Alterations in cardiac structure and function in hypertension

Leveraging Preexisting Cardiovascular Data to Improve the Detection and Treatment of Hypertension: The NOTIFY-LVH Randomized Clinical Trial

Importance

Hypertension is often underrecognized, leading to preventable morbidity and mortality. Tailored data systems combined with care augmented by trained nonphysicians have the potential to improve cardiovascular care.

Objective

To determine whether previously collected cardiovascular imaging data could be harnessed to improve the detection and treatment of hypertension through a system-level intervention.

Design, Setting, and Participants

The NOTIFY-LVH trial was a 2-arm, pragmatic randomized clinical trial conducted from March 2023 through June 2024 within the Mass General Brigham health care system, a multi-institutional network serving the greater Boston, Massachusetts, area. The study included individuals with a Mass General Brigham primary care affiliation who had left ventricular hypertrophy (LVH) on a prior echocardiogram, had no established cardiomyopathy diagnosis, and were not being treated with antihypertensive medications. Patients were followed for 12 months postintervention.

Intervention

Population health coordinators contacted clinicians of patients randomized to the intervention, notifying them of LVH and offering assistance with follow-up care. A clinical support pathway-including 24-hour ambulatory blood pressure monitoring or cardiology referrals-was provided to aid LVH evaluation.

Main Outcomes and Measures

The primary outcome was the initiation of an antihypertensive medication. Secondary outcomes included new hypertension and cardiomyopathy diagnoses.

Results

A total of 648 patients were randomized-326 to the intervention and 322 to the control. Mean (SD) patient age was 59.4 (10.8) years and 248 patients (38.3%) were female. A total of 102 patients (15.7%) had a baseline diagnosis of hypertension and 109 patients (20.1%) had a mean outpatient blood pressure of 130/80 mm Hg or higher. Over 12 months, 53 patients (16.3%) in the intervention arm were prescribed an antihypertensive medication vs 16 patients (5.0%) in the control arm (adjusted odds ratio [OR], 3.76; 95% CI, 2.09-6.75; P < .001). Individuals in the intervention group were also more likely to be diagnosed with hypertension (adjusted OR, 4.43; 95% CI, 2.36-8.33; P < .001). Cardiomyopathy diagnoses did not significantly differ between groups.

Conclusions and Relevance

In the NOTIFY-LVH randomized clinical trial, a centralized population health coordinator-led notification and clinical support pathway for individuals with LVH on prior echocardiograms increased the initial treatment of hypertension. This work highlights the potential benefit of leveraging preexisting but potentially underutilized cardiovascular data to improve health care delivery through mechanisms augmenting the traditional ambulatory care system.

Trial Registration

ClinicalTrials.gov Identifier: NCT05713916.

Trends in hypertensive heart disease-related mortality among older adults in the USA: a retrospective analysis from CDC WONDER between 1999 and 2020

BACKGROUND

While hypertensive heart disease (HHD) has been widely studied, this study uniquely examines the impact of the COVID-19 pandemic on HHD mortality trends, which has not been thoroughly explored in the current literature. The pandemic's effects on healthcare access, economic instability, and social isolation present new challenges and opportunities for understanding HHD mortality among the elderly.

RESULTS

Age-adjusted mortality rates (AAMRs) increased overall between 1999 and 2020, from 36.7 to 133.9 per 100,000 people, according to analysis. The data on AAMRs indicated a consistent rise from 1999 to 2017, with a notable uptick from 2017 to 2020. An investigation based on gender revealed that older men had a consistently higher AAMR than older women. The biggest AAMRs were found among the non-Hispanic (NH) Black or African-American population, according to variations in AAMR based on race and ethnicity. Geographic differences between states revealed that compared to Nebraska, Oregon, North Dakota, Maine, and Minnesota, the District of Columbia, Oklahoma, Nevada, Vermont, and Mississippi had substantially higher AAMRs. The West, Northeast, and Midwest were in second place with a continuously higher AAMR, followed by the South. Furthermore, compared to non-metropolitan areas, metropolitan areas had a higher AAMR.

CONCLUSION

The importance of including demographic and geographic factors in public health planning and interventions is highlighted by these findings, which provide insightful information on mortality trends associated with HHD in the elderly.

Ferroptosis in senescence and age-related diseases: pathogenic mechanisms and potential intervention targets

As the global population continues to age, the prevalence of age-related diseases is increasing, significantly influencing social and economic development, the stability of social security systems, and progress in medical technology. Ferroptosis, a recently discovered form of programmed cell death driven by iron-dependent lipid peroxidation, has emerged as a key area of research. Studies have revealed a strong association between ferroptosis and senescence. In this article, we systematically summarize the molecular mechanisms and associated signaling pathways underlying ferroptosis, emphasizing its pivotal role in the onset and progression of age-related diseases. By providing new perspectives, we aim to advance understanding of the pathogenesis of age-related diseases and guide the development of effective intervention strategies.

Association between echocardiographic parameters of cardiac structure and function and mild cognitive impairment

BACKGROUND

Cardiovascular diseases (CVDs) marked with cardiac morphological or hemodynamical abnormalities are associated with mild cognitive impairment (MCI). The links between cardiac structure and function and MCI are not well understood. We aimed to explore the association between echocardiographic parameters of cardiac structure and function and MCI in CVD patients.

METHODS

We conducted an age-, gender-, and education level-matched case-control study in general CVD participants with a 1:3 ratio of MCI (Montreal Cognitive Assessment [MoCA] score < 26 and Mini-Mental State Examination [MMSE] score ≥ 24) and cognitively normal participants at a tertiary hospital in Beijing, China. The echocardiographic cardiac parameters and cognitive status were retrieved through the clinical electronic database from May 2021 to August 2023. Principal component analysis (PCA), negative binomial, and conditional multivariate regression were performed.

RESULTS

A total of 1136 CVD participants (mean age, 61.2 ± 8.3 years) were included in the study, comprising 289 (25.3%) MCI and 847 cognitively normal participants. Compared to cognitively normal participants, MCI participants had a higher prevalence of left ventricular (LV) diastolic dysfunction (54.0% vs. 40.3%; P < 0.001) and greater interventricular septal thickness (IVST) (1.04 ± 0.20 cm vs. 1.00 ± 0.17 cm; P = 0.002). LV diastolic dysfunction (Beta [SE], 0.234 [0.045]; P < 0.001) and IVST (Beta [SE], 0.034 [0.016]; P = 0.036) were negatively correlated with the MoCA score of global cognitive function. LV diastolic dysfunction (OR, 2.03; 95% CI, 1.48-2.79; P < 0.001) and IVST (OR, 1.14; 95% CI, 1.03-1.27; P = 0.014) were positively associated with MCI, independent of diagnosed CVDs and the conventional MCI risk factors.

CONCLUSIONS

General CVD patients with abnormal echocardiographic LV diastolic dysfunction and IVST were associated with cognitive decline, suggesting further cognitive assessment for MCI.

TRIAL REGISTRATION

Retrospectively registered.

Hypertensive Response to Exercise in Normotensive Men and Women with Abdominal Obesity: Association with Subclinical Adverse Cardiac Remodeling

Background/Objectives: Hypertensive response to exercise (HRE) is an established risk factor for cardiovascular events. HRE is prevalent among people with excess adiposity. Both obesity and HRE have been individually associated with adverse cardiac remodeling. We hypothesized that HRE would be associated with adverse measures of cardiac structure and function in a subgroup of individuals with abdominal obesity. Methods: In a subgroup of 158 participants with elevated waist circumference (women: ≥80 cm, men: ≥94 cm) and resting blood pressure (BP) < 140/90 mm Hg, we evaluated maximal exercise BP and peak oxygen consumption (VO2peak) during cardiorespiratory exercise testing. HRE was defined as maximal exercise BP ≥ 90th percentile per sex and age. Cardiac structure and function on echocardiography were compared between HRE and no HRE (NHRE) groups for each sex. Multivariate linear regression was used to evaluate associations between maximal systolic BP (SBP) and echocardiographic variables, adjusting for age, body mass index, resting SBP, and VO2peak. Results: Participants (75% women) were aged 53 ± 11 years old. Women with HRE had higher resting SBP and subclinical cardiac remodeling abnormalities (increased left ventricular [LV] wall thickness, relative wall thickness, and mass) than NHRE women (p < 0.05). Men with HRE had higher relative wall thickness than NHRE men (p = 0.042). There was no difference in cardiac function between HRE groups (p > 0.05). After adjustment, maximal SBP remained associated with adverse cardiac remodeling parameters for each sex (p < 0.05). Conclusions: Among individuals with abdominal obesity and resting BP < 140/90 mm Hg, HRE was associated with adverse cardiac remodeling. HRE represents a potential screening tool and preventive target to detect those at higher risk of preclinical cardiac changes.

Cardiac magnetic resonance imaging for discrimination of hypertensive heart disease and hypertrophic cardiomyopathy: a systematic review and meta-analysis

Introduction

Differentiating hypertensive heart disease (HHD) from hypertrophic cardiomyopathy (HCM) is crucial yet challenging due to overlapping clinical and morphological features. Recent studies have explored the use of various cardiac magnetic resonance (CMR) parameters to distinguish between these conditions, but findings have remained inconclusive. This study aims to identify which CMR parameters effectively discriminate between HHD and HCM and to investigate their underlying pathophysiological mechanisms through a meta-analysis.

