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Introduction: Malnutrition during a critical window of development in a fetus or infant can result in abnormal cardiac remodeling and function. It is uncertain whether the contribution of these effects continues to impact the cardiac remodeling and function of adults over the course of several decades of growth. Our study examined the impact of early Chinese famine exposure on cardiac remodeling, left ventricular (LV) diastolic function, and LV systolic function in adults. Methods: Participants at high risk of cardiovascular disease from the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project (PEACE MPP) were enrolled. The famine in China lasted from 1959 to 1962. A total of three groups were formed based on the participants' birth dates: pre-famine group, famine exposure group, and post-famine group. Logistic regression and linear mixed models were used to explore the association between famine exposure and cardiac remodeling, LV diastolic function and LV systolic function in adults. Results: The study included 2,758 participants, the mean age was 57.05 years, 62.8% were female, 26.4% had LV hypertrophy (LVH), 59.6% had LV diastolic dysfunction (LVDD), and 10.5% had reduced global longitudinal strain (GLS). Compared to post-famine exposure, participants had independently increased risk of LVH in the famine exposure group (OR: 2.02, 95% CI: 1.60–2.56) and pre-famine exposure (OR: 1.36, 95% CI: 1.06–1.76). Compared to post-famine exposure, the risk of LVDD remarkably increased in the famine exposure group (OR: 3.04, 95% CI: 2.49–3.71) and pre-famine exposure group (OR: 1.87, 95% CI: 1.52–2.31). Famine exposure had no significant impact on GLS but was associated with a significant increase in LV ejection fraction (LVEF) and LV end-diastolic diameter (LVEDD). Significant interactions were observed between the effects of famine exposure and other clinical/sociodemographic variables (gender, systolic blood pressure [SBP] ≥140 mm Hg or not, high school or above or not, and annual income <50,000 RMB or not) on these outcomes. Conclusion: Exposure to famine, particularly during fetal and infant stages, increases the risk of LVH and LVDD in adults. However, the LV systolic function remains preserved. These impacts are more pronounced in females, individuals with SBP ≥140 mm Hg, those with low income, or those with high educational status. [ABSTRACT FROM AUTHOR]

Aim: Left ventricular hypertrophy and impaired systolic and diastolic function are commonly seen in patients with chronic kidney disease (CKD), but relationships between the disorders and cardiovascular outcomes are not well established among the patients. Methods: Totally, 2020 patients with CKD Stages 1–4 were used in the analysis. Left ventricular hypertrophy was defined by left ventricular mass index >49.2 g/m2.7 in men and > 46.7 g/m2.7 in women. Incident heart failure, non‐heart failure cardiovascular events, and all‐cause mortality were recorded longitudinally. Cox proportional hazards regression model was used to evaluate the association between the echo parameters and the outcomes, with death treated as the competing risk event for the cardiovascular events. Results: After a median follow‐up of 4.5 years, 53 heart failure, 76 non‐heart failure cardiovascular events and 82 deaths occurred. No overall association was found between left ventricular hypertrophy and subsequent heart failure, but the relationship was significant among patients with no diabetes with the multivariable adjusted hazard ratio of 3.66 (95% confidence interval: 1.42–9.46). Ejection fraction<55% was associated with both heart failure and non‐heart failure cardiovascular events with hazard ratios of 3.16 (1.28–7.77) and 2.76 (1.08–7.04), respectively. E/A ratio ≤ 0.75 was associated with non‐heart failure cardiovascular events [hazard ratio = 2.03 (1.09–3.80)], compared with E/A ratio of 0.76–1.49. Conclusion: Associations of reduced left ventricular ejection fraction with both heart failure and non‐heart failure cardiovascular events and of impaired left ventricular diastolic function with non‐heart failure cardiovascular events were validated in a Chinese cohort of CKD. SUMMARY AT A GLANCE: This is a multi‐centre cohort from China on the association of left ventricular hypertrophy and functional impairment with cardiovascular outcomes and mortality in CKD patients. Ejection fraction <55% was associated with both heart failure and non‐heart failure cardiovascular events. [ABSTRACT FROM AUTHOR]

