteinuria (p < 0.03), transplant dysfunction (p = 0.002) and posttransplantation ischemic heart disease (p < 0.037). Changes in LVH were analysed in 30 RRA. Frequency of LVH decreased for 2 years after transplantation (from 56 to 32%) but 36-60 and more months after transplantation it increased (46 and 64%, respectively). Transplant dysfunction was the leading factor hindering LVH regression after transplantation. CONCLUSION: The same mechanisms are involved in LVH pathogenesis after transplantation and at a predialysis stage of CKD. The significance of initial renal lesion signs--minimal proteinuria and hypercreatininemia--was higher after renal transplantation than in patients with CKD.     

Impact of day-to-day arterial pressure variability on the left ventricle geometry in patients with predialysis chronic kidney insufficiency

AIM: To estimate the impact of day-to-day variability of blood pressure (BP) on left ventricular geometry in pre-dialysis patients. MATERIAL AND METHODS: We estimate the impact of day-to-day variability of BP on left ventricular geometry in 42 non-diabetic pre-dialysis patients (22 F, 20 M, mean age 47 +/- 12 years) with arterial hypertension (> 140 and 90 mm Hg). Serum creatinine was 286.2 +/- 176.8 micromol/l. BP was measured in the morning during 12 days and M +/- SD and delta systolic blood pressure (dSBP = SBPmax - SBPmin) was calculated. Echocardiography was performed and left ventricular mass index and relative wall thickness (RWT) was estimated. RESULTS: LVH was detected in 35(83.3%) patients. Multiple stepwise regression analysis revealed that mean SBP is a stronger predictor of LVH than clinical SBP (R2 = 0.59; p = 0.000001 and R2 = 0.35; p = 0.0007, resp.). Standard deviation of mean SBP correlated with RWT (R2 = 0.30; p = 0.006). dSBP > 30 mmHg was associated with an increase of RWT. CONCLUSION: Mean SBP during 12 days is a stronger predictor of LVH than clinical SBP. Day-to-day variability of SBP with dSBP > 30 mm Hg was associated with development of concentric LVH.     

The role of major vessels remodeling in development of left ventricular hypertrophy in patients with a predialysis stage of chronic renal failure

AIM: To study correlation between development of left ventricular hypertrophy (LVH) and remodeling of major arteries at a predialysis stage of chronic renal failure (CRF). MATERIAL AND METHODS: A total of 95 non-diabetic patients (48 males-51% and 47 females-49%) with stage I-III CRF entered the trial. A mean age of the patients was 46.7 years (95% CI 43.7-49.8 years). Glomerular filtration rate calculated by Cockrott-Gault formula was 37.7 ml/min (33.9-41.4 ml/min), blood creatinine level--2.9 mg/dl (2.6-3.2 mg/dl). Arterial hypertension (AH) was registered in 96% patients, smoking--in 40%, cardiovascular hereditary burden--in 54%, hyperlipidemia--in 66%, overweight--in 60%, anemia--in 34%, hyperphosphatemia--in 45%. Echocardiography, ultrasonic dopplerography of the common carotid arteries (CCA) and common femoral artery (CFA) were performed in 83 and 37 patients, respectively. RESULTS: LVH (LV myocardium mass index > 134 g/m2 for males and > 110 g/m2 for females) was detected in 37.3% patients. Concentric remodeling was recorded in 31.3%, concentric myocardial hypertrophy--in 19.1% patients, excentric hypertrophy--in 18.1%. Development of LVH was linked with age, high systolic and pulse blood pressure, marked renal dysfunction, anemia, elevated ESR and hyperphosphatemia. The presence of L VH correlated with increased thickness of intima-media complex (IMC) of CCA and CFA (r = 0.65, p < 0.01 and r = 0.51, p < 0.05, respectively). There was correlation between thickness of LV posterior wall and impairment of CCA elasticity (r = -0.42, p < 0.05). CONCLUSION: Patients with initial and moderate disorders of renal function frequently have LVH related to conventional and "renal" risk factors. A LV mass increase and structural-functional changes of major vessels strongly correlate.     

