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Novel Index of Maladaptive Myocardial Remodeling in Hypertension.

Abstract Hypertensive left ventricular hypertrophy (HTN-LVH) is a leading cause of heart failure. Conventional patterns of cardiac geometry do not adequately risk-stratify patients with HTN-LVH. Using cardiovascular magnetic resonance, we developed a novel Remodeling Index (RI) that was designed to detect an exaggerated hypertrophic response to hypertension and tested its potential to risk-stratify hypertensive patients.
PMID
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Authors

Mayor MeshTerms

Magnetic Resonance Imaging

Ventricular Function, Left

Ventricular Remodeling

Keywords

blood pressure

heart diseases

hypertrophy, left ventricular

magnetic resonance imaging

natriuretic peptide, brain

Journal Title circulation. cardiovascular imaging
Publication Year Start




PMID- 28847911
OWN - NLM
STAT- MEDLINE
DA  - 20170829
DCOM- 20170905
LR  - 20170906
IS  - 1942-0080 (Electronic)
IS  - 1941-9651 (Linking)
VI  - 10
IP  - 9
DP  - 2017 Sep
TI  - Novel Index of Maladaptive Myocardial Remodeling in Hypertension.
LID - e006840 [pii]
LID - 10.1161/CIRCIMAGING.117.006840 [doi]
AB  - BACKGROUND: Hypertensive left ventricular hypertrophy (HTN-LVH) is a leading
      cause of heart failure. Conventional patterns of cardiac geometry do not
      adequately risk-stratify patients with HTN-LVH. Using cardiovascular magnetic
      resonance, we developed a novel Remodeling Index (RI) that was designed to detect
      an exaggerated hypertrophic response to hypertension and tested its potential to 
      risk-stratify hypertensive patients. METHODS AND RESULTS: The RI was derived
      using LaPlace's Law (), and normal RI ranges were established in 180 healthy
      volunteers. The utility of the RI was examined in 256 asymptomatic hypertensive
      patients and 10 patients with heart failure with preserved ejection fraction.
      Hypertensive patients underwent multimodal cardiac assessment: contrast-enhanced 
      cardiovascular magnetic resonance, echocardiograms, 24-hour blood pressure
      monitoring, and cardiac biomarkers (high-sensitivity cardiac troponins, NT-proBNP
      [N-terminal pro-B-type natriuretic peptide], and galectin-3). Blood pressure
      accounted for only 20% of the variance observed in LV mass. Although there was no
      association between blood pressure and myocardial fibrosis, LV mass was
      independently associated with fibrosis. Compared with hypertensive patients
      without LVH (n=191; 74.6%) and those with HTN-LVH and normal RI (n=50; 19.5%),
      patients with HTN-LVH and low RI (HTN-LVH/low RI; n=15, 5.9%) had an amplified
      myocardial response: elevated indexed LV masses (83+/-24 g/m2), more fibrosis
      (73%), and higher biomarkers of myocardial injury and dysfunction (P<0.05 for
      all). RI was similar in HTN-LVH/low RI and heart failure with preserved ejection 
      fraction (4.1 [3.4-4.5] versus 3.7 [3.4-4.0], respectively; P=0.15). CONCLUSIONS:
      We suggest that RI provides an approach for stratifying hypertensive patients and
      is suitable for testing in other disease cohorts to assess its clinical utility. 
      CLINICAL TRIAL REGISTRATION: URL: https://clinicaltrials.gov. Unique identifier: 
      NCT02670031.
CI  - (c) 2017 The Authors.
FAU - Goh, Vera J
AU  - Goh VJ
AD  - From the Department of Internal Medicine, Singapore General Hospital, Singapore
      (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L.,
      J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National
      University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, 
      Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi
      General Hospital, Singapore (T.C.A.).
FAU - Le, Thu-Thao
AU  - Le TT
AD  - From the Department of Internal Medicine, Singapore General Hospital, Singapore
      (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L.,
      J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National
      University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, 
      Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi
      General Hospital, Singapore (T.C.A.).
FAU - Bryant, Jennifer
AU  - Bryant J
AD  - From the Department of Internal Medicine, Singapore General Hospital, Singapore
      (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L.,
      J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National
      University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, 
      Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi
      General Hospital, Singapore (T.C.A.).
FAU - Wong, Jia Ing
AU  - Wong JI
AD  - From the Department of Internal Medicine, Singapore General Hospital, Singapore
      (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L.,
      J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National
      University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, 
      Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi
