Ethnicity differences in geometric remodelling and myocardial composition in hypertension unveiled by cardiovascular magnetic resonance.

AIMS: Hypertensive patients of African ancestry (Afr-a) have higher incidences of heart failure and worse clinical outcomes than hypertensive patients of European ancestry (Eu-a), yet the underlying mechanisms remain misunderstood. This study investigated right (RV) and left (LV) ventricular remodelling alongside myocardial tissue derangements between Afr-a and Eu-a hypertensives. METHODS AND RESULTS: 63 Afr-a and 47 Eu-a hypertensives underwent multi-parametric cardiovascular magnetic resonance. Biventricular volumes, mass, function, mass/end-diastolic volume (M/V) ratios, T2 and pre-/post-contrast T1 relaxation times, synthetic extracellular volume, and myocardial fibrosis (MF) were measured. 3D shape modelling was implemented to delineate ventricular geometry. LV and RV mass (indexed to body-surface-area) and M/V ratio were significantly greater in Afr-a than Eu-a hypertensives (67.1 ± 21.7 vs. 58.3 ± 16.7 g/m2, 12.6 ± 3.48 vs. 10.7 ± 2.71 g/m2, 0.79 ± 0.21 vs. 0.70 ± 0.14 g/mL, and 0.16 ± 0.04 vs. 0.13 ± 0.03 g/mL, respectively; P < 0.03). Afr-a patients showed greater basal interventricular septum thickness than Eu-a patients, influencing LV hypertrophy and RV cavity changes. This biventricular remodelling was associated with prolonged T2 relaxation time (47.0 ± 2.2 vs. 45.7 ± 2.2 ms, P = 0.005) and higher prevalence (23% vs. 4%, P = 0.001) and extent of MF [2.3 (0.6-14.3) vs. 1.6 (0.9-2.5) % LV mass, P = 0.008] in Afr-a patients. Multivariable linear regression showed that modifiable cardiovascular risk factors and greater end-diastolic volume, but not ethnicity, were independently associated with greater LV mass. CONCLUSION: Afr-a hypertensives had distinctive biventricular remodelling, including increased RV mass, septal thickening and myocardial tissue abnormalities compared with Eu-a hypertensives. From this study, modifiable cardiovascular risk factors and ventricular geometry, but not ethnicity, were independently associated with greater LV myocardial mass.

Left ventricular hypertrophy phenotype to predict incident atrial fibrillation: The Multi-Ethnic Study of Atherosclerosis.

BACKGROUND AND AIM: Left ventricular hypertrophy (LVH) has been shown to be associated with the occurrence of atrial fibrillation (AF). However, the predictive value of the LVH phenotype for incident AF remains uncertain. This study aimed to investigate the predictive value of LVH phenotype for incident AF. METHODS AND RESULTS: This study utilized the Multi-Ethnic Study of Atherosclerosis (MESA) data. LVH was defined by cardiac magnetic resonance measured LV mass index. Isolated LVH was determined as LVH without elevated cardiac biomarker and malignant LVH was determined as LVH with at least 1 elevated biomarker. Receiver-operating characteristic (ROC) analysis was performed to calculate areas under the curves (AUC) for predicting AF. A total of 4983 community-dwelling participants were included, with a mean age of 61.5 years. 279 (5.6 %) had isolated LVH, and 222 (4.5 %) had malignant LVH. During a median follow-up of 8.5 years, 272 incident AF was observed. Compared to participants without LVH and elevated cardiac biomarkers, those with isolated LVH (HR, 1.82; 95 % CI, 1.03-3.20) and malignant LVH (HR, 4.13; 95 % CI, 2.77-6.16) had a higher risk of incident AF. Malignant LVH carried a 1.5-fold increased risk of AF compared to isolated LVH (HR: 2.48, 95 % CI: 1.30-4.73). Including the LVH phenotype in the CHARGE-AF model improved model discrimination (AUC increase: 0.03, p < 0.001). CONCLUSIONS: The risks of AF incidence varied across LVH phenotypes. Malignant LVH carried the highest risk among LVH phenotypes. LVH phenotype provides incremental predictive value over the variables included in the CHARGE-AF model.