Myocardial remodeling in chronic renal failure patients on hemodialysis

Pathologic myocardial changes in is one of the main causes of death in patients with terminal chronic renal failure (CRF). The authors studied structural and functional condition of the myocardium and the effect of various CRF factors on cardiovascular complications. The study demonstrates positive correlation between systolic arterial pressure (AP) and left ventricular (LV) remodeling, as well as between the degree of anemia and LV remodeling in patients with CRF on program hemodialysis. Concentric LV hypertrophy (LVH) was revealed in 24 (65%) patients, eccentric LVH--in 7 (19%) patients. The results show that eccentric LVH with reduced ejection fraction in CRF patients on hemodialysis is associated with high systolic and pulse pressure.     

The Effects of Amlodipine on Left Ventricular Mass and Diastolic Function in Concentric and Eccentric Left Ventricular Hypertrophy

BACKGROUND: The effects of the antihypertensive therapy with amlodipine (5-10 mg/day) on left ventricular mass and diastolic function were examined in 30 mild to moderate essential hypertensive patients who have left ventricular hypertrophy (LVH) and diastolic dysfunction. METHODS AND RESULTS: Each patient's left ventricular mass was measured, and left ventricular diastolic function was assessed by echocardiographic Doppler examination at entry, and at 3 and 6 months after the initiation of the treatment. Amlodipine reduced both blood pressure (from 164 +/- 14/104 +/- 6 mmHg to 134 +/- 9/83 +/- 4 mmHg) and left ventricular mass index (from 160 +/- 30 g/m(2) to 137 +/- 26 g/m(2)) significantly at 3 months and both parameters maintained at these levels for 6 months. When the patients were classified according to the type of the LVH, a significant regression in left ventricular mass index was seen only in the patients who had concentric LVH was a relative wall thickness >/=0.44 (n = 16), but not in the eccentric LVH group (n = 14), although both groups were not significantly different from each other regarding the basal hemodynamic parameters, baseline left ventricular mass index and the decrease in blood pressure in response to amlodipine treatment. The mitral inflow E/A ratio did not show any significant change in either group. CONCLUSIONS: Amlodipine produced significant regression in LVH only in the patients with concentric LVH, but not those with eccentric LVH, while it did not change the diastolic dysfunction. Therefore, the type of LVH seems to be an important feature in determining the effects of antihypertensive treatment on left ventricular mass index.     

Cardioprotective effect of erythropoietin preparations in patients with chronic renal failure

AIM: To investigate effects of early correction of anemia on the rate of cardiovascular complications and survival on regular hemodialysis (RHD). MATERIAL AND METHODS: Eighty patients with chronic renal failure (CRF) on regular hemodialysis entered two groups: group 1 with hemoglobin (Hb) < 80 g/l (n = 36) and group 2 with Hb > 100 g/l (n = 44). 90% patients of group 2 were treated for renal anemia for 6-8 months of predialysis CRF. When placed on RHD, group 1 started therapy with epoetin, 39 patients of group 2 continued epoetin treatment. RESULTS: Patients of group 2 had a higher rate of eccentric left ventricular hypertrophy (LVH) with reduced ejection fraction and development of congestive cardiac failure and coronary heart disease. Eccentric LVH in group 1 patients regressed only in 80% when the patients were on hemodialysis and received epoetin for correction of anemia. Overall cardiac death in group 1 was twice that of group 2 patients. CONCLUSION: Early correction of anemia led to a 50% increase in 5-year survival. This fact can be explained with inhibited progression of eccentric LVH.     