Methods

The researchers conducted a systematic and comprehensive search for all studies that used CMR to discriminate between HHD and HCM and calculated the Hedges'g effect size for each of the included studies, which were then pooled using a random-effects model and tested for the effects of potential influencing variables through subgroup and regression analyses.

Results

In this review, 26 studies encompassing 1,349 HHD and 1,581 HCM cases were included for meta-analysis. Analysis revealed that HHD showed a significant lower in T1 mapping (g = -0.469, P < 0.001), extracellular volume (g = -0.417, P = 0.024), left ventricular mass index (g = -0.437, P < 0.001), and maximal left ventricular wall thickness (g = -2.076, P < 0.001), alongside a significant higher in end-systolic volume index (g = 0.993, P < 0.001) and end-diastolic volume index (g = 0.553, P < 0.001), compared to HCM.

Conclusion

This study clearly demonstrates that CMR parameters can effectively differentiate between HHD and HCM. HHD is characterized by significantly lower diffuse interstitial fibrosis and myocardial hypertrophy, along with better-preserved diastolic function but lower systolic function, compared to HCM. The findings highlight the need for standardized CMR protocols, considering the significant influence of MRI machine vendors, post-processing software, and study regions on diagnostic parameters. These insights are crucial for improving diagnostic accuracy and optimizing treatment strategies for patients with HHD and HCM.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023470557, PROSPERO (CRD42023470557).

Soluble ST2: A Novel Biomarker for Diagnosis and Prognosis of Cardiovascular Disease

The increasing incidence of cardiovascular disease (CVD) is a significant global health concern, affecting millions of individuals each year. Accurate diagnosis of acute CVD poses a formidable challenge, as misdiagnosis can significantly decrease patient survival rates. Traditional biomarkers have played a vital role in the diagnosis and prognosis of CVDs, but they can be influenced by various factors, such as age, sex, and renal function. Soluble ST2 (sST2) is a novel biomarker that is closely associated with different CVDs. Its low reference change value makes it suitable for continuous measurement, unaffected by age, kidney function, and other confounding factors, facilitating risk stratification of CVDs. Furthermore, the combination of sST2 with other biomarkers can enhance diagnostic accuracy and prognostic value. This review aims to provide a comprehensive overview of sST2, focusing on its diagnostic and prognostic value as a myocardial marker for different types of CVDs and discussing the current limitations of sST2.

Protective effects of the R-(+)-thioctic acid treatment: possible anti-inflammatory activity on heart of hypertensive rats

BACKGROUND

In cardiovascular disease, high blood pressure is associated with oxidative stress, promoting endothelial dysfunction, vascular remodeling, and inflammation. Clinical trials are discordant that the most effective treatment in the management of hypertension seems to be the administration of anti-hypertensive drugs with antioxidant properties. The study aims to evaluate the effects of the eutomer of thioctic acid on oxidative stress and inflammation in the heart of spontaneously hypertensive rats compared to normotensive Wistar Kyoto rats.

METHODS

To study the oxidative status, the malondialdehyde and 4-hydroxynonenal concentration, protein oxidation were measured in the heart. Morphological analysis were performed. Immunohistochemistry and Western blot were done for alpha-smooth muscle actin and transforming growth factor beta to assess fibrosis; cytokines and nuclear factor kappaB to assess inflammatory processes.

RESULTS

Spontaneously hypertensive rats were characterized by hypertension with increased malondialdehyde levels in the heart. OxyBlot in the heart of spontaneously hypertensive rats showed an increase in proteins' oxidative status. Cardiomyocyte hypertrophy and fibrosis in the ventricles were associated with an increased expression of alpha-smooth muscle actin and pro-inflammatory cytokines, reduced by the eutomer of thioctic acid supplementation.

CONCLUSIONS

Based on this evidence, eutomer of thioctic acid could represent an appropriate antioxidant molecule to reduce oxidative stress and prevent inflammatory processes on the cardiomyocytes and cardiac vascular endothelium.

The Relationship Between Changes of Left Heart Structure and Function and the Risk of Future Renal Damage in Patients with Essential Hypertension

Purpose

In essential hypertensive patients, cardiac remodeling may be associated with the risk of renal damage in the future which can be reflected by the estimated glomerular filtration rate (eGFR). Through retrospective analysis, we evaluated the potential of cardiac remodeling based on echocardiographic measurements to predict the risk of renal damage in the future with hypertensive patients.

Methods

We retrospectively analyzed the relationship between the changes of left heart structure and function and renal damage for 510 patients with hypertension, who were diagnosed between 2016 to 2022. Demography data, clinical data, blood samples and echocardiographic variables were used for survival analysis, and the Cox proportional hazards regression model was used.

Results

In our study, we found that age, serum creatinine (SCR), creatine kinase isoenzyme MB (CK MB), abnormal high-sensitivity troponin I (TNI), interventricular septum thickness (IVST) and left ventricular ejection fraction (LVEF) could be used as independent predictors in risk of renal impairment in hypertensive patients (p<0.05). Combined in a score where one point was given for the presence of each of the parameters above, this score could strongly predict renal function damage in the future (p<0.05). In receiver operating characteristics (ROC) curve analyses, the area under the curve of the risk factor score was 0.849 (P<0.001).

Conclusion

In essential hypertensive patients, LVEF and IVST can predict the risk of future adverse renal outcomes. Moreover, combining risk variables into a simplified score may enable to assess the risk of renal impairment in hypertensive patients at an early stage.

Association of pulmonary black carbon accumulation with cardiac fibrosis in residents of Sao Paulo, Brazil

Evidence suggests that myocardial interstitial fibrosis, resulting from cardiac remodeling, may possibly be influenced by mechanisms activated through the inhalation of airborne pollutants. However, limited studies have explored the relationship between lifetime exposure to carbon-based particles and cardiac fibrosis, specially using post-mortem samples. This study examined whether long-term exposure to air pollution (estimated by black carbon accumulated in the lungs) is associated with myocardial fibrosis in urban dwellers of megacity of Sao Paulo. Data collection included epidemiological and autopsy-based approaches. Information was obtained by interviewing the next of kin and through the pathologist's report. The individual index of exposure to carbon-based particles, which we designed as the fraction of black carbon (FBC), was estimated through quantification of particles on the macroscopic lung surface. Myocardium samples were collected for histopathological analysis to evaluate the fraction of cardiac fibrosis. The association between cardiac fibrosis and FBC, age, sex, smoking status and hypertension was assessed by means of multiple linear regression models. Our study demonstrated that the association of FBC with cardiac fibrosis is influenced by smoking status and hypertension. Among hypertensive individuals, the cardiac fibrosis fraction tended to increase with the increase of the FBC in both groups of smokers and non-smokers. In non-hypertensive individuals, the association between cardiac fibrosis fraction and FBC was observed primarily in smokers. Long-term exposure to tobacco smoke and environmental particles may contribute to the cardiac remodeling response in individuals with pre-existing hypertension. This highlights the importance of considering hypertension as an additional risk factor for the health effects of air pollution on the cardiovascular system. Moreover, the study endorses the role of autopsy to investigate the effects of urban environment and personal habits in determining human disease.

Cardiovascular health of offspring conceived by assisted reproduction technology: a comprehensive review

Recently, the use of assisted reproductive technology (ART) has rapidly increased. As a result, an increasing number of people are concerned about the safety of offspring produced through ART. Moreover, emerging evidence suggests an increased risk of cardiovascular disease (CVD) in offspring conceived using ART. In this review, we discuss the epigenetic mechanisms involved in altered DNA methylation, histone modification, and microRNA expression, as well as imprinting disorders. We also summarize studies on cardiovascular changes and other risk factors for cardiovascular disease, such as adverse intrauterine environments, perinatal complications, and altered metabolism following assisted reproductive technology (ART). Finally, we emphasize the epigenetic mechanisms underlying the increased risk of CVD in offspring conceived through ART, which could contribute to the early diagnosis and prevention of CVD in the ART population.

Left heart remodelling in hypertensive patients: a comprehensive echocardiography and computed tomography study

OBJECTIVES

This study aimed to assess left heart remodelling changes in hypertension, excluding underlying ischaemic heart disease, utilising computed tomography coronary angiography (CTCA) and transthoracic echocardiography (TTE).

METHODS

A total of 178 patients (mean age 60 ± 9 years, 53% female) were enrolled in the study: Group 1 consisted of patients with essential hypertension (n = 96, Group 1), and Group 2 served as age-matched controls (n = 82, Group 2). All participants underwent both CTCA and TTE. TTE measurements included left ventricle (LV) concentricity and function and left atrial (LA) volume and function. Using both CTCA and TTE, we measured LV diastasis volume (LVdias) and LA diastasis volume (LAdias).

