Abstract:Aim To study correlation between left ventricular hypertrophy (LVH) and index of blood pressure variability(BPV) in patients with hypertension complicated with diabetes mellitus. Methods 120 hypertension patients combined with diabetes mellitus were included, and divided into LVH group and non-LVH group according to their clinical confirmed information and electrocardiographic data. BPV-related indices were compared between the two groups, Logistic regression was used to analyze the risk associated with LVH in patients. Pearson correlation analysis was used to analyze the correlation between left ventricular mass index (LVMI) and BPV. Results In patients with hypertension and diabetes, daytime systolic blood pressure variability coefficient (dSBPCV), daytime diastolic blood pressure variability coefficient (dDBPCV), 24 h systolic blood pressure variaility coefficient (24hSBPCV), and 24 h diastolic blood pressure variability coefficient (24hDBPCV) in LVH group were significantly higher than those in non-LVH group (P＜0.05). Logistic regression analysis showed that the increase of dSBPCV, dDBPCV, 24hDBPCV and 24hSBPCV were related risk factors for LVH in hypertensive patients with diabetes mellitus (OR＞1, P＜0.05). Pearson correlation analysis showed that LVMI was positively correlated with 24hSBPCV, 24hDBPCV, dSBPCV and dDBPCV (r＝0.5,0.2,0.387 and 0.441, P＜0.05). Conclusions BPV in hypertensive patients with diabetes mellitus has a certain effect on left ventricular hypertrophy. BPV can be used as a predictor of target organ damage in hypertensive patients with diabetes mellitus. BPV control has a certain clinical value for early prevention and treatment of left ventricular hypertrophy.

Abstract:Aim To observe whether the new electrocardiogram (ECG) diagnostic criteria RLⅠ+SV4 and SD+SV4 are suitable for the diagnosis of hypertension complicated with left ventricular hypertrophy (LVH), and to study the clinical value of 13 ECG diagnostic criteria and the combined application of new and commonly used criteria for hypertension complicated with LVH. Methods Using the left ventricular mass index (LVMI) measured by echocardiography as the standard, 280 inpatients with essential hypertension or a history of hypertension treatment were selected, including 94 patients with hypertension complicated with LVH (LVH group), 186 patients with normal ventricle (normal left ventricle group). 12-lead ECG is recorded simultaneously. Receiver operating characteristic curve (ROC) for various ECG diagnostic criteria was plotted and the area under curve (AUC) of the ROC was compared. The sensitivity and specificity of various diagnostic criteria were calculated. The diagnostic value of RLⅠ+SV4, SD+SV4 and RLⅠ+SV4, SD+SV4 combined with the currently recognized ECG diagnostic criteria for hypertensive patients with LVH was analyzed. Results In a single ECG lead, RLⅠ, the R wave in lead Ⅰ, was one of the better predictors of LVH (AUC＝0.63, P＜0.01). In the study of the sum of the amplitudes of the two leads for the diagnosis of LVH, the sensitivity of the RLⅠ+SV4 standard (AUC＝0.64, P＜0.01) was 50%, and the specificity was 71%; Paired chi-square test showed no significant difference between RLⅠ+SV4 diagnosis of LVH and the gold standard (LVMI to determine LVH). The SD+SV4 standard (AUC＝0.59, P＜0.05) had a sensitivity of 31% and a specificity of 87%, in which the SD wave was the S wave with the largest amplitude in the 12 leads. RLⅠ+SV4 combined with Sokolow-Lyon voltage standard could improve the sensitivity of diagnosing hypertension complicated with LVH, the sensitivity was 59%, and the specificity was 60%. Conclusions RLⅠ+SV4 standard has higher AUC, which is suitable for the initial screening of hypertensive patients with LVH; RLⅠ+SV4 combined with Sokolow-Lyon voltage standard can improve the sensitivity of diagnosis. The clinical applicability of SD+SV4 standard is not as high as that of RLⅠ+SV4 standard.