Structural-functional alterations in the heart affecting dynamics of transmitral blood flow during a hemodialysis session

AIM: To study dynamics of transmitral circulation (TMC) during a hemodialysis (HD) session in patients with chronic renal failure (CRF) regarding structural-functional alterations of the heart and baseline condition of the diastolic function of left ventricular (LV) myocardium. MATERIAL AND METHODS: Sixty one patients (34 females and 27 males, mean age 47 +/- 11 years) on programmed HD free of heart valvular disease, ischemic heart disease, acute myocardial infarction, atrial fibrillation. Before and after HD session the patients underwent echocardiography, including Doppler regime. RESULTS: Normal LV geometry was detected in 3 (4.9%) patients, concentric remodeling - in 9 (14.8%), concentric LV hypertrophy (LVH) - in 37 (60.7%), excentric LVH - in 12 (19.7%) patients. The ejection fraction was under 45% in 5 (8.2%) patients. Diastolic dysfunction of LV myocardium was found in 42 (68.9%) patients, TMC characteristic of slow relaxation was registered most frequently (47.6%). A pseudonormal type of TMC was recorded in 16 (38.1%) patients. HD did not change TMC significantly in patients with normal diastolic function (before HD E peak velocity was 88.7 +/- 19.8 cm/s, after - 80.0 +/- 24.6 cm/s, p > 0.05). In patients with initially disturbed relaxation the velocity of early diastolic flow (Vp) (color M-mode Doppler) increased (before HD, Vp was 67.6 +/- 17.1 cm/s, after - 72.9 +/- 15.7 cm/s, p < 0.05), E/Vp reduced (before HDm E/Vp was 1.2 +/- 0.4, after 1.0 +/- 0.4, p < 0.05). The subgroup with initially pseudonormal TMC showed decreased velocity in the E peak (before HD - 103.4 +/- 13.5 cm/s, after - 76.8 +/- 24.0 cm/s, p < 0.001). In restrictive TMC this velocity also decreased - 129.0 +/- 17.8 cm/s and 108.8 +/- 14.7 cm/s, p < 0.05, respectively). CONCLUSION: TMC alteration during a HD session depends more on initial type of diastolic dysfunction than on LV geometry. A HD session improves intracardiac hemodynamics in patients with pseudonormal TMC.     

Influence of the Type and Degree of Left Ventricular Hypertrophy on the Prevalence of Ventricular Arrhythmias in Patients with Hypertensive Heart Disease

Abstract Purpose:   To investigate the correlation between the prevalence of ventricular arrhythmias (VA) and the type and degree of left ventricular hypertrophy (LVH) in hypertensive patients using exercise testing and Holter monitoring. Patients and Methods:   A total of 192 patients (87 men and 105 women) without coronary disease were divided into three groups according to type of LVH (concentric, eccentric, and asymmetric) and three subgroups in relation to the degree of hypertrophy (mild, moderate, and severe). In all subjects blood pressure was measured, electrocardiographic and echocardiographic data obtained and the prevalence of VA determined by Holter monitoring and bicycle ergometry. Results:   The most frequent LVH type was the concentric (63%), followed by eccentric (28%) and asymmetric (9%). Severe LVH was found in 10% of patients. Complex VA during Holter monitoring were identified in > 40% of patients. During the stress test this percentage increased by additional 7.4%. There was no statistically significant difference between groups in frequency of simple (p = 0.757) and complex (p = 0.657, p = 0.819, p = 0.617, for polytopic, pairs and ventricular tachycardia, respectively) VA. Increased prevalence of VA was found for the moderate and severe degree in all types. In the concentric type the difference was statistically significant for simple VA (p = 0.042). Conclusion:   There was no correlation between type of LVH and prevalence of VA. The severity of hypertrophy contributes more to a greater prevalence of VA than the LVH pattern. The combination of severe degree and concentric type carries the greatest cardiovascular risk.      

The diurnal blood pressure and the EchoCG parameters of the left ventricle in patients with diabetic nephropathy