RESULTS

LV mass index and LV mass/height2.7 were similar in both the groups. However, Group 1 had a higher prevalence of concentric LV remodelling, characterised by a larger mean LV wall thickness, increased relative wall thickness ratio, and a reduced ratio of LV end-diastolic volume (LVED) index to mean wall thickness (55 ± 14 vs. 65 ± 15, p = 0.0007). Group 1 showed higher LAdias and LA minimal volumes, while LA reservoir function was lower in Group 2. The LVdias/LAdias ratio was lower in Group 1 compared to Group 2 (TTE 1.77 ± 0.61 vs. 2.24 ± 1.24, p = 0.0025, CTCA 1.50 ± 0.23 vs. 1.69 ± 0.41, p = 0.0002). A composite score based on four combined TTE parameters, namely, LVED index/mean wall thickness ≤57, ratio of early diastolic mitral inflow to mitral annular tissue velocities (E/e') >8, LVdias/LAdias ≤1.62, and LA reservoir function ≤0.58, yielded the highest discriminatory power (area under the curve-AUC = 0.772) for distinguishing patients with hypertensive heart disease (HHD). Collectively, we refer to these parameters as the LEDA score, with each parameter scored as one point. For LEDA scores of 0, 1, 2, 3, 4, the probability of underlying HHD was 0%, 23%, 59%, 80%, and 95%, respectively. Furthermore, a CTCA-derived LVdias/LAdias ≤1.76, considered as a single parameter, demonstrated modest accuracy in differentiating patients with HHD (AUC = 0.646).

CONCLUSIONS

The TTE LEDA score, based on four parameters, namely, LVED index/mean wall thickness, E/e', LVdias/LAdias, and LA reservoir function, proved to be the most effective in defining left heart remodelling in hypertension.

A pragmatic clinical trial assessing the effect of a targeted notification and clinical support pathway on the diagnostic evaluation and treatment of individuals with left ventricular hypertrophy (NOTIFY-LVH)

BACKGROUND

Electronic health records contain vast amounts of cardiovascular data, including potential clues suggesting unrecognized conditions. One important example is the identification of left ventricular hypertrophy (LVH) on echocardiography. If the underlying causes are untreated, individuals are at increased risk of developing clinically significant pathology. As the most common cause of LVH, hypertension accounts for more cardiovascular deaths than any other modifiable risk factor. Contemporary healthcare systems have suboptimal mechanisms for detecting and effectively implementing hypertension treatment before downstream consequences develop. Thus, there is an urgent need to validate alternative intervention strategies for individuals with preexisting-but potentially unrecognized-LVH.

METHODS

Through a randomized pragmatic trial within a large integrated healthcare system, we will study the impact of a centralized clinical support pathway on the diagnosis and treatment of hypertension and other LVH-associated diseases in individuals with echocardiographic evidence of concentric LVH. Approximately 600 individuals who are not treated for hypertension and who do not have a known cardiomyopathy will be randomized. The intervention will be directed by population health coordinators who will notify longitudinal clinicians and offer to assist with the diagnostic evaluation of LVH. Our hypothesis is that an intervention that alerts clinicians to the presence of LVH will increase the detection and treatment of hypertension and the diagnosis of alternative causes of thickened myocardium. The primary outcome is the initiation of an antihypertensive medication. Secondary outcomes include new hypertension diagnoses and new cardiomyopathy diagnoses. The trial began in March 2023 and outcomes will be assessed 12 months from the start of follow-up.

CONCLUSION

The NOTIFY-LVH trial will assess the efficacy of a centralized intervention to improve the detection and treatment of hypertension and LVH-associated diseases. Additionally, it will serve as a proof-of-concept for how to effectively utilize previously collected electronic health data to improve the recognition and management of a broad range of chronic cardiovascular conditions.

TRIAL REGISTRATION

NCT05713916.

Incremental Effect of Mitral Regurgitation on Left Atrial Dysfunction and Atrioventricular Interaction in Hypertensive Patients by MRI

BACKGROUND

Mitral regurgitation may occur when hypertension causes left ventricular (LV) and left atrial (LA) remodeling. However, its role in LA function in hypertensive patients remains unclear.

PURPOSE

To explore how mitral regurgitation affects LA function in hypertension and to investigate atrioventricular interaction in hypertensive patients with mitral regurgitation.

STUDY TYPE

Retrospective.

POPULATION

A total of 193 hypertensive cases and 64 controls.

FIELD STRENGTH/SEQUENCE

A 3.0 T/balanced steady-state free precession.

ASSESSMENT

LA volume (LAV), LA strain (reservoir, conduit, and active), LA ejection fraction, and LV strain (global peak longitudinal [GLS], circumferential [GCS], and radial strain [GRS]) were evaluated and compared among groups. Regurgitant fraction (RF) was evaluated in regurgitation patients and used to subdivide patients into mild (RF: 0%-30%), moderate (RF: 30%-50%), and severe (RF: >50%) regurgitation categories.

STATISTICAL TESTS

One-way analysis of variance, Spearman and Pearson's correlation coefficients (r), and multivariable linear regression analysis. A P value <0.05 was considered statistically significant.

RESULTS

Hypertensive patients without mitral regurgitation showed significantly impaired LA reservoir and conduit functions and significantly decreased LV GLS but preserved pump function and LAV compared to controls (P = 0.193-1.0). Hypertensive cases with mild regurgitation (N = 22) had significantly enlarged LAV and further reduced LA reservoir function, while the group with moderate regurgitation (N = 20) showed significantly reduced LA pump function, further impaired conduit function, and significantly reduced LV strain. The severe regurgitation (N = 13) group demonstrated significantly more severely impaired LA and LV functions and LAV enlargement. Multivariable linear regression showed that regurgitation degree, GRS, GCS, and GLS were independently correlated with the LA reservoir, conduit, and active strain in hypertensive patients with mitral regurgitation.

DATA CONCLUSION

Mitral regurgitation may exacerbate LA and LV impairment in hypertension. Regurgitation degree, LV GRS, GCS, and GLS were independent determinants of the LA strain in hypertensive patients with mitral regurgitation, which demonstrated atrioventricular interaction.

EVIDENCE LEVEL

4.

TECHNICAL EFFICACY

Stage 3.

Neurochemical alterations of intrinsic cardiac ganglionated nerve plexus caused by arterial hypertension developed during ageing in spontaneously hypertensive and Wistar Kyoto rats

The acknowledged hypothesis of the cause of arterial hypertension is the emerging disbalance in sympathetic and parasympathetic regulations of the cardiovascular system. This disbalance manifests in a disorder of sustainability of endogenous autonomic and sensory neural substances including calcitonin gene-related peptide (CGRP). This study aimed to examine neurochemical alterations of intrinsic cardiac ganglionated nerve plexus (GP) triggered by arterial hypertension during ageing in spontaneously hypertensive rats of juvenile (prehypertensive, 8-9 weeks), adult (early hypertensive, 12-18 weeks) and elderly (persistent hypertensive, 46-60 weeks) age in comparison with the age-matched Wistar-Kyoto rats as controls. Parasympathetic, sympathetic and sensory neural structures of GP were analysed and evaluated morphometrically in tissue sections and whole-mount cardiac preparations. Both the elevated blood pressure and the evident ultrasonic signs of heart failure were identified for spontaneously hypertensive rats and in part for the aged control rats. The amount of adrenergic and immunoreactive to CGRP neural structures was increased in the adult group of spontaneously hypertensive rats along with the significant alterations that occurred during ageing. In conclusion, the revealed chemical alterations of GP support the hypothesis about the possible disbalance of efferent and afferent heart innervation and may be considered as the basis for the emergence and progression of arterial hypertension and perhaps even as a consequence of hypertension in the aged spontaneously hypertensive rats. The determined anatomical changes in the ageing Wistar-Kyoto rats suggest this breed being as inappropriate for its use as control animals for hypertension studies in older animal age.

The Relationship between Nocturnal Dipping Status, Morning Blood Pressure Surge, and Hospital Admissions in Patients with Systolic Heart Failure

BACKGROUND

Hypertension is a known risk factor for developing heart failure. However, there is limited data to investigate the association between morning blood pressure surge (MBPS), dipping status, echocardiographic parameters, and hospital admissions in patients with systolic heart failure.

OBJECTIVES

To evaluate the relationship between morning blood pressure surge, non-dipper blood pressure pattern, echocardiographic parameters, and hospital admissions in patients with systolic heart failure.

METHODS

We retrospectively analyzed data from 206 consecutive patients with hypertension and a left ventricular ejection fraction below 40%. We divided the patients into two groups according to 24-hour ambulatory blood pressure monitoring (ABPM) results: dippers (n=110) and non-dippers (n=96). Morning blood pressure surge was calculated. Echocardiographic findings and hospital admissions during follow-up were noted. Statistical significance was defined as p < 0.05.

RESULTS

The study group comprised 206 patients with a male predominance and mean age of 63.5 ± 16.1 years. The non-dipper group had significantly more hospital admissions compared to dippers. There was a positive correlation between MBPS and left atrial volume index (r=0.331, p=0.001), the ratio between early mitral inflow velocity and flow propagation velocity (r= 0.326, p=0.001), and the ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/Em) (r= 0.314, p=0.001). Non-dipper BP, MBPS, and E/Em pattern were found to be independently associated with increased hospital admissions.