Abstract:Aim This study tested a new criteria for electrocardiogram to improve the accuracy of primary hypertension with left ventricular hypertrophy. Methods The study measured left ventricular mass according to the American Society of Echocardiography (ASE) standard. We selected 129 patients with hypertension (HBP) and left ventricular hypertrophy (LVH) diagnosed in our hospital. At the same time, the normal wall thickness group of hypertension was matched according to age and gender. It simultaneously recorded 12-lead ECG, selected the deepest S-wave (SD) of all leads as the research object, and currently accepted LVH ECG criteria such as Cornell voltage and Sokolow-Lyon were used for comparison. Area under the curve (AUC) analysis was used for comparison of single and combined leads. Results The AUC, sensitivity, and specificity of SD predicted HBP with LVH were 0.2,6.05% and 81.65%, and SD+Sv4 showed the highest sensitivity of 88.37%. The equivalence test showed that Z value of SD was statistically different from that of Cornell,Sokolow-Lyon and SD+Sv4(all P＜0.05). The AUC, sensitivity and specificity of predicted male HBP with LVH were 0.1,0.29% and 75.34%. The equivalence test was superior to Cornell, Sokolow-Lyon and SD+Sv4 (all P＜0.05). Conclusion The new criteria SD to diagnose HBP with LVH improves the sensitivity of diagnosis, superior to Cornell and Sokolow-Lyon standards which is worthy of clinical promotion.

Abstract:Aim To observe the levels of plasma B-type natriuretic peptide（BNP)in people of non-hypertension（non-HP)and patients of isolated systolic hypertension（ISH)with or without left ventricular hypertrophy（LVH)and the changes of BNP, LVH and diastolic function before and after administration of angiotensin receptor blocker（ARB）, and to investigate the associations between the changes of BNP and LVH or diastolic function. Methods Thirty-three were designed to non-HP group, thirty-eight patients with ISH, and forty-two patients with ISH and LVH served as HP groups. Echocardiography was performed to determine left ventricular mass index(LVMI)and E/A ratio, and radioimmunoassay was used to detect plasma BNP levels. Results Plasma BNP was significantly higher in two ISH groups than that in non-HP group（P<0.05 or P<0.01）. LVMI was significantly increased（P<0.05)while E/A ratio reduced（P<0.01)in patients of ISH with LVH compared with those without LVH. After administration of ARB-valsartan, BNP levels lowered in HP groups(P<0.05 or P<0.01）, and LVMI reduced while E/A ratio increased in patients of ISH with LVH（P<0.01）. The BNP levels correlated positively with LVMI（r20.61, P<0.01)and negatively with E/A ratio（r20.26, P<0.01)before treatment. Conclusion The plasma BNP may be a sensitive biomarker for reverse remodeling in LVH and improvement in diastolic dysfunction.

Abstract:Aim To investigate the association between plasma omentin-1 level and left ventricular hypertrophy （LVH） in patients with essential hypertension （EH）. Methods We randomly enrolled 55 essential hypertensive patients with or without left ventricular hypertrophy （LVH）,and 32 participants with normal blood pressure.We measured plasma omentin-1 and nitric oxide （NO） levels.Left ventricular hypertrophy was assessed by left ventricular mass index （LVMI）. Results Plasma omentin-1 and nitric oxide levels were significantly decreased in essential hypertensive patients compared to normal control group （P<0.05）,and were further reduced in essential hypertensive patients with left ventricular hypertrophy compared to those without left ventricular hypertrophy （P<0.05）.Pearson correlation analysis showed that plasma omentin-1 was significantly positively related with NO （r＝0.565,P<0.01）,and significantly negatively related with systolic blood pressure,diastolic blood pressure,mean arterial blood pressure,pulse pressure,LVMI （r＝－0.713,－0.699,－0.788,－0.311,－0.675,P<0.05 or P<0.01）.Multiple linear regression analysis showed that omentin-1 was independently related with systolic blood pressure and diastolic blood pressure in patients with EH （bomentin-1＝－2.140,P<0.05 bomentin-1＝－1.382,P<0.05）.Omentin-1 and hypertension course were independently related with LVMI in patients with EH （bomentin-1＝－5.980,P<0.05 bhypertension course＝0.103,P<0.05）. Conclusions Plasma omentin-1 level decreases in hypertensive patients.Omentin-1 is positively related with nitric oxide,and is negatively related with LVMI in essential hypertensive patients.Omentin-1 may be an independent indicator for LVH in essential hypertensive patients.