The purpose of the study was to examine the geometry of the left ventricle (LV) in patients with type 1 diabetes mellitus (DM) in relation to the 24-hour profile of blood pressure (BP) and urinary albumin excretion. The study covered 60 patients with type 1 DM and normal creatinine clearance, including 20 patients with normal albuminuria, 23 with microalbuminuria, and 17 with proteinuria. 24-hour BP monitoring was performed oscillometrically; myocardial structural parameters were studied by echoCG. LV hypertrophy (LVH) was found in 1 patient with normal albuminuria and in 8 with proteinuria (5, 30.4, and 47%, respectively; chi2 = 9.3; p = 0.09). The frequency of concentric and eccentric types of LVH was equal. In patients with a lower nocturnal BP decrease, the LV myocardial mass index (LVMMI) and relative posterior wall thickness (RPWT) were higher than those in other patients (LVMMI, 120.8 +/- 24.6 and 95.0 +/- 23.1 g/m2, respectively; p < 0.001; RPWT, 0.35 +/- 0.06 and 0.31 +/- 0.06, respectively, p = 0.013). Multifactorial stepwise regression analysis has indicated that age, male sex, and proneinuria directly affected LVMMI (R2 = 0.70; p < 0.001). Diastolic BP, autonomic neuropathy, and hemoglobin levels were found to be independent predictors of RPWT (R2 = 0.70; p < 0.009). The findings suggest that there is a close relationship between diabetic neuropathy and LV remodeling in patients with type 1 DM. This relationship may be operative via factors, such as arterial hypertension, altered diurnal BP profile, autonomic neuropathy, and anemia.     

Investigative Concerns in Demonstrating Reduced Risk From Reversing Left Ventricular Hypertrophy

BACKGROUND: To demonstrate reduced risk from reversing left ventricular hypertrophy (LVH) in hypertension, one must show that it is independent of blood pressure reduction. METHODS AND RESULTS: A feasibility study was conducted with 15 patients. The study employed 48-hour Holter recording, exercise treadmill (for ST-segment changes) and, as necessary, thallium scintigraphy and coronary angiography. All patients were treated for 3 months with quinapril (10 mg) and demonstrated decreased mean arterial pressure (125 +/- 3.1 vs 103 +/- 1.9 mmHg; P <.01) and left ventricular mass index (125 +/- 6.4 vs 104 +/- 4.9; P <.02) with preserved left ventricular function. There were no significant changes in these patients with moderate LVH in the incidence of arrhythmias; however, 4 of the 15 patients developed ST-segment changes prior to LVH reversal, and these changes did not recur in 3 patients following reversal of LVH or when pressure was allowed to rise. CONCLUSIONS: Ischemic changes, rather than development of arrhythmias, may be of greater value in demonstrating risk reduction with LVH reversal. Moreover, these preliminary data suggest pitfalls in demonstrating risk reduction after LVH reversal, indicating that more sensitive and adequate techniques are necessary to show risk reduction from LVH.     

Clinico-genetic aspects of the hypotensive response and regression of left ventricular hypertrophy in arterial hypertension patients

AIM: To study clinicogenetic determinants of left ventricular hypertrophy (LVH) regress in 52-week antihypertensive therapy to achieve the target arterial pressure (AP) < 140/90 mm Hg. MATERIAL AND METHODS: I/D-polymorphism of angiotensin converting enzyme gene, T174M-polymorphism of angiotensinogen gene, A1166C-polymorphism of angiotensin II ATI-receptor gene (ATII), 4a/b-polymorphism of endothelial NO-synthetase gene (eNOS) were determined in 64 patients (24 males, 40 females, mean age 54 +/- 1.1 years) with arterial hypertension (AH) and LVH. Echocardiography, laboratory tests, clinical measurements of blood pressure (BP) and 24-h AP monitoring were made after 4 weeks of placebo and 52 weeks of treatment. RESULTS: Baseline values of LV myocardium mass index (LVMMI) correlated significantly with mean 24 hour and night systolic arterial pressure; 24-h, day and night pulse pressure (PP). In patients with regress of LVH the degree of LVMMI reduction significantly correlated with lowering of day and night PP, baseline level of neutrophils, uric acid and creatinine 52 weeks after treatment. Groups made by polymorphism, did not significantly differ by initial LVMMI, frequency of achievement of target AP. In patients with genotypes ID/II and aa, the level of achieved diastolic arterial pressure was significantly lower than in other groups. Resistant LVH was seen in 42.2% patients. Frequency of AP normalization was higher in the group of patients with LVH regress (48.6% vs 25.9%; p < 0.05). Resistant LVH occurred more frequently in patients with genotype DD (64.0 vs 28.2% in patients with II/ID, p < 0.05) and in patients with genotype 4ab (62.9 vs 30.4% in patients with genotype aa and 21.4%--with genotype bb; p < 0.05 in both cases). In patients with resistant LVH frequency of DD genotype increased (59.3 vs 24.3% in patients with regress of LVH; p < 0.01), genotype AA (74.5 vs 48.6%; p < 0.01) and genotype ab (63.0 vs 27.0%, p < 0.01). CONCLUSION: Regress of LVH in AH patients depends on dynamics and complex interactions of some hemodynamic, laboratory and genetic parameters.     