CONCLUSION

MBPS is associated with diastolic dysfunction and may be a sensitive predictor of hospital admission in patients with systolic heart failure.

Hypertensive Heart Disease: A Narrative Review Series-Part 2: Macrostructural and Functional Abnormalities

Hypertensive heart disease (HHD) remains a major global public health concern despite the implementation of new approaches for the management of hypertensive patients. The pathological changes occurring during HHD are complex and involve the development of structural and functional cardiac abnormalities. HHD describes a broad spectrum ranging from uncontrolled hypertension and asymptomatic left ventricular hypertrophy (LVH), either a concentric or an eccentric pattern, to the final development of clinical heart failure. Pressure-overload-induced LVH is recognised as the most important predictor of heart failure and sudden death and is associated with an increased risk of cardiac arrhythmias. Cardiac arrhythmias are considered to be one of the most important comorbidities affecting hypertensive patients. This is the second part of a three-part set of review articles. Here, we focus on the macrostructural and functional abnormalities associated with chronic high pressure, their involvement in HHD pathophysiology, and their role in the progression and prognosis of HHD.

Short-Term Mortality Associated With Hypertensive Emergencies: A Prospective Observational Cohort Study From South India

Background and aims Hypertensive emergencies are caused by acutely occurring massive elevations in blood pressure with features suggestive of acute end-organ damage and are a common complication of hypertension. About 1-2% of all patients with hypertension develop this complication in their lifetime. This study was undertaken to assess short-term outcomes associated with hypertensive emergencies in a tertiary care center. Methods We conducted a prospective cohort study and recruited 66 consenting adults with a hypertensive emergency. Sociodemographic details, clinical characteristics, blood pressure readings at different intervals, in-hospital course, and diagnosis of end-organ damage were recorded. The in-hospital outcome was noted as dead or alive. After four weeks, patients were followed up through telephonic interviews and the patient's status was then reviewed and recorded. Multiple logistic regression determined the predictors of death. Data were analyzed in SPSS version 26.0 (IBM Corp., Armonk, NY, USA). Results A total of 66 patients were enrolled, with a mean age of 54.57 (±38.18) years and a male predominance of 44 (66.35%) patients. The majority of patients were known hypertensives (n=55, 83.35%). Of the known hypertensives, 41 (74.54%) patients had discontinued their anti-hypertensive medications prior to admission. The median duration of hospitalization was 10 (7-14) days. The most common presenting complaints were dyspnea (n=35, 53.03%), pedal edema (n=29, 43.94%) and headache (n=25, 37.87%). Forty-one (62.12%) patients required ICU care, and 39 (59.09%) required ventilator support. The most common end-organ damage was acute-on-chronic kidney disease (n=21, 31.81%). The short-term mortality documented at the end of one month was 24 (36.36%). Of these, seven (10.6%) patients died in the hospital, and 17 (25.75) patients died within one month of getting discharged from the hospital. The factors that were associated with high mortality were newly-diagnosed hypertension and in-hospital hypotension. Conclusion We found high mortality associated with hypertensive emergencies. At one month follow-up, we found that more than one-third of the patients had died. Post-hospitalisation mortality was higher than in-hospital mortality. Most patients had discontinued their anti-hypertensive medication before admission. The most frequently encountered end-organ damage was acute-on-chronic kidney disease. The factors associated with high mortality were newly-diagnosed hypertension and in-hospital hypotension.

Left ventricular systolic function in subjects conceived through assisted reproductive technologies

Background

Over the past decades, assisted reproductive technologies (ART) have gained remarkable influence in the treatment of infertility and account for more than 2 % of births in European countries nowadays. Accumulating evidence suggests ART to cause cardiovascular alterations, including left ventricular (LV) dysfunctions, within its offspring. The aim of this study was to assess LV systolic function in subjects conceived through ART in comparison to spontaneously conceived peers.

Methods

For the assessment of LV morphology and LV function, M-Mode echocardiography, pulsed wave Doppler and two-dimensional speckle tracking echocardiography (2DSTE) were applied. LV ejection fraction (EF) and fractional shortening (FS) were assessed in M-Mode and calculated by Teichholz formula. EF was additionally assessed semiautomatically through 2DSTE.

Results

In total, 64 ART subjects and 83 spontaneously conceived controls with no significant differences in age (12.52 ± 5.64 years vs. 13.20 ± 5.95 years, p = 0.486) and sex were included in the analysis. In the ART cohort, significantly lower values were observed for M-Mode assessed EF (63.63 ± 5.17 % vs. 65.35 ± 5.10 %, p = 0.046) and FS (34.26 ± 3.87 % vs. 35.60 ± 3.84 %, p = 0.038). However, after the adjustment for birth weight percentile and gestational age, M-Mode assessed EF and FS displayed no significant differences between both groups. LV morphology and remaining systolic function parameters, such as mitral annular plane systolic excursion, aortic velocity time integral, global peak longitudinal strain and 2DSTE measured EF, were comparable between both groups.

Conclusion

This study suggests a lower LV systolic function in ART subjects, visualized by significantly lower values for M-Mode assessed EF and FS, compared to spontaneously conceived peers. The clinical relevance of these findings has to be investigated as the above-mentioned parameters were in normal reference range. In addition, LV systolic function parameters evaluated by other echocardiographic imaging modalities were comparable between both groups. Therefore, further studies will be required to evaluate the influence of ART on LV systolic function and cardiovascular morbidity in the future.

Prevalence and Characterisation of Severe Left Ventricular Hypertrophy Diagnosed by Echocardiography in Hypertensive Patients

BACKGROUND

Arterial hypertension (AHT) is the leading preventable cause of death worldwide. Left ventricular hypertrophy (LVH) is one of the most important prognostic markers in hypertension and a predictor for mortality. The goals of this study were to examine the prevalence of LVH detected by echocardiography in patients with AHT and to describe patients with severe LVH.

METHODS

This is a retrospective monocentric study including patients treated at a tertiary hypertension clinic. Echocardiographic data were taken from written reports from our hospital's echocardiography laboratories. We compared patients with severe LVH (septum thickness ≥ 15 mm) with patients with normal left ventricular (LV) geometry and with patients with concentric or eccentric hypertrophy regarding age, gender, comorbidities, medication, duration of hypertension, blood pressure (BP) and ECG changes at time of echocardiography.

RESULTS

Twenty-nine patients (7.3%) out of four hundred patients showed severe LVH and one hundred and eighty-nine (47.3%) a normal geometry. In comparison to patients with normal geometry, patients with severe LVH were more likely to be male, older, and with more uncontrolled BP, especially regarding asleep values, multi-drug antihypertensive treatment and comorbidities. In comparison to patients with concentric or eccentric hypertrophy, patients with severe LVH had a significantly higher diastolic BP in the 24 h mean, awake and asleep values. A positive Sokolow-Lyon index did not predict LVH. However, patients with severe LVH were more likely to have T-wave-inversions V4-V6 in at least one lead.

CONCLUSIONS

More than half of the patients with AHT have an abnormal geometry in our study (52.5%) and 7.3% a severe LVH. Patients with severe LVH have more often an uncontrolled AHT than patients with a normal LV geometry, despite more antihypertensive treatment. The Sokolow-Lyon index seems to be insufficient to detect LVH.

Clinical Evidence on the Potential Beneficial Effects of Probiotics and Prebiotics in Cardiovascular Disease

The 'gut microbiome'-the hundreds of trillions of bacteria in the human gastrointestinal tract-serves several functions. The gut microbiome includes all the microorganisms, bacteria, viruses, protozoa, and fungi in the gastrointestinal tract and their genetic material. It helps digest indigestible foods and produces nutrients. Through the metabolism of sugars and proteins, it helps the intestinal barrier, the immune system, and metabolism. Some bacteria, such as those in the gut microbiome, cause disease, but others are essential to our health. These "good" microbes protect us from pathogens. Numerous studies have linked an unhealthy gut microbiome to obesity, insulin resistance, depression, and cardiometabolic risk factors. To maximize probiotic benefits in each case, knowledge of probiotic bacterial strains and how to consume them should be increased. This study aims to examine the benefits of probiotic and prebiotic organisms on cardiovascular health, specifically on heart disease, coronary heart disease, stroke, and hypertension. To complete the research, a literature review was conducted by gathering clinical studies and data. The clinical evidence demonstrates the beneficial effect of probiotics and prebiotic microorganisms on the gut microbiome, which has multiple benefits for overall health and especially for cardiovascular diseases.