Associação do eletrocardiograma com diabete melito e síndrome metabólica em nipo-brasileiros / Relationship between electrocardiogram with diabetes mellitus and metabolic syndrome in Japanese-Brazilians / Asociación del electrocardiograma con diabetes mellitus y síndrome metabólico en nipobrasileños

Fundamento: Ao migrarem para as Américas, os japoneses submeteram-se a processo de ocidentalização, com estilo de vida, especialmente dieta, muito diferente, podendo explicar o aumento de diabete melito (DM), síndrome metabólica (SM) e doenças cardiovasculares. Objetivo: Analisar a presença de necrose miocárdica e hipertrofia ventricular esquerda (HVE) pelo ECG e sua relação com DM e SM em população de nipo-brasileiros. Métodos: Estudo transversal que avaliou 1.042 nipo-brasileiros acima de 30 anos, 202 nascidos no Japão (isseis) e 840 nascidos no Brasil (nisseis), provenientes da segunda fase do estudo Japanese-Brazilian Diabetes Study Group iniciado em 2000. A SM foi definida pelos critérios da NCEP-ATP III modificados para os japoneses. A presença de DM e SM se associou ao encontro de necrose miocárdica pelo critério de Minnesota e de HVE pelo critério de Perugia no ECG. Utilizou-se o método estatístico do qui-quadrado para rejeição da hipótese de nulidade. Resultados: Dos 1.042 participantes 35,3% tinham DM (38,6% entre os isseis e 34,5% nos nisseis); 51,8% tinham SM (59,4% nos isseis e 50,0% nos nisseis). A presença de zona inativa nos isseis diabéticos não foi estatisticamente significante quando comparada com os não-diabéticos, porém entre os nisseis diabéticos a zona inativa estava presente em 7,5%. Houve correlação estatisticamente significante entre a SM e HVE nos isseis e nisseis. Conclusão: Distúrbios metabólicos tiveram alta prevalência em nipo-brasileiros com correlações significantes com necrose e hipertrofia pelo ECG.

Background: When the Japanese immigrated to the Americas, they were subjected to Westernization, with a great change in lifestyle, specially in dietary habits, and this may explain the increase in the incidence of diabetes mellitus (DM), metabolic syndrome (MS) and cardiovascular disease among them. Objective: To study the presence of myocardial necrosis and left ventricular hypertrophy (LVH) in a population of Japanese-Brazilians, using the ECG and its relationship with DM and MS. Methods: This was a cross-sectional study which evaluated 1,042 Japanese-Brazilians aged 30 or over, 202 of them born in Japan (Issei) and 840 of them born in Brazil (Nissei), from the second phase of the Japanese-Brazilian Diabetes Study Group initiated in 2000. MS was defined according to the NCEP-ATP III criteria modified for the Japanese. DM and MS were associated with the presence of myocardial necrosis (according to the Minnesota criteria) and LVH (according the Perugia score on the ECG). The statistic chi square method was used to reject the null hypothesis. Results: Of the 1,042 participants, 35.3% had DM (38.6% of the Issei and 34.5% of the Nissei); 51.8% had MS (59.4% of the Issei and 50.0% of the Nissei). The presence of an inactive zone in the diabetic Issei group was not statistically significant when compared to the non-diabetic group, but among the diabetic Nissei group an inactive zone was present in 7.5% of them. There was a statistically significant correlation between MS and LVH in the Issei and Nissei groups. Conclusion: Metabolic disorders presented a high prevalence in Japanese-Brazilians with significant correlations with necrosis and hypertrophy on the ECG.