Abstract:Aim To investigate whether increased plasma levels of serum 25-hydroxy vitamin D ［25（OH）VD］ are associated with cardiac structural and functional abnormalities in obstructive sleep apnea-hypopnea syndrome （OSAHS） patients. Methods We documented 337 consecutive patients with OSAHS. Left ventricular hypertrophy （LVH） ［left ventricular mass index （LVMI）≥125 g/m2 in male,and LVMI≥120 g/m2 in female］ was determined by echocardiography. The serum 25-hydroxy vitamin D concentration was measured by using enzyme-linked immunosorbent assay （ELISA） method. Results The LVMI,prevalence rate of LVH and body mass index （BMI） were higher in the subjects with severe OSAHS （apnoea-hypopnoea index≥30/h,LVH 75%,n＝226） than in those with mild to moderate OSAHS （LVH 40%,n＝111）（P<0.01）,and serum 25（OH）VD levels were lower in the severe OSAHS groups. Although the serum 25（OH）VD level showed a negative correlation with BMI,the results of binary logistic regression analysis demonstrated that the quartile value of 25（OH）VD was an independent significant variable for the identification of LVH （adjusted OR in quartile＝4.11,95%CI: 1.15-12.70,P<0.01）,even after adjusting for obesity and other risk factors. Conclusion Decreased serum levels of 25（OH）VD do seem to reflect an increased likelihood of LVH in patients with severe OSAHS.

Abstract:AimTo explore the incidence and affecting factors of left ventricular hypertrophy (LVH) in chronic kidney disease (CKD) 3～5 patients.Methods270 CKD 3～5 patients were enrolled from department of nephrology, the 3rd hospital of Sun Yat-Sen University in this study from 2010 to 2012.Ambulatory blood pressure, clinical blood pressure, cardiac ultrasonography, proteinuria, and other clinical data were collected.Results46.67% CKD patients had LVH, in which male accounted for 39.74% and female accounted for 55.46%.Female group had more LVH patients than male group (P<0.05).There were 25.0% CKD 3 patients, 44.9% CKD 4 patients and 53.6% CKD 5 patients with LVH respectively, which had significant difference among the three groups(P<0.05).LVH group had higher intact parathyroid hormone (iPTH), body mass index (BMI), phosphorus, serum creatinine (SCr), left ventricular mass index (LVMI), pulse, PP, left ventricular end diastolic dimension (LVDd), left ventricular posterior wall thickness (LVPWT), interventricular septal thickness (IVST), and higher clinic systolic blood pressure (SBP), ambulatory SBP and diastolic blood pressure (DBP), day and night SBP and DBP(P<0.05), but had lower estimated glomerular filtration rate (eGFR), hemoglobin (HGB), calcium (Ca) and ejection fraction (EF) value(P<0.05) compared with non LVH group.Multivariate linear analysis indicated that BMI, iPTH and night SBP were independently associated with LVMI.