Factors influencing left ventricular diastolic function in elderly patients with chronic heart failure

The purpose of the study was to define factors influencing the diastolic left ventricular (LV) function in elderly patients with chronic heart failure (CHF). Ninety-seven I to IV functional class CHF patients aged 65 to 88 (mean age 76.6+/-5.1 yr), 61 women and 36 men, were examined. CHF was caused by coronary artery disease in 22 (22.7%) patients, by arterial hypertension in 14 (14.4%) patients, and by both in 61 (62.9%) patients. Fourteen (14.4%) patients had type 2 diabetes. Hemoglobin level lower than 130g/l in men or 120g/l in women was considered anemia. Glomerular filtration speed (GFS) was calculated using Cockcroft-Gault formula. EchoCG and Doppler EchoCG were performed in all patients. LV hypertrophy (LVH) was revealed in 90 (92%) of the patients; 52patients had concentric L VH and 38 patients had eccentric LVH. Ejection fraction was less than 45% in 17 (17.5%) patients. Isovolemic relaxation time (IVRT) was over the normal limit in 73 (75.3%) patients; the time of early diastolic flow slowing (DT) changed in different directions and was 211.2+/-55.6 msec. A type of transmitral blood flow with relaxation disorder was found in 58 (59.8%) patients, a pseudonormal type was revealed in 32 (33%), and a restrictive type was found in 7 (7.2%) of patients. The study found a reverse independent correlation between hemoglobin level and the speed of LV filling during atrial systole. An independent correlation between the degree of renal dysfunction (GFS) and disorder of LV relaxation was found: the lower GFS, the longer IVRT and DT. Thus, in addition to age and structural changes in the heart, factors that have adverse effects on diastolic filling parameters are anemia, lowered renal function, and the level of systolic and diastolic pressure.     

Risk factors of vascular complications in patients at a predialysis stage of chronic renal failure

AIM: To specify risk factors of vascular complications at a predialysis stage of renal failure. MATERIAL AND METHODS: The trial enrolled 165 patients with chronic renal failure (CRF) aged 46 +/- 15 years, glomerular filtration rate (GFR) - 37.2 (35.02-40.83) and arterial hypertension (96%). The examination included ultrasound dopplerography of the common carotid arteries (CCA) and common femoral arteries (CFA) for detection of atherosclerotic plaques (AP), estimation of the thickness of arterial intima-media, elasticity and rigidity of the vascular wall. Factors of risk for atherosclerosis and cardiovascular complications were assessed. RESULTS: Aortic atherosclerosis was detected in 60 patients, that of cardiac vessels, brain, kidneys and lower limbs - in 35, 30, 23 and 8 patients, respectively. Acute cardiovascular complications occurred in 13 patients. Main atherosclerosis risk factors were age, body mass index, systolic and pulse arterial pressure, disturbances of phosphorus-calcium metabolism. Structure and function of CCA and CFA were studied with dopplerography in 37 CRF patients. Increased intima-media thickness was associated with age, male sex, overweight, hypercholesterinemia, systolic and pulse arterial pressure. Body mass index, GFR, creatinin level were independent factors of intima-media thickness. Abnormal elasticity of CCA was related to hypertension, CFA - to hypercholesterolemia.     