Reduced left ventricular function and sustained hypertension in women seven years after severe preeclampsia

Objective. To study left ventricular (LV) function and blood pressure (BP) at a long-term follow-up in women after severe pre-eclampsia. Design. In this single-centre, cross-sectional study, 96 patients were eligible for inclusion. LV function was examined by transthoracic echocardiography including tissue Doppler echocardiography and speckle tracking. BP was measured at rest using repeated non-invasive techniques. Results. We compared 36 patients with early-onset and 33 patients with late-onset pre-eclampsia with 28 healthy controls. Mean age (40 ± 3 years) and median time since delivery (7 ± 2 years) were similar across the study groups. The patients had 18% higher systolic BP (139 ± 15 mmHg) and 24% higher diastolic BP (87 ± 19 mmHg) than controls (p < .01). Hypertension was present in 23 patients (33%), where the estimated LV mass was 16% higher (p = .05) than in controls. The LV ejection fraction was 19% lower in the early-onset group (51 ± 4%; p = .01) and 14% lower in the late-onset group (54 ± 6; p = .04) compared with controls. LV global longitudinal strain was 18% lower in the patient group (-17.7 ± 2.1%) compared with controls (p = .01). Indicative of a more restrictive filling pattern, the diastolic indices showed a lower e' mean (p < .01) and subsequently higher E/e' ratio (p < .01). There were no significant differences in BP, systolic or diastolic function indices between the patient groups. Conclusion. We found sustained hypertension, higher LV mass and reduced LV systolic and diastolic function 7 y after severe pre-eclampsia. Our findings emphasize the importance of early risk stratification and clinical counselling, and follow-up for such cases.

Additive effects of mitral regurgitation on left ventricular strain in essential hypertensive patients as evaluated by cardiac magnetic resonance feature tracking

Objectives

Hypertension is one of the leading risk factors for cardiovascular disease. Mitral regurgitation (MR) is a heart valve disease commonly seen in hypertensive cases. This study aims to assess the effect of MR on left ventricle (LV) strain impairment among essential hypertensive cases and determine factors that independently impact the global peak strain of the LV.

Materials and methods

We enrolled 184 essential hypertensive patients, of which 53 were patients with MR [HTN (MR +) group] and 131 were without MR [HTN (MR−) group]. Another group of 61 age-and gender-matched controls was also included in the study. All participants had received cardiac magnetic resonance examination. The HTN (MR +) group was classified into three subsets based on regurgitation fraction, comprising mild MR (n = 22), moderate MR (n = 19), and severe MR (n = 12). We compared the LV function and strain parameters across different groups. Moreover, we performed multivariate linear regression to determine the independent factors affecting LV global radial peak strain (GRS), circumferential peak strain (GCS), and global longitudinal peak strain (GLS).

Results

HTN (MR−) cases exhibited markedly impaired GLS and peak diastolic strain rate (PDSR) but preserved LV ejection fraction (LVEF) compared to the controls. However, HTN (MR +) patients showed a decrease in LVEF and further deteriorated GRS, GCS, GLS, PDSR, and the peak systolic strain rate (PSSR) compared to the HTN (MR−) group and controls. With increasing degrees of regurgitation, the LV strain parameters were gradually reduced in HTN (MR +) patients. Even the mild MR group showed impaired GCS, GLS, PDSR, and PSSR compared to the HTN (MR−) group. Multiple regression analyses indicated that the degree of regurgitation was independently associated with GRS (β = -0.348), GCS (β = -0.339), and GLS (β = -0.344) in HTN (MR +) patients.

Conclusion

GLS was significantly impaired in HTN (MR−) patients. MR may further exacerbate the deterioration of LV strain among essential hypertensive cases. Besides, the degree of regurgitation was independently correlated with GRS, GCS, and GLS in HTN (MR +) patients.

The Impact of Hypertension on Left Ventricular Function and Remodeling in Non-Ischemic Dilated Cardiomyopathy Patients: A 3.0 T MRI Study

BACKGROUND

Hypertension (HTN) is highly prevalent in non-ischemic dilated cardiomyopathy (NIDCM) patients, but little is known about its impact on left ventricular (LV) function and remodeling.

PURPOSE

To evaluate the effect of hypertension on LV function and remodeling in NIDCM patients.

STUDY TYPE

Retrospective.

POPULATION

Two-hundred and twelve NIDCM (HTN-) patients, 91 NIDCM (HTN+) patients, and 74 normal controls.

FIELD STRENGTH/SEQUENCE

3.0 T/bSSFP and phase-sensitive inversion recovery sequence.

ASSESSMENT

The LV geometry, myocardial strain, remodeling index (calculated as LVM/LVEDV), and LGE were measured and compared between groups. Determinants of LV strain and remodeling in NIDCM were investigated.

STATISTICAL TESTS

Student's t-test, Mann-Whitney U test, one-way analysis of variance, Kruskal-Wallis test, univariable and multivariable linear regression. A P value <0.05 was considered statistically significant.

RESULTS

Compared with normal controls, NIDCM patients had significantly higher LVEDV and significantly impaired LV strains, including LV global peak strain (PS) and peak systolic and diastolic strain rates in the radial, circumferential, and longitudinal directions. The NIDCM (HTN+) group had significantly decreased LV global longitudinal PS and peak diastolic strain rate (PDSR), and significantly increased LV mass index and remodeling index compared to the NIDCM (HTN-) group, despite there being no significant difference in ejection fraction (P = 0.241). The prevalence of LV LGE was significantly higher in the NIDCM (HTN+) group than in the NIDCM (HTN-) group. In multivariable regression models adjusted for potential confounders, hypertension was independently associated with LV global longitudinal PS and PDSR. Male sex, resting heart rate, and log(NT-proBNP) level were independent determinants of LV strains. Moreover, male sex, systolic and diastolic blood pressure, and presence of LGE were independent determinants of LV remodeling index.

DATA CONCLUSION

These findings suggest that coexistence of hypertension may further exacerbate the reduction in LV global strain and the aggravation of LV remodeling in NIDCM patients.

LEVEL OF EVIDENCE

3 TECHNICAL EFFICACY: Stage 3.

Circulating microparticles as indicators of cardiometabolic risk in PCOS

Polycystic ovary syndrome (PCOS), the most prevalent endocrine disturbance of the female reproductive system, is associated with several pathologic conditions, such as metabolic syndrome, obesity, diabetes, dyslipidemia, and insulin resistance, all of which are tightly connected to its progression. These factors are associated with a type of extracellular vesicle, ie, microparticles (MPs), released by shedding due to cell activation and apoptosis. Circulating MPs (cMPs) are secreted by a variety of cells, such as platelets, endothelial, leukocytes, and erythrocytes, and contain cytoplasmic substances derived from parent cells that account for their biologic activity. Current evidence has clearly shown that increased cMPs contribute to endothelial dysfunction, diabetes, hypertriglyceridemia, metabolic syndrome, cardiovascular abnormalities as well as PCOS. It has also been reported that platelet and endothelial MPs are specifically increased in PCOS thus endangering vascular health and subsequent cardiovascular disease. Given the importance of cMPs in the pathophysiology of PCOS, we review the role of cMPs in PCOS with a special focus on cardiometabolic significance.

Comorbidities and mortality risk among extensive-stage small-cell lung cancer patients in mainland China: impacts of hypertension, type 2 diabetes mellitus, and chronic hepatitis B virus infection

The present study investigated the impact of major comorbidities, including hypertension, type 2 diabetes mellitus (T2DM), and chronic hepatitis B virus (HBV) infection, on the progression-free survival (PFS) and overall survival (OS) of extensive-stage small-cell lung cancer (ES-SCLC) patients in China. Patients having a pathologic diagnosis of ES-SCLC between 2009 and 2017 were enrolled and grouped according to their specific comorbidities. The PFS and OS for each group were evaluated using the Kaplan-Meier method and Cox proportional hazard models. In total, 632 patients were analyzed. The median PFS (mPFS) of these patients was 9 months [95% confidence interval (CI), 6-12 months]. The mPFS of patients without hypertension or T2DM was 9 months; conversely, it was significantly reduced for patients with hypertension [7 months (P < 0.0001)] or T2DM [5 months (P < 0.0001)]. However, mPFS was not significantly different between patients with and without HBV infection (P = 0.2936). A similar trend was observed for OS as well. Further multivariate analyses showed that the OS of patients with hypertension [hazard ratio (HR), 1.344; 95% CI, 1.073-1.683; P = 0.010] or T2DM (HR, 1.455; 95% CI, 1.134-1.868; P = 0.003) was significantly shorter than that of patients without these comorbidities. Accordingly, mortality risk was the highest in patients with concurrent hypertension and T2DM (HR, 1.665; 95% CI, 1.037-2.672; P = 0.00058). Our study found that hypertension and T2DM may be associated with a worse prognosis in ES-SCLC patients. Considerable attention should be paid to the accompanying anti-comorbidity therapies available for patients with ES-SCLC.

Assessments of left ventricular systolic and diastolic functions with tissue Doppler imaging and myocardial performance index in children with chronic kidney disease

BACKGROUND

This study aimed to document early left ventricular (LV) dysfunction in chronic kidney disease (CKD) using methods such as tissue Doppler imaging and the myocardial performance index (MPI).

METHODS

A total of 40 patients diagnosed with CKD (mean age, 10.1 ± 4.1 years) and 40 sex- and age-matched healthy controls (mean age, 9.6 ± 4.3 years) were examined. In the patient group, 20 patients had early stage (Stage 2-3) CKD and 20 patients had late-stage (stage 4-5) CKD, and 18 patients had hypertension.