Abstract:AimTo confirm the effects of left ventricular hypertrophy reversed by loosening abdominal aortic banding, and observe the changes of cardiac morphology, myocardial collagen volume fraction (CVF) and myocardial apoptotic index (AI).Methods75 SD rats were randomly divided into the normal group (N group, n=15), abdominal aortic banding group (AAB group, n=30) and loosening abdominal aortic banding group (LAAB group, n=30).AAB and LAAB group received the first operation of narrowing the abdominal aorta to establish left ventricular hypertrophy model in rat.After 5 weeks, the LAAB group received the second operation of removing the abdominal aorta banding.After 5 weeks of the first operation and after 4 weeks of the second operation, heart mass index (HMI), left ventricular mass index (LVMI), interventricular septum thickness of end-diastolic (IVSTd), left ventricular posterior wall thickness of end-diastolic (LVPWTd), myocardial CVF and myocardial AI of three groups of rats were observed by general observation, ultrasonic cardiogram, myocardial Masson staining, myocardial tunel staining.ResultsHMI, LVMI, IVSTd, LVPWTd, myocardial CVF and myocardial AI were significantly increased in AAB group.After 4 weeks of removing the abdominal aorta banding, HMI, LVMI, IVSTd, LVPWTd, myocardial CVF and myocardial AI of LAAB group were significantly decreased compared with AAB group, but still higher than N group.ConclusionLoosening abdominal aortic banding could partly reverse the left ventricular hypertrophy.

Abstract:Aim To investigate the effects of rosiglitazone on left ventricular hypertrophy in 5/6 nephrectomized rats. Methods Chronic renal failure of rats was induced by 5/6 nephrectomy.Then the inhibiting development of left ventricular hypertrophy(LVH) mechanism of the rats was explored by observing the nephrectomized rats which were randomly allocated into four groups: XL group(rosiglitazone treatment,5 mg/(kg·d)),DL group(rosiglitazone treatment,15 mg/(kg·d)),model group and sham group,in which the rats with sham operation served as control.5 mg/kg rosiglitazone,15 mg/kg rosiglitazone were respectively delivered daily via gavage for a period of eight weeks.The urinary protein,blood urea nitrogen(BUN),serum creatinine(Scr),blood pressure(BP),angiotensin Ⅱ(AngⅡ),endothelin(ET),body weight(BW),left ventricular weight(LVW) and LVW/BW were measured at the end of the study.Left ventricular hypertrophy was accessed by pathological analysis,and myocardium collagen fibers were stained with Picric acid-Sirius red. Results Compared with model group,the blood pressure of rats in XL group and DL group substantially decreased(P<0.01).So was the case with 24 hours urinary protein,Scr,BUN and plasma AngⅡ,ET.Compared with sham group,the ratio of left ventricle weight to body weight as well as collagen expressions of the left ventricular myocardium in the model group significantly increased(P<0.05).Compared with model group,the above parameters in DL group significantly decreased(P<0.01). Conclusion Rosiglitazone can obviously lower the blood pressure,reduce 24 hours urinary protein,BUN,Scr and recover renal historical damage,regress left ventricular hypertrophy,attenuate remodeling of myocardial collagen network in rats with chronic renal failure.The effect of rosiglitazone is possibly mediated by AngⅡ and ET.

Abstract:Aim To determine whether the degree of carotid atherosclerosis is associated with left ventricular hypertrophy(LVH) in maintenance hemodialysis(MHD) patients. Methods Thirty-six MHD patients were included in this study. Their biochemical parameters,including C-reactive protein before hemodialysis,creatinine,blood urea nitrogen (BUN),total cholesterol,haemoglobin,plasma albumin,calcium,phosphorus and parathormone were examined by routine methods. The anatomy,hemodynamics,atheromatous plaque and intima media thickness(IMT) of bilateral carotid artery,carotid bifuracation and carotid internal artery were measured by color Doppler. The left ventricular end-diastolic dimension,left atrium diameter,interventricular septum thickness at end diastole,left ventricular posterior wall thickness at end diastole,right ventricular outflow tract diameter,right ventricular diameter,stroke volume,cardiac output and left ventricular ejection fraction were also detected by ultrasonic cardiography. The left ventricular mass index was calculated as well. Results The plaque-positive was detected in 24 of the patients (67%). The plaque-positive patients had elder age,longer dialysis time,more C-reactive protein,lower plasma albumin(P<0.05). And the plaque-positive patients had higher intima media thickness of carotid,interventricular septum thickness at end diastole and left ventricular mass index. Conclusion The carotid atherosclerosis is associated with LVH in MHD patients. Whether the treatment of atherosclerosis may cause regression or even prevent LVH in MHD patients remains to elucidate.