      General Hospital, Singapore (T.C.A.).
FAU - Su, Boyang
AU  - Su B
AD  - From the Department of Internal Medicine, Singapore General Hospital, Singapore
      (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L.,
      J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National
      University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, 
      Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi
      General Hospital, Singapore (T.C.A.).
FAU - Lee, Chi-Hang
AU  - Lee CH
AD  - From the Department of Internal Medicine, Singapore General Hospital, Singapore
      (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L.,
      J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National
      University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, 
      Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi
      General Hospital, Singapore (T.C.A.).
FAU - Pua, Chee Jian
AU  - Pua CJ
AD  - From the Department of Internal Medicine, Singapore General Hospital, Singapore
      (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L.,
      J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National
      University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, 
      Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi
      General Hospital, Singapore (T.C.A.).
FAU - Sim, Chloe P Y
AU  - Sim CPY
AD  - From the Department of Internal Medicine, Singapore General Hospital, Singapore
      (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L.,
      J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National
      University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, 
      Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi
      General Hospital, Singapore (T.C.A.).
FAU - Ang, Briana
AU  - Ang B
AD  - From the Department of Internal Medicine, Singapore General Hospital, Singapore
      (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L.,
      J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National
      University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, 
      Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi
      General Hospital, Singapore (T.C.A.).
FAU - Aw, Tar Choon
AU  - Aw TC
AD  - From the Department of Internal Medicine, Singapore General Hospital, Singapore
      (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L.,
      J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National
      University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, 
      Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi
      General Hospital, Singapore (T.C.A.).
FAU - Cook, Stuart A
AU  - Cook SA
AD  - From the Department of Internal Medicine, Singapore General Hospital, Singapore
      (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L.,
      J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National
      University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, 
      Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi
      General Hospital, Singapore (T.C.A.).
FAU - Chin, Calvin W L
AU  - Chin CWL
AD  - From the Department of Internal Medicine, Singapore General Hospital, Singapore
      (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L.,
      J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National
      University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, 
      Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi
      General Hospital, Singapore (T.C.A.). [email protected]
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Circ Cardiovasc Imaging
JT  - Circulation. Cardiovascular imaging
JID - 101479935
RN  - 0 (Biomarkers)
RN  - 0 (Peptide Fragments)
RN  - 0 (Troponin I)
RN  - 0 (Troponin T)
RN  - 0 (pro-brain natriuretic peptide (1-76))
RN  - 114471-18-0 (Natriuretic Peptide, Brain)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Biomarkers/blood
MH  - Blood Pressure Monitoring, Ambulatory
MH  - Case-Control Studies
MH  - Echocardiography
MH  - Electrocardiography
MH  - Female
MH  - Fibrosis
MH  - Humans
MH  - Hypertension/*complications/diagnosis/physiopathology
MH  - Hypertrophy, Left Ventricular/blood/*diagnostic imaging/etiology/physiopathology
MH  - *Magnetic Resonance Imaging
MH  - Male
MH  - Middle Aged
MH  - Models, Cardiovascular
MH  - Natriuretic Peptide, Brain/blood
MH  - Peptide Fragments/blood
MH  - Predictive Value of Tests
MH  - Prognosis
MH  - Risk Assessment
MH  - Risk Factors
MH  - Troponin I/blood
MH  - Troponin T/blood
MH  - *Ventricular Function, Left
MH  - *Ventricular Remodeling
MH  - Young Adult
OTO - NOTNLM
OT  - blood pressure
OT  - heart diseases
OT  - hypertrophy, left ventricular
OT  - magnetic resonance imaging
OT  - natriuretic peptide, brain
EDAT- 2017/08/30 06:00
MHDA- 2017/09/07 06:00
CRDT- 2017/08/30 06:00
PHST- 2017/06/22 [received]
PHST- 2017/07/26 [accepted]
AID - CIRCIMAGING.117.006840 [pii]
AID - 10.1161/CIRCIMAGING.117.006840 [doi]
PST - ppublish
SO  - Circ Cardiovasc Imaging. 2017 Sep;10(9). pii: e006840. doi:
      10.1161/CIRCIMAGING.117.006840.