To compare central and brachial blood pressure (BP) in the association of target organ damage (TOD) in a community-based elderly population, 1599 (aged 71.4 ± 6.1 years) participants in northern Shanghai were recruited. TOD included left ventricular hypertrophy (n = 1556), left ventricular diastolic dysfunction (n = 1524), carotid plaque (n = 1558), arteriosclerosis (n = 1485), and microalbuminuria (n = 1516). Both central and brachial BP significantly correlated with TOD. In full-model regression, central BP was significantly associated with all TOD (P ≤ .04), whereas brachial BP was only significantly associated with left ventricular hypertrophy and arteriosclerosis (P ≤ .01). Similarly, in stepwise regression, central BP was significantly associated with left ventricular hypertrophy, left ventricular diastolic dysfunction, arteriosclerosis, and microalbuminuria (P ≤ .04), while brachial BP was not associated with any TOD. Receiver operating characteristic analyses indicated that central BP identified arteriosclerosis and microalbuminuria better than brachial BP (P ≤ .01). In conclusion, central BP showed superiority over brachial BP in the association of hypertensive TOD in a community-based elderly population. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to assess left atrial (LA) function with two-dimensional speckle tracking echocardiography (2DSTE) in addition to standard echocardiographic assessments in patients with hypertrophic obstructive cardiomyopathy (HOCM) before and 1 year after septal ablation (SA). Methods The study included 31 patients with HOCM, who underwent SA. Each patient with HOCM underwent a complete two-dimensional transthoracic echocardiography before and 1 year after the SA. The measurements included basal septal thickness, left ventricular outflow trace (LVOT) gradient, mitral regurgitation (MR) grade, LA dimensions, left ventricular (LV) ejection fraction, and tissue Doppler parameters of lateral mitral annular e ′ and septal mitral annular e ′. The LA wall was tracked on a frame-by-frame basis using 2DSTE, and LA volume waveforms were generated. The maximum LA volume (LAVmax), minimal LA volume (LAVmin), and the LA volume before atrial contraction (LAVpre-a) were measured. The LA reservoir function was calculated as the expansion index and diastolic emptying index. The LA conduit function was calculated as the passive emptying percentage of total emptying (PE) and the passive emptying index (PEI). The LA booster function was calculated as the active emptying percentage of total emptying (AE) and the active emptying index (AEI). Results The LVOT gradient, end-diastolic septal base thickness, the grade of MR, and LA end-diastolic size were significantly decreased in patients with HOCM before and 1 year after the SA (All P<.05). The lateral mitral annular e ′ was significantly increased ( P<.05), and the E/lateral e ′ ratio was significantly decreased ( P<.05), whereas septal mitral annular e ′ was significantly decreased ( P<.05), and the E/septal e ′ ratio was significantly increased ( P<.05). LAVImax, LAVImin, and LAVIpre-a were significantly decreased 1 year after the SA (All P<.05). The expansion and diastolic emptying indices were significantly increased (All P<.05) at 1 year after the SA. PE and PEI were significantly increased (All P<.05). The AE and AEI were significantly decreased (All P<.05). LAVImax, LAVImin, and LAVIpre-a of the responders group were significantly lower than those of the nonresponders group (All P<.05). The expansion and diastolic emptying indices of the responders group were significantly higher than those of the nonresponders group (All P<.05). The PE and PEI of the responders were significantly higher than those of the nonresponders group (All P<.05). The AE and AEI of the responders were significantly lower than those of the nonresponders group (All P<.05). Conclusions We found an improvement in the LA reservoir and conduit function but a reduction in LA booster pump function 1 year after the SA in the responders. [ABSTRACT FROM AUTHOR]

Background There is debate regarding the predictive value of interventricular septum ( IVS) wall thickness for adverse events. Aims The study investigated the association between the severity of thickened IVS and all-cause death in Chinese patients with coronary artery disease ( CAD). Methods A total of 2297 CAD patients verified by angiography was consecutively included. Patients were grouped according to the severity of thickened IVS. Cox regression analysis was conducted to determine the independent prognostic value of thickened IVS for all-cause death. Results During a median follow up of 25 months, 149 patients died. A gradient increase in the risk of death was observed across thickened IVS groups. Compared to patients with normal IVS thickness, the adjusted hazard ratio ( HR) was 1.49 (95% confidence interval ( CI) 1.00-2.23, P = 0.05) and 2.13 (95% CI 1.29-3.54, P = 0.003) for all-cause death in those with mildly and moderately/severely thickened IVS respectively. For one unit increase in IVS thickness, the risk of all-cause death was elevated by 14% (adjusted HR 1.14, 95% CI 1.05-1.24, P = 0.003). In patients with normal indexed left ventricular mass, thickened IVS was also demonstrated as an independent risk factor for all-cause death. Conclusion Thickened IVS can be served as a reliable marker for predicting all-cause death in Chinese patients with CAD, even in those with normal left ventricular mass. [ABSTRACT FROM AUTHOR]

