Genetically determined pattern of left ventricular function in normal and hypertensive hearts

Kovács, Attila; Molnár, Andrea; Kolossváry, Márton; Szilveszter, Bálint; Panajotu, Alexisz; Lakatos, Bálint Károly; Littvay, Levente; Tárnoki, Ádám Domonkos; Tárnoki, Dávid László; Vörös, Szilárd; Jermendy, György; Sengupta, Partho P.; Merkely, Béla; Maurovich-Horvat, Pál

doi:10.1111/jch.13271

Cited by 6 publications

(12 citation statements)

References 38 publications

(44 reference statements)

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“…In the current study, we included 184 twin subjects (92 twin pairs, 65% female, 54 MZ, and 38 same-gender DZ twin pairs). We excluded nine twin pairs from the original BUDAPEST-GLOBAL cohort because of inadequate echocardiographic image quality [ 5 , 9 ].…”

Section: Resultsmentioning

confidence: 99%

“…Demographic characteristics and basic echocardiographic parameters of the study population were published previously by our workgroup [ 5 ]. Briefly, our twin cohort represented a middle-aged Caucasian population (age: 56 ± 9 years), with a representative prevalence of hypertension (40%, 74/184 siblings), diabetes mellitus (8%, 15/184 siblings), and dyslipidemia (41%, 76/184 siblings) to the general population.…”

Section: Resultsmentioning

confidence: 99%

“…All other and echocardiographic parameters, including strain and strain rate measurements, were in normal range and comparable between the MZ and DZ pairs. Detailed comparisons were published earlier [ 5 ].…”

Section: Resultsmentioning

confidence: 99%

“…Detailed enrollment and exclusion criteria were previously published. In brief, twin pairs with obstructive coronary artery disease (indicated by coronary CT angiography), any cardiomyopathy, severe valvular heart disease or symptoms of heart failure were excluded [ 5 , 9 ]. All twin siblings provided written consent for participation.…”

Section: Methodsmentioning

confidence: 99%

“…Previously, we have demonstrated that mathematical modelling of genetic influence shows high systolic myocardial deformation heritability in a Caucasian population without systolic dysfunction. However, environmental factors have a stronger influence on LV diastolic function [ 5 ]. Furthermore, comparably higher LV systolic functional heritability was found in Asian and American population-based family studies as well [ 6 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Left Ventricular Systolic Function Has Strong Independent Genetic Background from Diastolic Function: A Classical Twin Study

et al. 2021

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Background and Objectives: No data are available on whether the heritability of left ventricle (LV) systolic and diastolic parameters are independent of each other. Therefore, our aim was to assess the magnitude of common and independent genetic and environmental factors defining LV systolic and diastolic function. Materials and Methods: We analyzed 184 asymptomatic twins (65% female, mean age: 56 ± 9 years). Transthoracic echocardiography was performed to measure LV systolic (global longitudinal and circumferential strain; basal and apical rotation) and diastolic (early diastolic velocity of mitral inflow and lateral mitral annulus tissue; deceleration time and early diastolic strain rate) parameters using conventional and speckle-tracking echocardiography. Genetic structural equation models were evaluated to quantify the proportion of common and specific genetic (Ac, As) and environmental factors (Ec, Es) contributing to the phenotypes. Results: LV systolic parameters had no common genetic or environmental heritability (Ac range: 0–0%; Ec range: 0–0%; As range: 57–77%; Es range: 24–43%). Diastolic LV parameters were mainly determined by common genetic and environmental effects (Ac range: 9–40%; Ec range: 11–49%; As range: 0–29%; Es range: 0–51%). Systolic parameters had no common genetic or environmental factors (Ac = 0%; Ec = 0%) with diastolic metrics. Conclusions: Systolic LV parameters have a strong genetic predisposition to any impact. They share no common genetic or environmental factors with each other or with diastolic parameters, indicating that they may deteriorate specifically to given effects. However, diastolic functional parameters are mainly affected by common environmental influences, suggesting that pathological conditions may deteriorate them equally. Estimation of the genetic and environmental influence and interdependence on systolic and diastolic LV function may help the understanding of the pathomechanism of different heart failure classification types.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Left Ventricular Systolic Function Has Strong Independent Genetic Background from Diastolic Function: A Classical Twin Study

et al. 2021

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Diagnosis of acute heart failure in CT pulmonary angiography: feasibility and accuracy

