Multiple Autoantibodies against Cardiovascular Receptors as Biomarkers in Hypertensive Heart Disease

Cardiology ◽  
2019 ◽  
Vol 142 (1) ◽  
pp. 47-55 ◽  
Author(s):  
Xin Wang ◽  
Yuan Zhang ◽  
Juan Zhang ◽  
Yu-Xing Wang ◽  
Xiao-Rong Xu ◽  
...  
Keyword(s):  
Heart Disease ◽  
Angiotensin Ii ◽  
Muscarinic Receptors ◽  
Hypertensive Heart Disease ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Enzyme Linked Immunosorbent Assay ◽  
Ventricular Ejection Fraction ◽  
M2 Muscarinic Receptors ◽  
Normal Controls

Objectives: The pathogenesis of hypertensive heart disease (HHD) remains unclear, which might include autoimmunity. The aim of the present study was to determine whether a relationship exists between the presence of autoantibodies against β1, β2, α1 adrenoreceptors, M2-muscarinic receptors, angiotensin II type1 receptors and HHD. Methods: In the present study, 44 patients diagnosed with HHD, 36 patients with hypertension, and 40 controls were also enrolled. The measurement of these 5 autoantibodies was performed by enzyme-linked immunosorbent assay. Results: The frequencies of autoantibodies against β1, β2, α1 adrenoreceptors, autoantibodies against M2-muscarinic receptors and autoantibodies against angiotensin II type1 receptors were significantly higher in patients with HHD, when compared to patients with hypertension and normal controls (all p < 0.001). In addition, the titers of these 5 autoantibodies significantly increased in patients with HHD. Patients who were positive for all 5 autoantibodies had larger left ventricular end-diastolic diameter (60.5 ± 4.9 vs. 57.8 ± 5.0 vs. 52.5 ± 5.3 mm) and worse left ventricular ejection fraction (45.0 ± 11.0 vs. 56.6 ± 10.4 vs. 57.8 ± 5.3%), when compared to patients not positive for all the 5 autoantibodies and patients negative for all the 5 autoantibodies (χ2 = 9.524, p = 0.009 and χ2 = 7.689, p = 0.021). Furthermore, a significant positive correlation was observed between each 2 autoantibodies of these 5 autoantibodies (all p < 0.001). Conclusion: Multiple autoantibodies of cardiovascular receptors may be involved in the pathogenesis and may be predictive factors of HHD.

scholarly journals COMBINED MITRAL AND TRICUSPID STENOSIS IN 47-YEAR OLD RHEUMATIC VALVULAR HEART DISEASE PATIENT: A CASE REPORT

2020 ◽  
Vol 14 (2) ◽  
pp. 153-156
Author(s):  
*Ejeagba OO ◽  
◽  
*Ayoola YA ◽  
*Ejeh AB ◽  
*Adamu A ◽  
...  
Keyword(s):  
Heart Disease ◽  
Left Atrium ◽  
Valvular Heart Disease ◽  
Systolic Dysfunction ◽  
Disease Patient ◽  
Hypertensive Heart Disease ◽  
Left Ventricular ◽  
Valve Disease ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Background: Rheumatic valvular heart disease is a common complication of rheumatic fever; however combined mitral and tricuspid stenosis is an extremely rare form of multi-valve disease presentation. Case Presentation: We report a case of combined mitral and tricuspid stenosis from rheumatic heart disease (RHD) in a 47-year-old woman who was being managed for hypertensive heart disease (HHDx) on anti-hypertensives for 2yrs prior to presentation. However, on further review with transthoracic echocardiography (TTE), she was found to have thickened mitral valve and hockey stick appearance with dilated left atrium (dimension of 60mm) and reduced left ventricular ejection fraction (LVEF) of 45%. A repeat TTE done 8 years after the first one showed a severely dilated left atrium (LAD 71mm) with estimated area of 55.4cm2; moderate mitral stenosis and severe tricuspid stenosis with moderate TR. The LVEF was 29% with a severe right ventricular (RV) systolic dysfunction (TAPSE of 9mm). Patient is being managed conservatively due to economic constraints and the likelihood of very poor surgical outcome due to severe biventricular dysfunction. Conclusion: The case is reported for its rarity as well as the importance of interval evaluation of unaffected valves in a setting of single valve disease for early detection and possible prompt treatment and intervention.