RESULTS

The pulmonary artery systolic pressure (PAPs) and LV mass index (LVMI) were significantly higher in the patient group (P < 0.05). The LV septal and lateral margins of the mitral annulus E'/A' ratio, E/E' ratio and MPI results were significantly different between the groups (P < 0.05). The MPI scores were higher in late-stage CKD than in early stage CKD (P < 0.05). The E'/A' ratio was lower and the MPI was higher in the hypertensive CKD group compared with the normotensive CKD group (P < 0.05). The E/E' ratio was correlated positively with the LVMI, and the PAPs, and negatively with glomerular filtration rate, S' value, E'/A' ratio. The MPI was correlated positively with blood pressure, LVMI, PAPs, and the S value, and negatively with the E'/A' ratio.

CONCLUSIONS

The E'/A' ratio, the E/E' ratio, and the isovolumetric relaxation time measured by tissue Doppler imaging is highly accurate and easily applicable for detecting diastolic LV function, and the MPI is suitable for detecting both systolic and diastolic LV dysfunction. Their routine use may be useful in evaluating LV functions in children with CKD.

Long-term consequences of previous preeclampsia and complicated pregnancy: analysis of echocardiographic aspects

AIM

To evaluated echocardiographic aspects in women with history of preeclampsia or preeclampsia-related complications in their previous pregnancies.

MATERIALS AND METHODS

Consecutive women receiving echocardiography during daily clinical echolab activity were studied using complete echocardiographic examination data and anamnestic data collection of hypertension, diabetes, dyslipidemia, and rheumatic diseases. Studied women should have at least one pregnancy in more than the 10 past years, and were subdivided into two groups according to the history of complicated or physiological pregnancy. Complicated pregnancies were defined by preeclampsia or preeclampsia-related complication, such as preterm delivery or small-for-gestational age newborn. Echocardiographic parameters and prevalence of hypertension, diabetes, dyslipidemia, and rheumatic disease were compared between the two groups of studied women.

RESULTS

From March 2016 to May 2020, 545 women were studied, of whom 218 had a history of complicated pregnancy (mean age 60.81 ± 11.109 years vs. 62.78 ± 9.758 years of not complicated pregnancy; P = 0.03). Compared with physiological pregnancy women, complicated pregnancy ones were shorter (159.97 ± 6.608 vs. 161.42 ± 6.427 cm; P = 0.012) with lower body surface area (1.678 ± 0.1937 vs. 1.715 ± 0.1662 m2; P = 0.02), had higher prevalence of diabetes (6.9 vs. 3.1%; P = 0.04; odds ratio = 2.34; CI 1.0323--5.3148) and rheumatic diseases (33 vs. 22.3%; P = 0.006; odds ratio = 1.72; CI 1.1688--2.5191), and showed a slight, not significant higher prevalence of hypertension. As for echocardiographic parameters, they showed significantly higher values of end-diastolic left ventricular posterior wall (LPWd) (P = 0.034), a trend toward a more concentric geometry, and a worse longitudinal systolic left and right ventricle performance, represented by lower tissue Doppler systolic waves (septal: 7.41 ± 1.255 vs. 7.69 ± 1.376 cm/s; P = 0.018; and tricuspidalic: 12.64 ± 2.377 vs. 13.32 ± 2.548 cm/s; P = 0.003).

CONCLUSION

Patients with previous preeclampsia present an increased risk of hypertension, diabetes, and rheumatic diseases, suggesting that these women could share a specific predisposition to a high-risk profile. Furthermore, they show a higher prevalence of classically considered echocardiographic hypertensive-derived cardiac damage, suggesting structural and functional left ventricular modifications as subclinical aspects of long-term worse cardiovascular prognosis for these women.

The Mechanism Actions of Astragaloside IV Prevents the Progression of Hypertensive Heart Disease Based on Network Pharmacology and Experimental Pharmacology

Astragaloside IV (AS-IV) has been used to treat cardiovascular disease. However, whether AS-IV exerts a protective effect against hypertensive heart disease has not been investigated. This study aimed to investigate the antihypertensive and cardioprotective effects of AS-IV on L-NAME-induced hypertensive rats via network pharmacology and experimental pharmacology. The network pharmacology and bioinformatics analyses were performed to obtain the potential targets of AS-IV and hypertensive heart disease. The rat hypertension model was established by administrated 50 mg/kg/day of L-NAME for 5 weeks. Meanwhile, hypertension rats were intragastrically administrated with vehicle or AS-IV or fosinopril for 5 weeks. Cardiovascular parameters (systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rates, and body weight), cardiac function parameters (LVEDd, LVEDs, and fractional shortening), cardiac marker enzymes (creatine kinase, CK-MB, and lactate dehydrogenase), cardiac hypertrophy markers (atrial natriuretic peptide and brain natriuretic peptide), endothelial function biomarkers (nitric oxide and eNOS), inflammation biomarkers (IL-6 and TNF-α) and oxidative stress biomarkers (SOD, MDA, and GSH) were measured and cardiac tissue histology performed. Network pharmacological analysis screened the top 20 key genes in the treatment of hypertensive heart disease treated with AS-IV. Besides, AS-IV exerted a beneficial effect on cardiovascular and cardiac function parameters. Moreover, AS-IV alleviated cardiac hypertrophy via down-regulating the expression of ANP and BNP and improved histopathology changes of cardiac tissue. AS-IV improved endothelial function via the up-regulation of eNOS expression, alleviated oxidative stress via increasing antioxidant enzymes activities, and inhibited cardiac inflammation via down-regulating IL-6 and TNF-α expression. Our findings suggested that AS-IV is a potential therapeutic drug to improve L-NAME-induced hypertensive heart disease partly mediated via modulation of eNOS and oxidative stress.

Antioxidant Properties of Alpha-Lipoic (Thioctic) Acid Treatment on Renal and Heart Parenchyma in a Rat Model of Hypertension

Renal and cardiac impairments are frequent events in the presence of hypertension. Organ damage is mainly linked to oxidative stress due to high blood pressure and may be reduced by antioxidant supplementation. Alpha-lipoic acid (ALA) is one of most effective antioxidants. It is widely used as a nutritional supplement in a racemic mixture (+/–), even though the (+)-enantiomer is biologically active. This study was designed to investigate the effect of treatment with (+/–)-ALA and its enantiomers on renal and heart parenchyma in spontaneously hypertensive rats (SHR), using immunochemical and immunohistochemical techniques. The results confirmed that the oxidative mechanisms of organ alterations, due to hypertension, and characterized by glomerular and tubular lesions, left ventricular hypertrophy, and fibrosis but not by apoptosis were accompanied by proteins’ and nucleic acids’ oxidation. We found greater effectiveness of (+)-ALA compared to (+/−)-ALA in reducing oxidative stress, cardiac and renal damages in SHR. To conclude, these data propose (+)-ALA as one of the more appropriate antioxidant molecules to prevent renal and cardiac alterations associated with hypertension.

QiShenYiQi Pill Improves Myocardial Hypertrophy Caused by Pressure Overload in Rats

Pressure-overloaded myocardial hypertrophy is an independent risk factor for various cardiovascular diseases (CVDs), such as heart failure (HF), arrhythmia, and even sudden death. It is reported that QiShenYiQi pill (QSYQ) is widely used in the treatment of CVDs and can prevent pathological hypertrophy of myocardium, but its specific mechanism is still unclear. In this study, a rat model of myocardial hypertrophy was established through the pressure overload caused by abdominal aortic constriction in Wistar rats. The rats were randomly divided into model group, valsartan group, and QSYQ group, and sham-operated animals served as the control group. At the 4 and 8 weeks of intervention, the general morphology of the heart, myocardial collagen content, collagen volume factor (CVF), collagen type I, collagen type III, myocardial pathological changes, and the expression of ANP, β-MHC, TGF-β1, and CTGF were analyzed, respectively, in order to explore the possible effect of QSYQ on the mechanism of myocardial hypertrophy. We observed that QSYQ could effectively improve myocardial hypertrophy in pressure-overloaded rats, which was related to the regulatory mechanism of TGF-β1 and CTGF.

Sex Differences of the Diabetic Heart

Type 2 diabetes is a chronic disease associated with micro- and macro-vascular complications, including myocardial ischemia, and also with a specific and intrinsic cardiac dysfunction called diabetic cardiomyopathy (DCM). Both clinical and animal studies demonstrate significant sex differences in prevalence, pathophysiology, and outcomes of cardiovascular diseases (CVDs), including those associated with diabetes. The increased risk of CVDs with diabetes is higher in women compared to men with 50% higher risk of coronary artery diseases and increased mortality when exposed to acute myocardial infarction. Clinical studies also reveal a sexual dimorphism in the incidence and outcomes of DCM. Based on these clinical findings, growing experimental research was initiated to understand the impact of sex on CVDs associated with diabetes and to identify the molecular mechanisms involved. Endothelial dysfunction, atherosclerosis, coagulation, and fibrosis are mechanisms found to be sex-differentially modulated in the diabetic cardiovascular system. Recently, impairment of energy metabolism also emerged as a determinant of multiple CVDs associated with diabetes. Therefore, future studies should thoroughly analyze the sex-specific metabolic determinants to propose new therapeutic targets. With current medicine tending toward more personalized care of patients, we finally propose to discuss the importance of sex as determinant in the treatment of diabetes-associated cardiac diseases to promote a more systemic inclusion of both males and females in clinical and preclinical studies.