et al. 2022

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Objectives To evaluate the feasibility and accuracy of diagnosing acute heart failure (HF) with CT pulmonary angiography (CTPA) in emergency department patients. Methods In this retrospective single-center study, we evaluated 150 emergency department patients (mean age 65 ± 17 years) undergoing CTPA with a fixed scan (100 kVp) and contrast media protocol (60 mL, 4 mL/s) who had no pulmonary embolism (PE). Patients were subdivided into training cohort (n = 100) and test cohort (n = 50). Three independent, blinded readers measured the attenuation in the right ventricle (RV) and left ventricle (LV) on axial images. The ratio (HUratio) and difference (HUdiff) between RV and LV attenuation were calculated. Diagnosis of acute HF was made on the basis of clinical, laboratory, and echocardiography data. Optimal thresholds, sensitivity, and specificity were calculated using the area under the curve (AUC) from receiver operating characteristics analysis. Results Fifty-nine of the 150 patients (40%) were diagnosed with acute HF. Attenuation measurements showed an almost perfect interobserver agreement (intraclass correlation coefficient: 0.986, 95%CI: 0.980–0.991). NT-pro BNP exhibited moderate correlations with HUratio (r = 0.50, p < 0.001) and HUdiff (r = 0.50, p < 0.001). In the training cohort, HUratio (AUC: 0.89, 95%CI: 0.82–0.95) and HUdiff (AUC: 0.88, 95%CI: 0.81–0.95) showed a very good performance to diagnose HF. Optimal cutoff values were 1.42 for HUratio (sensitivity 93%; specificity 75%) and 113 for HUdiff (sensitivity 93%; specificity 73%). Applying these thresholds to the test cohort yielded a sensitivity of 89% and 89% and a specificity of 69% and 63% for HUratio and HUdiff, respectively. Conclusion In emergency department patients undergoing CTPA and showing no PE, both HUratio and HUdiff have a high sensitivity for diagnosing acute HF. Key Points • Heart failure is a common differential diagnosis in patients undergoing CT pulmonary angiography. • In emergency department patients undergoing CT pulmonary angiography and showing no pulmonary embolism, attenuation differences of the left and right ventricle have a high sensitivity for diagnosing acute heart failure.

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Myocardial strain in hypertension: a meta-analysis of two-dimensional speckle tracking echocardiographic studies

Tadić

Sala

Carugo

et al. 2021

Journal of Hypertension

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Available evidence on systolic dysfunction in systemic hypertension, as assessed by left ventricular (LV) mechanics, is still based on single studies. Thus, we performed a systematic meta-analysis of two-dimensional speckle-tracking studies in order to provide an updated comprehensive information on this issue. Methods:The PubMed, OVID-MEDLINE, and Cochrane library databases were analyzed to search English language articles published from the inception up to 31 December 2020. Studies were identified by using MeSH terms and crossing the following search items: 'myocardial strain', 'left ventricular mechanics', 'speckle tracking echocardiography', 'systolic dysfunction', 'hypertensive heart disease', 'systemic hypertension', 'essential hypertension'.Results: Data from 4276 individuals (2089 normotensive controls and 2187 mostly uncomplicated hypertensive patients) were included. Left ventricular (LV) mass index, relative wall thickness, left atrial volume index and E/e' ratio were significantly higher in hypertensive patients than in normotensive controls. LV ejection fraction did not differ in the two pooled groups (SMD À0.048 AE 0.054, 95% CI À0.20 to 0.10, P ¼ 0.30), whereas LV global longitudinal strain (GLS) was significantly impaired in the hypertensive group (SMD: 1.07 AE 0. 15, 95% CI 0.77-1.36, P < 0.0001). Similar findings were obtained in a subanalysis restricted to 15 studies in which mean age was similar in cases and controls (SMD 1.21 AE 0.23, 95% CI 0.76-1.67, P ¼ 0.002). Conclusion:The present meta-analysis suggests that GLS assessment unmasks systolic dysfunction undetected by conventional ejection fraction in the uncomplicated hypertension setting and that this parameter should be incorporated into routine work-up aimed to identify hypertension-mediated cardiac damage.

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Genetically determined pattern of left ventricular function in normal and hypertensive hearts

Cited by 6 publications

References 38 publications

Left Ventricular Systolic Function Has Strong Independent Genetic Background from Diastolic Function: A Classical Twin Study

Left Ventricular Systolic Function Has Strong Independent Genetic Background from Diastolic Function: A Classical Twin Study

Diagnosis of acute heart failure in CT pulmonary angiography: feasibility and accuracy

Myocardial strain in hypertension: a meta-analysis of two-dimensional speckle tracking echocardiographic studies

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