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Results for “Hypertrophy”

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At least 253 records · Page 14Linked to original sources

PubMed1999

Circulating N-terminal pro-atrial natriuretic peptide is an independent predictor of left ventricular hypertrophy in the general population. The Tromsø Study.

PURPOSE: The purpose of this study was to determine whether circulating N-terminal pro-atrial natriuretic peptide (N-ANP) levels predict left ventricular hypertrophy in the general population after adjustment for relevant risk factors. METHODS AND RESULTS: In a population-based sample of 3287 subjects aged 25-85 years, circulating N-ANP was measured in a subgroup of 389 subjects. Left ventricular mass and ejection fraction were determined by two-dimensional guided M-mode echocardiography. Left ventricular hypertrophy was defined as height adjusted mass above 145.5 g. m-1 and 125.4 g. m-1, in men and women, respectively. Fifty-one subjects with left ventricular hypertrophy had significantly higher N-ANP levels than controls (1075 vs 763 pmol. l-1;P<0.0001). A gradually increasing prevalence of left ventricular hypertrophy over increasing 500 pmol. l-1 intervals of N-ANP was observed (1.8 to 64. 3%; (Chi-squared P for trend <0.001). N-ANP was an independent predictor of left ventricular hypertrophy after adjustment for ejection fraction, body mass index, hypertension, valvular disease, a history of myocardial infarction, gender, and age. The adjusted odds ratio for left ventricular hypertrophy was 1.79 (95% CI 1.04-3. 07) for a 500 pmol. l-1 increase in N-ANP. A substantial proportion of subjects with elevated N-ANP levels had combined left ventricular hypertrophy and left ventricular dysfunction. CONCLUSION: These results suggests that N-ANP is an independent predictor of left ventricular hypertrophy in the general population. N-ANP determination is, however, poorly suited to distinguish between subjects with isolated left ventricular hypertrophy and left ventricular dysfunction with or without left ventricular hypertrophy.

Adult↗

PubMed2001

The action of isoprenaline on the electrophysiological properties of hypertrophied left ventricular myocytes.

The electrophysiological effects of the beta-agonist, isoprenaline, on hypertrophied left ventricular myocardium were measured to understand better the arrhythmic effects of beta-stimulation on the hypertrophied heart. Left ventricular hypertrophy was induced in guinea-pigs by constriction of the thoracic aorta. An age-matched sham-operated group served as controls. Isolated myocytes were held under voltage- and current clamp and the effect of isoprenaline on the L-type Ca2+ current, I(Ca), a Cl- current, I(Cl), and action potential morphology were measured. Cardiac growth was mirrored by cellular hypertrophy. I(Ca) and I(Cl) current density were reduced as myocyte hypertrophy progressed. The augmentation of I(Ca) and I(Cl) by isoprenaline was also reduced in hypertrophy, but no other characteristics of the two currents, or the dose-dependency of the action of isoprenaline were a function of cardiac growth. Isoprenaline prolonged the action potential, but to a smaller extent in hypertrophied myocytes. This difference in action potential prolongation was abolished by glibenclamide. The changes to I(Ca) and I(Cl) in hypertrophy would not tend to increase triggered activity in this situation. Under maximum inotropic stimulation hypertrophied myocytes show action potential changes which are consistent with intracellular ATP depletion, and which could enhance the likelihood of re-entrant circuits. A simple diffusion model for oxygen is constructed to demonstrate the possibility of cellular hypoxia in hypertrophied myocytes.

Action Potentials↗

PubMed2005

Expression profiling reveals differences in metabolic gene expression between exercise-induced cardiac effects and maladaptive cardiac hypertrophy.

While cardiac hypertrophy elicited by pathological stimuli eventually leads to cardiac dysfunction, exercise-induced hypertrophy does not. This suggests that a beneficial hypertrophic phenotype exists. In search of an underlying molecular substrate we used microarray technology to identify cardiac gene expression in response to exercise. Rats exercised for seven weeks on a treadmill were characterized by invasive blood pressure measurements and echocardiography. RNA was isolated from the left ventricle and analysed on DNA microarrays containing 8740 genes. Selected genes were analysed by quantitative PCR. The exercise program resulted in cardiac hypertrophy without impaired cardiac function. Principal component analysis identified an exercise-induced change in gene expression that was distinct from the program observed in maladaptive hypertrophy. Statistical analysis identified 267 upregulated genes and 62 downregulated genes in response to exercise. Expression changes in genes encoding extracellular matrix proteins, cytoskeletal elements, signalling factors and ribosomal proteins mimicked changes previously described in maladaptive hypertrophy. Our most striking observation was that expression changes of genes involved in beta-oxidation of fatty acids and glucose metabolism differentiate adaptive from maladaptive hypertrophy. Direct comparison to maladaptive hypertrophy was enabled by quantitative PCR of key metabolic enzymes including uncoupling protein 2 (UCP2) and fatty acid translocase (CD36). DNA microarray analysis of gene expression changes in exercise-induced cardiac hypertrophy suggests that a set of genes involved in fatty acid and glucose metabolism could be fundamental to the beneficial phenotype of exercise-induced hypertrophy, as these changes are absent or reversed in maladaptive hypertrophy.