Endovascular reversal of renovascular hypertension blunts cardiac dysfunction and deformation in swine

OBJECTIVE

Renovascular hypertension (RVH) induces hemodynamic and humoral aberrations that may impair cardiac function, structure and mechanics, including cardiac twist and deformation. Revascularization of a stenotic renal artery can decrease blood pressure (BP), but its ability to restore cardiac mechanics in RVH remains unclear. We hypothesized that percutaneous transluminal renal angioplasty (PTRA) would improve cardiac function and left ventricular (LV) deformation in swine RVH.

METHODS

Seventeen domestic pigs were studied for 16 weeks: RVH, RVH + PTRA and normal controls (n = 5-6 each). Global LV function was estimated by multidetector computed-tomography, and LV deformation by electrocardiographically triggered MRI tagging at the apical, mid, and basal LV levels. Cardiomyocyte hypertrophy, myocardial capillary density, and fibrosis were evaluated ex vivo.

RESULTS

BP and wall thickness were elevated in RVH and decreased by PTRA, yet remained higher than in controls. LV myocardial muscle mass increased in RVH pigs, which also developed diastolic dysfunction, whereas cardiac output increased. Furthermore, both apical rotation and peak torsion angle increased in RVH compared with controls. Ex vivo, RVH induced myocardial fibrosis and vascular rarefaction. PTRA restored cardiac function and alleviated hypertrophy, vascular rarefaction, and fibrosis. PTRA also normalized apical rotation and peak torsion angle, and elevated basal peak radial strain and apical peak radial strain compared with RVH.

CONCLUSION

In addition to cardiac LV adaptive hypertrophy and diastolic dysfunction, short-term RVH causes cardiac deformation. Despite only partial improvement in BP, PTRA effectively restored cardiac function and reversed abnormal mechanics. Hence, renal revascularization may be a useful strategy to preserve cardiac function in RVH.

Evaluation of left ventricular systolic functions in two-dimensional speckle-tracking echocardiography in children with chronic renal failure

BACKGROUND AND AIM

Chronic kidney disease may lead to left ventricular dysfunction. Early detection of cardiovascular disease in children with chronic kidney disease is essential to prevent cardiovascular morbidity and mortality in early adulthood. This study aimed to document the dysfunction using methods such as two-dimensional speckle-tracking echocardiography in the early stage.

METHODS

A total of 34 patients diagnosed with chronic kidney disease (mean age ± standard deviation, 10.5 ± 4.1 years) and 37 sex- and age-matched (mean age 9.8 ± 4.2 years) healthy controls were studied. The results of the two groups were compared along with those of the published studies.

RESULTS

The echocardiography measurements had no significant difference in the end-diastolic and end-systolic diameter values of left ventricular, ejection fraction, shortening fraction, mitral E value, mitral A value, and E/A ratio between the groups. Pulmonary artery systolic and diastolic pressure and left ventricular mass index were significantly higher in the patient group (p < 0.01). The longitudinal global strain values in the apical four-chamber, three-chamber, and two-chamber views and the total global strain values were significantly lower in the patients (p < 0.01). The circumferential global strain values in the apical, mid, basal, and total global strain were lower in the patient group, but this difference was statistically significant in the apical global and total global strain values (p < 0.05).

CONCLUSIONS

Speckle-tracking echocardiography might help identify subclinical left ventricular dysfunction in patients with chronic kidney disease with unremarkable conventional echocardiography.

QiShenYiQi pill activates autophagy to attenuate reactive myocardial fibrosis via the PI3K/AKT/mTOR pathway

QiShenYiQi pill (QSYQ), a traditional Chinese medicine, is used to treat cardiovascular diseases. However, the dose-effect relationship of its intervention in the reactive myocardial fibrosis is elusive. In this work, rat models of reactive myocardial fibrosis induced by partial abdominal aortic coarctation were constructed and randomly classified into the model group, 3-methyladenine group, rapamycin group, QSYQ low-dose group, QSYQ medium-dose group, QSYQ high-dose group, and sham-operated rats (control group). We revealed that QSYQ lowered the heart mass index (HMI), left ventricular mass index (LVMI), and myocardial collagen volume fraction (CVF) levels in a dose-dependent mechanism. Additionally, QSYQ increased the number of autophagosomes, and the expression of myocardial Beclin-1 and LC3B. In contrast, it reduced the expression of myocardial p62 and decreased the ratios of myocardial p-PI3K/PI3K, p-Akt/Akt, and p-mTOR/mTOR. In conclusion, our results have revealed that QSYQ impacts anti-reactive myocardial fibrosis in a dose-dependent mechanism which is mediated by the activation of myocardial autophagy via the PI3K/AKT/mTOR pathway.

Impact of gender on left ventricular deformation in patients with essential hypertension assessed by cardiac magnetic resonance tissue tracking

Left ventricular (LV) myocardial strain impairment has been demonstrated in hypertension despite normal LV ejection fraction (LVEF); however, limited data exist on any difference in results between genders. The aim of this study was to investigate the impact of gender on LV deformation in patients with essential hypertension. This was a cross-sectional study, in which 94 patients (47 men and 47 women) with essential hypertension and 62 age- and gender-matched controls (31 men and 31 women) were enrolled. A 3.0 T/two-dimensional balanced steady-state free precession cine, late gadolinium enhancement was used. The LV endocardial and epicardial contours were drawn by radiologists, then LV volumes, mass, function, and myocardial strain, including peak global radial (GRS), circumferential (GCS), and longitudinal strain (GLS) were automatically calculated. Chi-square test, Student's t-test, general linear model analysis, univariate linear regression analysis, stepwise multivariate linear regression analysis, and intraclass correlation coefficient analysis were performed. Women had significantly higher magnitudes of LV GRS, GCS, and GLS than men in both patients and controls (all p < 0.05). In the overall patients, LV GLS was significantly reduced compared with controls (p < 0.05), while GRS and GCS were preserved (p = 0.092 and 0.27, respectively). Compared with their counterpart controls, LV GRS, GCS, and GLS (all p < 0.05) were significantly reduced in hypertensive men, while only GLS (p < 0.05) was reduced in hypertensive women. Male gender and its interaction with hypertension were associated with higher LV mass and volume, decreased LV GRS, GCS, and GLS compared with hypertensive women. Multivariate analyses revealed that gender and LVEF were independently associated with GRS, GCS, and GLS (all p < 0.001) in hypertension. LV deformation is significantly reduced in hypertension, and gender may influence the response of LV deformation to hypertension, with men suffering more pronounced subclinical myocardial dysfunction. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 3.

Joint influences of obesity, diabetes, and hypertension on indices of ventricular remodeling: Findings from the community-based Framingham Heart Study

Introduction

Obesity, hypertension, and diabetes are independently associated with cardiac remodeling and frequently co-cluster. The conjoint and separate influences of these conditions on cardiac remodeling have not been investigated.

Materials and methods

We evaluated 5,741 Framingham Study participants (mean age 50 years, 55% women) who underwent echocardiographic measurements of left ventricular (LV) mass (LVM), LV ejection fraction (LVEF), global longitudinal strain (GLS), mitral E/e’, left atrial end-systolic (peak) dimension (LASD) and emptying fraction (LAEF). We used multivariable generalized linear models to estimate the adjusted-least square means of these measures according to cross-classified categories of body mass index (BMI; normal, overweight and obese), hypertension (yes/no), and diabetes (yes/no).

Results

We observed statistically significant interactions of BMI category, hypertension, and diabetes with LVM, LVEF, GLS, and LAEF (p for all 3-way interactions <0.01). Overweight and obesity (compared to normal BMI), hypertension, and diabetes status were individually and conjointly associated with higher LVM and worse GLS (p<0.01 for all). We observed an increase of 34% for LVM and of 9% for GLS between individuals with a normal BMI and without hypertension or diabetes compared to obese individuals with hypertension and diabetes. Presence of hypertension was associated with higher LVEF, whereas people with diabetes had lower LVEF.

Conclusions

Obesity, hypertension, and diabetes interact synergistically to influence cardiac remodeling. These findings may explain the markedly heightened risk of heart failure and cardiovascular disease when these factors co-cluster.

Novel genomic targets of valosin-containing protein in protecting pathological cardiac hypertrophy

Pressure overload-induced cardiac hypertrophy, such as that caused by hypertension, is a key risk factor for heart failure. However, the underlying molecular mechanisms remain largely unknown. We previously reported that the valosin-containing protein (VCP), an ATPase-associated protein newly identified in the heart, acts as a significant mediator of cardiac protection against pressure overload-induced pathological cardiac hypertrophy. Still, the underlying molecular basis for the protection is unclear. This study used a cardiac-specific VCP transgenic mouse model to understand the transcriptomic alterations induced by VCP under the cardiac stress caused by pressure overload. Using RNA sequencing and comprehensive bioinformatic analysis, we found that overexpression of the VCP in the heart was able to normalize the pressure overload-stimulated hypertrophic signals by activating G protein-coupled receptors, particularly, the olfactory receptor family, and inhibiting the transcription factor controlling cell proliferation and differentiation. Moreover, VCP overexpression restored pro-survival signaling through regulating alternative splicing alterations of mitochondrial genes. Together, our study revealed a novel molecular regulation mediated by VCP under pressure overload that may bring new insight into the mechanisms involved in protecting against hypertensive heart failure.