Fundamento: Al migrar hacia las Américas, los japoneses se sometieron a un proceso de occidentalización, con estilo de vida, y especialmente dieta, muy diferente, lo que puede explicar el aumento de diabetes mellitus (DM), síndrome metabólico (SM) y enfermedades cardiovasculares. Objetivo: Analizar la presencia de necrosis miocárdica e hipertrofia ventricular izquierda (HVI), indicada en ECG, y su relación con DM y SM en población de nipobrasileños. Métodos: Estudio transversal que evaluó a 1.042 nipobrasileños con edad superior a 30 años: 202 nacidos en Japão (iseis) y 840 nacidos en Brasil (niseis), provenientes de la segunda fase del estudio Japanese-Brazilian Diabetes Study Group iniciado en 2000. Se definió el SM desde los criterios de la NCEP-ATP III, modificados para los japoneses. La presencia de DM y SM se asoció a la formación de necrosis miocárdica, según el de Minnesota, y de HVI según el criterio de Perugia, ambas reveladas en el ECG. Se utilizó el método estadístico del Chi-cuadrado para rechazo de la hipótesis de nulidad.Resultados: De los 1.042 participantes, el 35,3% presentaba DM (el 38,6% entre los iseis y el 34,5% en niseis); el 51,8% tenían SM (el 59,4% entre iseis y el 50,0% en niseis). La presencia de zona inactiva en los iseis diabéticos no se mostró estadísticamente significante, si se la compara a los no diabéticos; sin embargo, entre los niseis diabéticos la zona inactiva se presentaba en el 7,5%. Hubo correlación estadísticamente significante entre el SM y la HVE entre iseis y niseis. Conclusión: Disturbios metabólicos tuvieron alta prevalencia en nipobrasileños con correlaciones significantes con necrosis e hipertrofia reveladas por el ECG.

Sensitivity and specificity of the electrocardiogram in predicting the presence of increased left ventricular mass index on the echocardiogram in Afro-Caribbean hypertensive patients / Sensibilidad y especificidad del electrocardiograma en la predicción de la presencia de aumento del indice de masa ventricular izquierda en el ecocardiograma en pacientes Afro-caribeños hipertensos

Cardiovascular disease is emerging as the leading cause of death in the Caribbean region with hypertension along with diabetes mellitus representing the major causes. Left ventricular hypertrophy associated with hypertension results in a two to fourfold increase in cardiac morbidity and mortality. One hundred and eleven patients, 67% female, mean age 46 years with a mean of seven years since diagnosis, had resting blood pressure, electrocardiogram and sector-focused M-mode echocardiogram performed The electrocardiograms were analyzed for left ventricular hypertrophy using Sokolow-Lyon, Cornell, Romhilts-Estes, 12 lead sum, QRS duration, 12 lead-QRS product and left ventricular strain pattern. The echocardiograms were analyzed for increased left ventricular mass using the formula of Devereux and Reichek indexed to height. The mean systolic blood pressure was 156 mmHg, mean diastolic blood pressure was 97 mmHg on treatment. At least one electrocardiographic criterion for left ventricular hypertrophy was seen in 47/111 (42%) patients and increased left ventricular mass index was seen in 55/111 (50%) patients. Sensitivity, specificity and positive predictive value of the electrocardiogram in predicting increased left ventricular mass index was best for Sokolow-Lyon (31%, 86%, 76%), Cornell (23%, 96%, 88%) and 12 lead-QRS product (30%, 86%, 72%). Sensitivity ranged from 3 to 31%, specificity from 80 to 96% and positive predictive value from 40 to 88%. The electrocardiogram is insensitive in detecting increased echocardiographic left ventricular mass index, as in patients from developed countries, and is less specific for the finding as in African Americans.