Variants of heart remodeling in essential hypertension: prevalence and determinants

AIM: To study myocardial remodeling (MR) in hypertensive patients with normal and excessive body mass, to analyse MR features depending on clinical and hemodynamic parameters. MATERIAL AND METHODS: Structural-functional conditions of the myocardium were studied with echocardiography, and determination of left ventricular remodeling (LVR) type was made in 734 untreated hypertensive patients aged 19-76 years. RESULTS: Patients with essential hypertension (EH) stage I had mostly excentric left ventricular hypertrophy (LVH). The number of patients with concentric LVH increases with age, disease severity. This type of LVH occurs more frequently in males than in females. In females, LVH severity depends, primarily, on the degree of obesity. If EH combines with obesity, structural alterations of the myocardium are more prominent than in isolated pathology. In android obesity, LVH is more frequent. CONCLUSION: In EH, structural alterations of the heart and a LVR variant are determined, besides arterial pressure, by such factors as age and gender, duration of EH, obesity, its degree and kind.     

Left ventricular remodeling in association of arterial hypertension with diabetes mellitus type 2: correlation with gender and disease duration

AIM: To study specific features of left ventricular remodeling (LVR) in patients with hypertension and diabetes mellitus type 2 (DM-2). MATERIAL AND METHODS: The study group comprised 290 patients, the control group consisted of 79 patients with essential hypertension free of carbohydrate tolerance impairment. The age of the examinees ranged from 35 to 60 years. Structural-geometric left ventricular model was determined by echocardiography. Estimation of significant determinants of myocardial mass index (MMI) and types of left ventricular remodeling was made with multiple regression analysis and logistic regression. The parameters of 24-h monitoring of blood pressure, glycemic control, blood lipid-transport function, plasma insulin, aldosteron, hydrocortisone levels, blood rennin activity were used as independent variants. Incidence of registration of left ventricular excentric hypertrophy (LVEH) in the study group was higher as compared to control (27.6 and 16.5%, respectively; p < 0.05). A rise of left ventricular MMI in the study group was related to 24-h systolic arterial pressure and basal insulinemia (R2 = 0.4229). Development of left ventricular structural-geometric model in the study group depended on the gender, duration of diabetes, 24-h systolic blood pressure (direct correlation) and 24-h diastolic blood pressure (inverse correlation), R2 = 0.6500. In DM duration about 5 years, percentage of males with concentric left ventricular hypertrophy (CLVH) and LVEH was 63% versus 37% (chi-square 5.0815, p < 0.03). In longer diabetes LVEH was seen more frequently than CLVH (73.3 and 26.7%, respectively). Among women with left ventricular hypertrophy and hypertension under 10 years LVEH and CLVH were detected in 69.1 and 30.9% cases, respectively (chi-square 7.9356, p < 0.01). Later, these differences became less obvious (41.7 and 58.3%, respectively). CONCLUSION: Hypertensive patients with diabetes mellitus type 2 develop structural-geometric changes of the heart earlier. LVR in such patients is associated with gender, duration of DM and non-proportional growth of 24-h systolic blood pressure leading to gender-related differences in the time of formation of LVEH and CLVH.     

Contribution of plasma matrix metalloproteinases to development of left ventricular hypertrophy and diastolic dysfunction in hypertensive subjects

Matrix metalloproteinases (MMPs) are involved in the regulation of the extracellular matrix (ECM) of the myocardium and thus the pathogenesis of vascular and cardiac hypertrophy. In this study, we investigated contribution of plasma matrix metalloproteinases to development of left ventricular hypertrophy (LVH) and diastolic dysfunction in hypertensive subjects. Hypertensive patients with (n = 27) and without LVH (n = 23) were included. All participants underwent a complete transthoracic echocardiographic examination, including recordings of the mitral annular early, late, systolic and diastolic velocities by Doppler imaging. Plasma concentrations of MMP-3 and MMP-9 were determined by the one-step sandwich enzyme immunoassay method. Plasma MMP-3 and MMP-9 concentrations were significantly higher in patients with LVH than those without LVH (2.4 +/- 1.2 vs 1.5 +/- 0.7 ng/ml, p = 0.006 and 5.2 +/- 2.8 vs 3.3 +/- 1.7 ng/ml, p = 0.003, respectively). MMP-3 and MMP-9 levels were also correlated with left ventricular posterior wall thickness and Doppler indices of diastolic dysfunction. Our findings have suggested that increased MMP levels may contribute to LVH and left ventricular diastolic dysfunction. Therefore, treatment of hypertension with MMP lowering drugs, such as angiotensin converting enzyme inhibitors and angiotensin receptor blockers, may have favorable effects on LVH and left ventricular diastolic dysfunction.     