Influence of TEVAR on blood pressure in subacute type B aortic dissection (TBAD) patients with refractory and non-refractory arterial hypertension

BACKGROUND

Aim of this study was to compare the modifications of systemic blood pressure in patients with subacute type b aortic dissection (TBAD) and refractory (rHTN) and non-refractory arterial hypertension (N-rHTN) treated by thoracic endovascular aortic repair (TEVAR).

METHODS

Patients were divided into two groups, rHTN defined as blood pressure >140/90 mmHg with ≥5 antihypertensive drugs and patients with N-rHTN. Primary endpoint was the variation of mean systolic, diastolic and overall pressure (MSP, MDP and MAP) before and after antihypertensive treatment or TEVAR. Secondary endpoints were the 30-days mortality. Fifty-seven patients were included in this study.

RESULTS

Of the 44 Patients of the TEVAR group 21 were included in the N-rHTN group. The MSP before and after surgery for the N-rHTN group was 130 (±10 SD) and 111 (±22 SD) mmHg, P=0.01. In the rHTN group 164 (±17 SD) and 118 (±17 SD) mmHg (P=0.01). The reduction of MSP was greater in the rHTN group (P=0.01). The MAP before and after the TEVAR for the N-rHTN group was 90 (±10 SD) and 74 (±12 SD) mmHg (P=0.01), in the rHTN group 111 (±14 SD) and 70 (±9 SD) mmHg (P=0.01). The overall mortality rate group was 2.2% (1/44).

CONCLUSIONS

TEVAR for TBAD appears to positively affect blood pressure in patients with rHTN and N-rHTN.

Treatment of Hypertensive Heart Disease by Targeting Smad3 Signaling in Mice

Transforming growth factor β (TGF-β)/Smad3 signaling plays a central role in chronic heart disease. Here, we report that targeting Smad3 with a Smad3 inhibitor SIS3 in an established mouse model of hypertension significantly improved cardiac dysfunctions by preserving the left ventricle (LV) ejection fraction (LVEF) and LV fractional shortening (LVFS), while reducing the LV mass. In addition, SIS3 treatment also halted the progression of myocardial fibrosis by blocking α-smooth muscle actin-positive (α-SMA⁺) myofibroblasts and collagen matrix accumulation, and inhibited cardiac inflammation by suppressing interleukin (IL)-1β, tumor necrosis factor alpha (TNF-α), monocyte chemotactic protein 1 (MCP1), intercellular cell adhesion molecule-1 (ICAM1) expression, and infiltration of CD3⁺ T cells and F4/80⁺ macrophages. Interestingly, treatment with SIS3 did not alter levels of high blood pressure, revealing a blood pressure-independent cardioprotective effect of SIS3. Mechanistically, treatment with SIS3 not only directly inactivated TGF-β/Smad3 signaling but also protected cardiac Smad7 from Smurf2-mediated proteasomal ubiquitin degradation. Because Smad7 functions as an inhibitor for both TGF-β/Smad and nuclear factor κB (NF-κB) signaling, increased cardiac Smad7 could be another mechanism through which SIS3 treatment blocked Smad3-mediated myocardial fibrosis and NF-κB-driven cardiac inflammation. In conclusion, SIS3 is a therapeutic agent for hypertensive heart disease. Results from this study demonstrate that targeting Smad3 signaling with SIS3 may be a novel and effective therapy for chronic heart disease.

Genomic characterization reveals novel mechanisms underlying the valosin-containing protein-mediated cardiac protection against heart failure

Chronic hypertension is a key risk factor for heart failure. However, the underlying molecular mechanisms are not fully understood. Our previous studies found that the valosin-containing protein (VCP), an ATPase-associated protein, was significantly decreased in the hypertensive heart tissues. In this study, we tested the hypothesis that restoration of VCP protected the heart against pressure overload-induced heart failure. With a cardiac-specific transgenic (TG) mouse model, we showed that a moderate increase of VCP was able to attenuate chronic pressure overload-induced maladaptive cardiac hypertrophy and dysfunction. RNA sequencing and a comprehensive bioinformatic analysis further demonstrated that overexpression of VCP in the heart normalized the pressure overload-stimulated hypertrophic signals and repressed the stress-induced inflammatory response. In addition, VCP overexpression promoted cell survival by enhancing the mitochondria resistance to the oxidative stress via activating the Rictor-mediated-gene networks. VCP was also found to be involved in the regulation of the alternative splicing and differential isoform expression for some genes that are related to ATP production and protein synthesis by interacting with long no-coding RNAs and histone deacetylases, indicating a novel epigenetic regulation of VCP in integrating coding and noncoding genomic network in the stressed heart. In summary, our study demonstrated that the rescuing of a deficient VCP in the heart could prevent pressure overload-induced heart failure by rectifying cardiac hypertrophic and inflammatory signaling and enhancing the cardiac resistance to oxidative stress, which brought in novel insights into the understanding of the mechanism of VCP in protecting patients from hypertensive heart failure.

•

Deficiency of VCP contributes to the pathogenesis of hypertensive heart failure.

•

Rescue of VCP prevents stress-induced cardiac remodeling and cell death.

•

VCP attenuates stress-induced inflammatory and hypertrophic signaling.

•

VCP promotes cardiac resistance to oxidative stress.

•

VCP mediates a novel epigenetic integrating regulation in the stressed heart.

Left Ventricular Myocardial Deformations in Hemodialysis Children by Speckle Tracking Echocardiography

Background:

Cardiac systolic dysfunction was potentially found in adult patients with end-stage renal disease (ESRD) who have preserved left ventricular ejection fraction (EF%). In children with ESRD, little data are available on early changes in myocardial function. This study aimed to detect the early changes in myocardial mechanics in pediatric patients with ESRD using speckle tracking echocardiography (STE).

Methods:

Thirty ESRD children receiving hemodialysis (HD) and30 age-matched controls were prospectively studied. Patients underwent echocardiographic studies before and after HD. Left ventricular longitudinal strain (LS), circumferential strain (CS), and radial strain (RS) myocardial deformation parameters (strain, strain rate) were evaluated by STE.

Results:

The LS was significantly reduced in pre-HD and post-HD patients compared with controls (P = .000). Controls showed the highest global longitudinal strain. The RS measurements did not differ significantly among the studied groups except for the inferior segment that is significantly reduced after HD compared with controls (P < .05). The CS was significantly reduced in pre-HD and post-HD patients compared with controls at the lateral and posterior segments (P = .035 and P = .013, respectively).

Conclusion:

Speckle-tracking echocardiography might detect early changes in myocardial mechanics in children with ESRD with preserved EF%.

Cardiovascular Changes Associated with Hypertensive Heart Disease and Aging

Cardiovascular diseases are the leading cause of mortality and morbidity worldwide and account for more than 17.9 million deaths (World Health Organization report). Hypertension and aging are two major risk factors for the development of cardiac structural and functional abnormalities. Hypertension, or elevated blood pressure, if left untreated can result in myocardial hypertrophy leading to heart failure (HF). Left ventricular hypertrophy consequent to pressure overload is recognized as the most important predictor of congestive HF and sudden death. The pathological changes occurring during hypertensive heart disease are very complex and involve many cellular and molecular alterations. In contrast, the cardiac changes that occur with aging are a slow but life-long process and involve all of the structural components in the heart and vasculature. However, these structural changes in the cardiovascular system lead to alterations in overall cardiac physiology and function. The pace at which these pathophysiological changes occur varies between individuals owing to many genetic and environmental risk factors. This review highlights the molecular mechanisms of cardiac structural and functional alterations associated with hypertension and aging.

The Capabilities of Amlodipine/Lisinopril Single-Pill Combination in the Treatment of Newly Diagnosed Arterial Hypertension in a Middle-Aged Patient (Case Report)

Arterial hypertension (AH) is one of the most significant modifiable risk factors that increase cardiovascular morbidity and mortality worldwide, including Russia. The complex of structural and functional changes in the heart that occurs during AH consists not only in the formation of left ventricular (LV) myocardial hypertrophy, but also in the myocardial stiffness increasing due to collagen formation and cardiomyocytes apoptosis. These abnormalities are substrate for diastolic function disturbances, electrical myocardial instability and ischemia. The article provides a clinical case of amlodipine/lisinopril single-pill combination (A/L SPC) use in real clinical practice in a patient with stage II grade 2 newly diagnosed AH and its effect on blood pressure and echocardiographic myocardial fibrosis markers, including speckle tracking parameters The high antihypertensive efficacy of A/L SPC, a favorable effect on blood pressure circadian rhythm, as well as pronounced target-organ protective properties, in particular the ability to reduce LV and left atrial stiffness, were demonstrated. So, we conclude that A/L SPC improve the elastic properties of the left heart.