La enfermedad cardiovascular está pasando a ocupar el primer plano como causa principal de muertes en la región del Caribe, siendo la hipertensión junto con la diabetes las causas principales. La hipertrofia del ventrículo izquierdo asociada con los resultados de la hipertensión, trae como consecuencia que la morbilidad y la mortalidad cardíacas aumenten de dos a cuatro veces. A ciento once pacientes – el 67% mujeres, con una edad promedio de 46 años y un promedio de siete años transcurridos desde el diagnóstico – se les midió la presión arterial en reposo, y se les hizo un electrocardiograma, así como un ecocardiograma en Modo-M enfocado por sectores. Los electrocardiogramas fueron analizados en busca de alguna hipertrofia ventricular izquierda, usando los criterios de Sokolow-Lyon, Cornell, Romhilts-Estes, la suma de 12 derivaciones, la duración del QRS, el producto del QRS en las 12 derivaciones, y el patrón de tensión ventricular izquierda. Los ecocardiogramas fueron analizados fueron analizados en busca de un aumento de la masa ventricular izquierda, usando la fórmula de Devereux y Reichek indexada por la altura. La media de la presión arterial sistólica fue 156 mmHg, y la media de la presión arterial diastólica fue 97 mmHg en el tratamiento. Al menos un criterio electrocardiográfico de la hipertrofia ventricular izquierda fue visto en 47/111 (42%) pacientes, y el índice de masa ventricular izquierda aumentada, fue visto en 55/111 (50%). La sensibilidad, especificidad y valor predictivo positivo del electrocardiograma en la predicción del índice de masa ventricular izquierda aumentada fue mejor en Sokolow-Lyon (31%, 86%, 76%), Cornell (23%, 96%, 88%) y el producto del QRS en las 12 derivaciones (30%, 86%, 72%). La sensibilidad fluctuó del 3 al 31%; la especificidad, del 80 al 96%; y el valor predictivo positivo, del 40 al 88%. El electrocardiograma es insensible en cuanto a detectar el índice de masa ventricular izquierda aumentada, como...

Raça e lesão de órgãos-alvo da hipertensão arterial em pacientes atendidos em um ambulatório universitário de referência na cidade de Salvador / Race and hypertensive target-organ damage in patients from an university-affiliated outpatient care referral clinic in the city of Salvador

OBJETIVO: Avaliar se a raça do paciente estaria associada à presença de hipertrofia ventricular esquerda, acidente vascular cerebral e insuficiência renal crônica em hipertensos atendidos em ambulatório de referência em Salvador-BA. MÉTODOS: Analisados dados de 622 pacientes com o primeiro atendimento em ambulatório de hipertensão, entre 1982 e 1986, e identificados os com história prévia ou seqüela de acidente vascular cerebral, hipertrofia ventricular esquerda ou insuficiência renal (creatinina sérica > 1,4 mg/dL). Modelos de regressão logística foram utilizados para estimar odds ratio (OR) da associação entre raça (mulatos ou negros vs brancos) e lesão de órgãos-alvo de hipertensão, ajustadas para sexo e idade. RESULTADOS: A média de idade dos pacientes foi 53,8±14,3 anos, 74,1 por cento mulheres. Quanto à raça, 15,1 por cento eram brancos, 65,9 por cento mulatos e 19,0 por cento negros. Acidente vascular cerebral foi significantemente mais freqüente em negros ou mulatos do que em brancos (odds ratio ajustada (ORa)=3,44; intervalo de confiança (IC) 95 por cento=1,23-9,67). Quanto às associações envolvendo raça com os eventos hipertrofia ventricular esquerda e insuficiência renal as ORa não foram estatisticamente significantes, mas foram consistentes com maior prevalência de hipertrofia ventricular esquerda e insuficiência renal em negros e mulatos. CONCLUSAO: Negros e mulatos hipertensos têm maior risco de lesão de órgão alvo do que brancos, com diferença racial maior para acidente vascular cerebral não fatal. Deve ser avaliada se diferenças raciais em mortalidade relacionada a complicações da hipertensão influenciam as associações observadas entre raça e lesão de órgãos-alvo.