Background Pacing has been proposed as a treatment for patients with hypertrophic obstructive cardiomyopathy (HOCM), but there are few studies with long-term follow-up. We evaluated the long-term effects of dual-chamber pacing therapy for patients with HOCM, and to identify the most prognosis-specific factors for predicting outcome in such treating methods. Methods A total of 37 HOCM patients implanted with dual-chamber pacemakers were enrolled consecutively and followed-up. Thirty-seven cases were followed for 1 year, 26 cases for 2 years, 10 cases for 3 years, and eight cases for 4 years. At each annual point of follow-up after pacemaker implantation, the pacing frequency, pacing threshold, impedance, atrioventricular delay, and cumulative percentage of atrial and ventricular pacing were tested, respectively. In addition, left atrial dimension (LAD), left ventricular end diastolic dimension (LVEDd), left ventricular posterior wall thickness (LVPW), interventricular septum thickness (IVS), left ventricular outflow tract dimension (LVOTd), peak velocity of left ventricular outflow tract (VLVOT), left ventricular outflow tract pressure gradient (LVOTPG), left ventricular ejection fraction (LVEF), and pulmonary artery systolic pressure (PASP) were measured. Mitral valve systolic anterior motion (SAM) was also observed. Pacing parameters and echocardiography indexes before and after pacemaker implantation were dynamically compared. Results Pacing frequency and atrioventricular delay were adjusted to 60-70 beats per minute and 90-180 ms, respectively, in order to ensure the ratio of ventricular pacing was more than 98%. Pacing threshold and pacing impedance were kept in normal ranges. The differences of various pacing parameters were of no statistical significance within the 4 years of follow-up (P > 0.05). Compared with prior to pacing, it was observed that the IVS, VLVOT, and LVOTPG declined significantly (P < 0.01), the LVOTd widened significantly (P < 0.01), and the SAM phenomenon improved obviously (P < 0.01) at 1, 2, 3, and 4 years after pacemaker implantation. Additionally, the changes in LAD, LVEDd, LVPW, LVEF, and PASP were statistically insignificant (P > 0.05). Conclusions The cardiac structural reconstruction in patients with HOCM can be chronically improved by dual-chamber pacing therapy. The IVS, LVOTd, VLVOT, and LVOTPG can be used as sensitive and specific factors in evaluating the long-term effects of dual-chamber pacing therapy for HOCM. (PACE 2013; 36:86-93) [ABSTRACT FROM AUTHOR]

Background: Percutaneous transluminal septal myocardial ablation (PTSMA) has been introduced as an alternative treatment for hypertrophic obstructive cardiomyopathy (HOCM). We report on the acute, short- and long-term results of our experiences in 119 patients from a single center in China. Methods and results: PTSMA was performed in 119 patients with symptomatic HOCM (mean age 35.4±14.8 years, male 80, female 39). All patients had echocardiography performed prior to the procedure, 2-week post-PTSMA, and 6-month post-PTSMA, and 65 patients had echocardiography repeated at 2-year follow-up. The average left ventricular outflow tract (LVOT) gradient was 67.3±7.8 mm Hg before the procedure, and 15.9±6.8 mm Hg after the procedure (p<0.05). The thickness of interventricular septum (IVS) was 23.3±5.6 mm before the procedure, 18.6±4.8 mm 2-week post-PTSMA (p<0.05), and 16.8±3.4 mm 6-month post-PTSMA in all of the patients, and 15.6±3.1 mm 2-year post-PTSMA in 65 patients. The mean width of LVOT was 6.7±2.0 mm before the procedure, 8.2±3.4 mm 2-week post-PTSMA (p<0.05), 13.7±6.3 mm 6-month post-PTSMA and 15.1±2.4 mm 2-year post-PTSMA. The incidence of right bundle branch block development post-PTSMA was 52.9%, and three patients (2.5%) had complete heart block. There was no death. Conclusions: PTSMA is a promising non-surgical procedure for symptomatic patients with HOCM because of its low risk and its significant hemodynamic, echocardiographic and clinical improvement. The significant therapeutic remodeling period was up to 6 months rather than 2 years following the procedure. [Copyright &y& Elsevier]

: BackgroundData on the phenotypical pattern and natural history of hypertrophic cardiomyopathy in Chinese patients are very limited. The purpose of this study was to describe the clinical characteristics of and long-term outcome in Chinese patients with hypertrophic cardiomyopathy.: MethodsWe evaluated 118 Chinese patients (62 male) who were diagnosed with hypertrophic cardiomyopathy at Queen Mary Hospital from 1973 to 2002. Diagnosis was based on the demonstration of left ventricular hypertrophy (wall thickness ≥15 mm during diastole), either in a specific region or with diffuse distribution, using echocardiography or magnetic resonance imaging. Clinical predictors of major cardiovascular events related to hypertrophic cardiomyopathy (cardiovascular death, potentially fatal cardiac arrhythmia, and refractory heart failure requiring cardiac transplantation or percutaneous alcohol septal ablation) were evaluated with univariate and multivariate Cox proportional hazards regression models.: ResultsThe mean (± SD) age at presentation was 54 ± 18 years. During a mean follow-up of 5.8 ± 4.3 years (range, 1 to 29 years) from presentation, major cardiovascular events related to hypertrophic cardiomyopathy occurred in 19 patients (16%), including 9 deaths. Annual cardiovascular mortality was 1.6%. Fifty-five patients (47%) had one or more cardiovascular complications related to hypertrophic cardiomyopathy, of which atrial fibrillation was the most common (35%, n = 41). The most common type of hypertrophic cardiomyopathy was the apical variant (41%, n = 49). In multivariate analysis, female sex was the only independent predictor of major cardiovascular events related to hypertrophic cardiomyopathy (hazard ratio = 5.86; 95% confidence interval: 1.77 to 7.21; P = 0.007).: ConclusionHypertrophic cardiomyopathy in Chinese patients is characterized by late onset of presentation, a high incidence of the apical form of the condition, and adverse clinical outcome in female patients, which suggest a different phenotypical pattern than in white patients. [Copyright &y& Elsevier]