Left ventricular apical pacing in children: feasibility and long-term effect on ventricular function

EP Europace ◽  
2019 ◽  
Vol 22 (2) ◽  
pp. 306-313
Author(s):  
Jan Kovanda ◽  
Miroslav Ložek ◽  
Shin Ono ◽  
Peter Kubuš ◽  
Viktor Tomek ◽  
...  
Keyword(s):  
Heart Disease ◽  
Structural Heart Disease ◽  
Left Ventricular ◽  
Exercise Stress ◽  
Left Ventricular Ejection ◽  
Lv Function ◽  
Ventricular Ejection Fraction ◽  
Death Probability ◽  
Normal Controls

Abstract Aims  Left ventricular apical pacing (LVAP) has been reported to preserve left ventricular (LV) function in chronically paced children with complete atrioventricular block (CAVB). We sought to evaluate long-term feasibility of LVAP and the effect on LV mechanics and exercise capacity as compared to normal controls. Methods and results  Thirty-six consecutive paediatric patients with CAVB and LVAP in the absence (N = 22) or presence of repaired structural heart disease (N = 14, systemic LV in all) and 25 age-matched normal controls were cross-sectionally studied after a median of 3.9 (interquartile range 2.1–6.8) years of pacing using echocardiography and exercise stress testing. Pacemaker implantation was uneventful and there was no death. Probability of the absence of pacemaker-related surgical revision (elective generator replacement excluded) was 89.0% at 5 years after implantation. Left ventricular apical pacing patients had lower maximum oxygen uptake (P = 0.009), no septal to lateral but significant apical to basal LV mechanical delay (P &lt; 0.001) which correlated with decreased LV contraction efficiency (P = 0.001). Left ventricular ejection fraction and global longitudinal LV strain were, however, not different from controls. Results were similar in both the presence and absence of structural heart disease. Conclusion  Left ventricular apical pacing is technically feasible with a low reintervention rate. Mechanical synchrony between LV septum and free wall is maintained at the price of an apical to basal mechanical delay associated with LV contraction inefficiency as compared to healthy controls. Global LV systolic function is, however, not negatively affected by LVAP.

CMR fast-SENC segmental intramyocardial LV strain monitors decline in heart function before ejection fraction in patient with arterial hypertension

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Montenbruck ◽  
S Kelle ◽  
S Esch ◽  
A.K Schwarz ◽  
S Giusca ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ejection Fraction ◽  
Cardiac Function ◽  
Arterial Hypertension ◽  
Global Longitudinal Strain ◽  
Hypertensive Heart Disease ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Peak Strain ◽  
Ventricular Ejection Fraction

Abstract Background Left ventricular ejection fraction (LVEF) is commonly used to assess cardiac function for patients with chronic cardiac diseases. LVEF, like most systemic function assessments, detects dysfunction once enough damage has occurred to prevent common compensatory mechanisms from maintaining cardiac output. More sensitive metrics are being evaluated to more accurately identify subclinical regional dysfunction before cardiac remodeling results in changes in LVEF and global longitudinal strain (GLS). Fast-SENC intramyocardial strain (fSENC) is a unique cardiac magnetic resonance imaging (CMR) modality that measures intramyocardial contraction in 1 heartbeat per image plane. This prospective registry compares segmental fSENC to standard CMR calculations (e.g. LVEF, volumes, mass, etc.) for patients with arterial hypertension in the absence of non-ischemic cardiomyopathy. Methods A single center, prospective registry of CMR scans acquired with a 1.5T scanner were evaluated for standard CMR calculations as well as fSENC scans. Intramyocardial LV & RV strain was quantified with MyoStrain software. Three short axis scans (basal, midventricular, & apical) were used to calculate peak strain in 16 LV & 6 RV longitudinal segments while three long axis scans (2-, 3-, & 4-chamber) were used to calculate 21 LV & 5 RV circumferential segments. Results A total of 773 scans in 650 patients with arterial hypertension but without non-ischemic cardiomyopathies were included in the study. Patients had an average (± stdev) age of 64 (13) yrs and BMI of 28 (5) kg/m2; 24% diabetes mellitus, 10% atrial fibrillation, 15% pulmonary disease, and 39% coronary artery disease. Figure 1 shows a Box & Whisker's plot demonstrating the non-linear relationship between segmental fSENC strain (% of normal LV segments ≤−17%) versus LVEF. The progression of hypertensive heart disease was associated with reduction in septal circumferential contraction despite normal LVEF. Conclusion Segmental fSENC detects subclinical LV dysfunction in patients with early hypertensive heart disease before changes in LVEF. Evaluating segmental longitudinal and circumferential fSENC peak strain provides an alternative metric that shows consistent changes in cardiac function in patients with arterial hypertension. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Hypertensive heart disease: Benefit of carvedilol in hemodynamic, left ventricular remodeling, and survival

