Elevated extracellular volume and arterial stiffness are associated with left ventricular hypertrophy in hypertensive heart disease

Journal of the American Society of Hypertension 8(4S) (2014) e95–e97

HEART FAILURE/HYPERTROPHY (DIASTOLIC DYSFUNCTION) P-162 Diagnostic value of iron deficiency state in hypertensives with chronic heart failure Mariya A. Orynchak, Iryna I. Vakalyuk, Olga S. Chovganuyk, Iryna O. Gaman, Yuriy V. Bortnyk. Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine Background: To determine interconnection between serum none heme iron levels and different functional classes of chronic heart failure (CHF) in hypertensives with anemia. Methods: This study included 79 hypertensives (28 male, 51 female; age 53.11
7.97 years) with CHF Class II-III NYHA with preserved left ventricular ejection fraction (LVEF >50%). All patients were divided into 2 groups accordingly to the presence symptoms and signs of anemia: 24 patients without anemia (group I) and 55 patients with anemia (group II). There were patients with CHF Class II (NYHA) (subgroup A) and CHF Class III (subgroup B) in each group. Complete blood count [haemoglobin (Hb), erythrocytes (Er)], serum iron, ferritin and transferrin levels by ELISA methods were measured. Control group consisted of 20 healthy people. Results: Patients in group I have normal blood Hb and Er levels in the range of 123.71
7.42 g/L and 4.27
0.691012/L vs. 120.35
2.05 g/L and 3.79
0.931012/L in the control group (p>0.05). Patients in group II have Hb and Er levels lower by 26.19% and 28.98% accordingly vs. the control group (p0.05). In group IB serum iron, ferritin and transferrin levels were lower by 19.95%; 22.32% and 10.12% accordingly vs. the patients in group IA (p<0.05). In group IIA serum iron, ferritin and transferrin levels were equal to 10.56
3.88 mmol/L; 61.14
8.26 mcU/L and 2.18
0.18 g/L accordingly and were lover vs. group IA and IB (p<0.05). In group IIB serum iron, ferritin and transferrin levels were lower by 25.37%; 12.87% and 16.05% accordingly vs. the patients in group IIA (p<0.05). Conclusions: The serum non heme iron levels depend on the functional class of CHF. There is a necessity to identify the iron deficiency states by measuring not only the indexes of serum iron, but also ferritin and transferrin levels. Serum concentration of none heme iron is useful marker in the diagnostic and treatment effectiveness of anemia in hypertensives with CHF. Keywords: arterial hypertension; heart failure; anemia; iron P-163 Elevated extracellular volume and arterial stiffness are associated with left ventricular hypertrophy in hypertensive heart disease Sujith Kuruvilla, Rajesh Janardhanan, Ellen Keeley, Frederick H. Epstein, Christopher M. Kramer, Michael Salerno. University of Virginia Medical Center, Charlottesville, VA, United States Increased extracellular volume (ECV) due to diffuse myocardial fibrosis in hypertensive patients with left ventricular hypertrophy (LVH) may be an underlying mechanism contributing to increased cardiovascular risk. Moreover HTN LVH patients have increased arterial stiffness when compared to HTN Non-LVH subjects. We compared levels of ECV and arterial stiffness as measured by pulse wave velocity (PWV) between HTN LVH and control subjects. T1 mapping was performed in 20 HTN LVH (55
11 years) and 21 controls (52
9) subjects on a Siemens 1.5T

Avanto using 3-5 a Modified Look-Locker Imaging (MOLLI) pulse sequence (11 heart beats, 2 inversions, 3 recovery beats, 8 images). Patients with known CAD, valvular disease, and other causes of LVH were excluded. MOLLI parameters: TE/TR/flip angle 1.1 ms/2.5ms/35 , field of view 340 x 260, resolution 1.8mm x 1.8mm x 8mm. T1 was determined pre-contrast and 10,15 and 20 minutes post-injection of 0.15 mmol/kg GdDTPA. T1 maps were generated using MATLAB. Partition Coefficient (l) was determined from the slope of a plot of 1/T1 of the myocardium versus 1/T1 of the blood. Volume of distribution (Vd) was calculated as l*(1-Hematocrit). LV mass and function was assessed by steady state free precession cine imaging. In 14 subjects (9 controls, 5 HTN LVH subjects)aortic PWV was measured as distance divided by time delay between proximaldescending and distal-descending aorta. Values were compared between groups using 2 tailed t-tests. HTN LVH subjects had higher BP and LV mass when compared to normotensive controls (Table). HTN LVH subjects had higher levels of ECV as measured by l (0.49
0.04 vs. 0.43
0.02 in controls, p < 0.001) and Vd (0.28
0.02 vs. 0.26
0.02 in controls, p¼0.03) (Table). In the subset of 14 patients, PWV was significantly higher in HTN LVH subjects as compared to controls (11.6
2.7 vs. 8.2
2.5, p¼0.03, respectively). In conclusion, HTN LVH patients have higher ECV and associated increased arterial stiffness when compared to controls. Increased ECV as a surrogate for diffuse fibrosis and associated increased arterial stiffness may contribute to the increased cardiovascular morbidity and mortality seen in HTN LVH. Keywords: Cardiac MRI; T1 mapping; Hypertension; Arterial Stiffness

P-164 Impact of beta blocker and angiotensin converting enzyme inhibitor/ angiotensin II receptor blocker on prognosis of apical hypertrophic cardiomyopathy Sung Kee Ryu,2 Dong Geum Shin,2 Geu-Ru Hong,5 Ji Young Park,2 Jae Woong Choi,2 Choong-Won Goh,3 Sung Jin Oh,4 Jung-Woo Son.1 1 Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon, Korea, Republic of; 2Eulji University, Eulji Hospital, Seoul, Korea, Republic of; 3Inje University, Sanggye Paik Hospital, Seoul, Korea, Republic of; 4National Health Insurance Service Ilsan Hospital, Goyang, Korea, Republic of; 5Yonsei Cardiovascular Hospital, Seoul, Korea, Republic of Background: Apical hypertrophic cardiomyopathy(AHCM) is rare variation of HCM. It is known to have favorable prognosis, but few definite risk factors have been identified for morbidity and mortality in AHCM. The purpose of this study is to know the impact of drugs affecting sympathorenal axis on the prognosis of AHCM. Method: We analyzed 98 consecutive AHCM who received coronary angiography (n¼71) and 3D CT scan (n¼27) in two hospitals. Mean age was 61.5
9.8 years and female was 38.7%. Prevalence of diabetes and hypertension was 25.5% and 62.2% each. Total 22(22.4%) CV event - all cause death, non-fatal myocardial infarction or stroke, heart failure, admission due to cardiovascular disease - were occurred during follow-up (mean 53.1
60.7 months). Higher age (59.9
9.9 vs. 66.8
7.2 years p<0.01), current smoking (47.6% vs. 21.7%, p<0.05), and coronary artery disease diagnosed by angiography (41.9% vs. 13.4%, p<0.01) were significant risk factor for CV events. CV event was significantly lower in the patients taking beta blocker (51.3% vs. 27.3% p <0.05) and ACEI or ARB (38.2% vs. 13.6%). Multiple binary logistic regression analysis with significant factors, use of both beta blocker and ACEI/ARB reduced CV event significantly (OR¼0.032, 95% CI 0.023-0.842). Beta blocker alone

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