Factors influencing the condition of the intima-media complex of carotid and femoral arteries at initial stages of chronic renal failure

AIM: To examine changes in the structure of large (carotid and femoral) arteries at an early stage of chronic renal failure (CRF) and factors significant for their development. MATERIAL AND METHODS: Duplex ultrasonography of the common carotid arteries (CCA) and common femoral arteries (CFA), serum biochemical tests, echocardiography were made in 32 patients (15 males and 17 females) with chronic diffuse renal disease at an initial stage of CRF (creatinine 2.7 mg%, CRF duration 2.7 years). Increased thickness of the intima-media complex (IMC) in both vascular territories was found in 72% of the examinees. There was a close correlation between CCA and CFA IMC (chi-square = 14.05; p = 0.0002). Plaques in the carotid arteries correlated with smoking (chi-square = 4.60; p = 0.0320), in the femoral arteries--with male sex (chi-square = 5.18; p = 0.0228). IMC of both arteries correlated with age (r = 0.49 and r = 50, respectively, p < 0.05), body mass index (r = 0.50, p < 0.05), thickness of the left ventricular posterior wall and interventricular septum (r = 0.65 and r = 0.55, respectively, p < 0.05), CFA IMC correlated also with creatinine level (r = 0.39, p < 0.05), hypertriglyceridemia (chi-square = 10.33; p = 0.0013), systolic, pulse and mean arterial pressure (r = 0.45, r = 0.38, r = 0.36, respectively, p < 0.05), smoking (r = 0.48, r = 0.40, respectively, p < 0.05) and family history of cardiovascular diseases (chi-square = 7.16; p = 0.0075). A linear multifactorial regression analysis has detected that an independent factor of increased CCA and CFA IMC in patients under 50 years of age was creatinine, in patients over 50 years--age. CONCLUSION: Even at early stages of renal failure patients have thicker IMC associated with both standard risk factors (age, hypertension, smoking, lipid disbolism) and development of renal failure itself.     

Cardiovascular magnetic resonance in the diagnosis of acute heart transplant rejection: a review

Background

Left ventricular hypertrophy (LVH) is a hallmark of chronic pressure or volume overload of the left ventricle and is associated with risk of cardiovascular morbidity and mortality. The purpose was to evaluate different electrocardiographic criteria for LVH as determined by cardiovascular magnetic resonance (CMR). Additionally, the effects of concentric and eccentric LVH on depolarization and repolarization were assessed.

Methods

120 patients with aortic valve disease and 30 healthy volunteers were analysed. As ECG criteria for LVH, we assessed the Sokolow-Lyon voltage/product, Gubner-Ungerleider voltage, Cornell voltage/product, Perugia-score and Romhilt-Estes score.

Results

All ECG criteria demonstrated a significant correlation with LV mass and chamber size. The highest predictive values were achieved by the Romhilt-Estes score 4 points with a sensitivity of 86% and specificity of 81%. There was no difference in all ECG criteria between concentric and eccentric LVH. However, the intrinsicoid deflection (V6 37 ± 1.0 ms vs. 43 ± 1.6 ms, p < 0.05) was shorter in concentric LVH than in eccentric LVH and amplitudes of ST-segment (V5 -0.06 ± 0.01 vs. -0.02 ± 0.01) and T-wave (V5 -0.03 ± 0.04 vs. 0.18 ± 0.05) in the anterolateral leads (p < 0.05) were deeper.

Conclusion

By calibration with CMR, a wide range of predictive values was found for the various ECG criteria for LVH with the most favourable results for the Romhilt-Estes score. As electrocardiographic correlate for concentric LVH as compared with eccentric LVH, a shorter intrinsicoid deflection and a significant ST-segment and T-wave depression in the anterolateral leads was noted.