2019 ◽  
Vol 7 ◽  
pp. 205031211882358 ◽  
Author(s):  
Renata F Dominguez ◽  
Valeria A da Costa-Hong ◽  
Luan Ferretti ◽  
Fabio Fernandes ◽  
Luiz A Bortolotto ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Heart Disease ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Hypertensive Heart Disease ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Objectives: The aim of this study was to determine if carvedilol improved structural and functional changes in the left ventricle and reduced mortality in patients with hypertensive heart disease. Methods: Blood pressure, heart rate, echocardiographic parameters, and laboratory variables, were assessed pre and post treatment with carvedilol in 98 eligible patients. Results: Carvedilol at a median dose of 50 mg/day during the treatment period in hypertensive heart disease lowered blood pressure 10/10 mmHg, heart rate 10 beats/min, improved left ventricular ejection fraction from baseline to follow-up (median: 6 years) (36%–47%)) and reduced left ventricular end-diastolic and end-systolic dimensions (62 vs 56 mm; 53 vs 42 mm, respectively, all p-values <0.01). Left ventricular ejection fraction increased in 69% of patients. Patients who did not have improved left ventricular ejection fraction had nearly six-fold higher mortality than those that improved (relative risk; 5.7, 95% confidence interval: 1.3–25, p = 0.022). Conclusion: Carvedilol reduced cardiac dimensions and improved left ventricular ejection fraction and cardiac remodeling in patients with hypertensive heart disease. These treatment-related changes had a favorable effect on survival.

Vergleich von Belastungs- EKG und Radionuklid- Ventrikulographie bezüglich des Nachweises einer Myokardischämie bei isolierten Stenosen des Ramus interventricularis anterior

1988 ◽  
Vol 27 (02) ◽  
pp. 57-62
Author(s):  
R. Standke ◽  
R. P. Baum ◽  
S. Tezak ◽  
D. Mildenberger ◽  
F. D. Maul ◽  
...  
Keyword(s):  
Heart Disease ◽  
Left Ventricular Ejection Fraction ◽  
Myocardial Ischemia ◽  
Ejection Fraction ◽  
Anterior Wall ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Global Ejection Fraction ◽  
Ventricular Ejection Fraction ◽  
Exercise Ecg

21 patients with LAD-stenoses of at least 70% and 21 patients with LAD- stenoses and additional intramural anterior wall infarctions were studied. 20 patients without heart disease or after successful transluminal coronary angioplasty and 18 patients with intramural anterior wall infarction after successful transluminal dilatation of the LAD (remaining stenosis maximal 30%) served as controls. The normal range of global and regional left ventricular ejection fraction response to exercise was defined based on the data of 25 further patients without relevant coronary heart disease. Thus, a decrease in global ejection fraction and regional wall motion abnormalities were judged pathological. All patients were comparable with respect to age, ejection fraction at rest and work load. Myocardial ischemia could be detected by the exercise ECG in 81 % of all patients without infarction and in 71 % of patients with infarction. The corresponding values for global left ventricular ejection fraction were 76% and 81 %, respectively, and for regional ejection fraction 95% in both groups. No false-positive exercise ECGs were observed in the healthy controls and 2 (11 %) in the corresponding group with intramural infarction. The global ejection fraction was pathological in 1 (5%) healthy subject without infarction and in 3 (17%) corresponding patients with infarction. Sectorial analysis revealed 5 and 22%, respectively. Our findings suggest that the exercise ECG has a limited sensitivity to detect myocardial ischemia in patients with isolated LAD-stenoses and intramural myocardial infarction. Radionuclide ventriculography yields pathological values more often; however, false-positive results also occur more frequently.

scholarly journals Major Left Bundle Branch Block and Coronary Heart Disease—Are There Any Differences between the Sexes?

2021 ◽  
Vol 10 (11) ◽  
pp. 2284
Author(s):  
Diana Gurzău ◽  
Alexandra Dădârlat-Pop ◽  
Bogdan Caloian ◽  
Gabriel Cismaru ◽  
Horaţiu Comşa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Left Bundle Branch Block ◽  
Left Ventricular ◽  
Ischemic Heart ◽  
Left Ventricular Ejection ◽  
Bundle Branch Block ◽  
Microvascular Angina ◽  
Ventricular Ejection Fraction

Left bundle branch block is not a benign pathology, and its presence requires the identification of a pathological substrate, such as ischemic heart disease. Left bundle branch block appears to be more commonly associated with normal coronary arteries, especially in women. The objectives of our study were to describe the particularities of left bundle branch block in women compared to men with ischemic heart disease. Result: We included seventy patients with left bundle branch block and ischemic heart disease, with a mean age of 67.01 ± 8.89 years. There were no differences in the profile of risk factors, except for smoking and uric acid. The ventricular depolarization (QRS) duration was longer in men than women (136.86 ± 8.32 vs. 132.57 ± 9.19 msec; p = 0.018) and also men were observed to have larger left ventricular diameters. Left bundle branch block duration was directly associated with ventricular diameters and indirectly associated with left ventricular ejection fraction value, especially in women (R = −0.52, p = 0.0012 vs. R = −0.50, p = 0.002). In angiography, 80% of women had normal epicardial arteries compared with 65.7% of men; all these patients presented with microvascular dysfunction. Conclusion: The differences between the sexes were not so obvious in terms of the presence of risk factors; instead, there were differences in electrocardiographic, echocardiographic, and angiographic aspects. Left bundle branch block appears to be a marker of microvascular angina and systolic dysfunction, especially in women.

Extracting and analyzing ejection fraction values from electronic echocardiography reports in a large health maintenance organization

2016 ◽  
Vol 23 (4) ◽  
pp. 319-328 ◽  
Author(s):  
Fagen Xie ◽  
Chengyi Zheng ◽  
Albert Yuh-Jer Shen ◽  
Wansu Chen
Keyword(s):  
Heart Disease ◽  
Ejection Fraction ◽  
Health Maintenance Organization ◽  
Prognostic Indicator ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Free Text ◽  
Ventricular Ejection Fraction ◽  
Health Maintenance ◽  
Systolic Left Ventricular Function

The left ventricular ejection fraction value is an important prognostic indicator of cardiovascular outcomes including morbidity and mortality and is often used clinically to indicate severity of heart disease. However, it is usually reported in free-text echocardiography reports. We developed and validated a computerized algorithm to extract ejection fraction values from echocardiography reports and applied the algorithm to a large volume of unstructured echocardiography reports between 1995 and 2011 in a large health maintenance organization. A total of 621,856 echocardiography reports with a description of ejection fraction values or systolic functions were identified, of which 70 percent contained numeric ejection fraction values and the rest (30%) were text descriptions explicitly indicating the systolic left ventricular function. The 12.1 percent (16.0% for male and 8.4% for female) of these extracted ejection fraction values are <45 percent. Validation conducted based on a random sample of 200 reports yielded 95.0 percent sensitivity and 96.9 percent positive predictive value.

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