Animals↗

PubMed1996

NH4Cl-induced hypertrophy is mediated by weak base effects and is independent of cell cycle processes.

Renal hypertrophy occurs in a number of clinical conditions, some of which are associated with increases in ambient ammonia concentrations. NH4Cl induces hypertrophy in cultured renal epithelial cells. The present studies examined the mechanism of NH4Cl-induced hypertrophy in NRK-52E cells. Hypertrophy was also induced by methylammonium chloride, a related weak base, but not by tetramethylammonium chloride, a weak base analogue that can neither accept nor donate protons. Bafilo-mycin A1, an inhibitor of vacuolar proton pumps, also induced hypertrophy. Together, these studies suggest that NH4Cl-induced hypertrophy is mediated by its weak base property, allowing it to enter and alkalinize acid vesicular compartments. Additional studies demonstrated that NH4Cl-induced hypertrophy is not mediated by modulation of cell cycle processes. NH4Cl addition had no effect on the following: c-fos mRNA abundance, typically associated with entrance into the cell cycle; cyclin E protein abundance, which increases as cells progress through G1; or protein synthesis, which also increases during G1. In addition, inactivation of pRB by overexpression of human papilloma virus-16 carrying the E7 gene, which inhibits cell cycle-dependent hypertrophy, had no effect on the ability of NH4Cl to induce hypertrophy. Based on these data, we postulate that, in hypertrophic conditions associated with increased ammoniagenesis, hypertrophy is mediated by vesicular alkalinization and occurs independently of processes that govern progression through the cell cycle.

Ammonium Chloride↗

PubMed1994

Stress protein induction in skeletal muscle: comparison of laboratory models to naturally occurring hypertrophy.

The purpose of the study was to compare stress protein [heat shock protein (HSP) 72] response in laboratory models of hypertrophy to naturally occurring work-induced hypertrophy. Two laboratory models of hypertrophy inducement, namely, compensatory hypertrophy and stretch hypertrophy, were compared with hypertrophy resulting from migratory flight in the blue-winged teal. We hypothesized that HSP 72 would be expressed more strongly in hypertrophied muscle than in control muscle. Furthermore, we hypothesized that changes occurring in laboratory models would also occur in work-induced enlargement. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western blot analyses were used to assess HSP 72 levels in control and hypertrophied muscle. Laboratory models elicited similar responses, with increased HSP 72 content in hypertrophied muscle. Work-induced hypertrophy or disuse atrophy did not change the degree of HSP 72 expression in the blue-winged teal. The presence of HSP 72 in these conditions may indicate that stressors eliciting changes in muscle protein expression, including the loss of muscle mass, may elicit HSP 72 synthesis.

Adaptation, Physiological↗

PubMed2005

Mitogen-activated protein kinases (p38 and c-Jun NH2-terminal kinase) are differentially regulated during cardiac volume and pressure overload hypertrophy.

Chronic pressure overload (PO) and volume overload (VO) result in morphologically and functionally distinct forms of myocardial hypertrophy. However, the molecular mechanism initiating these two types of hypertrophy is not yet understood. Data obtained from different cell types have indicated that the mitogen-activated protein kinases (MAPKs) comprising c-Jun NH2-terminal kinase (JNK), extracellular signal-regulated kinase (ERK), and p38 play an important role in transmitting signals of stress stimuli to elicit the cellular response. We tested the hypothesis that early induction of MAPKs differs in two types of overload on the heart and associates with distinct expression of hypertrophic marker genes, namely ANF, alpha-myosin heavy chain (alpha-MHC), and beta-MHC. In rats, VO was induced by aortocaval shunt and PO by constriction of the abdominal aorta. The PO animals were further divided into two groups depending on the severity of the constriction, mild (MPO) and severe pressure overload (SPO), having 35 and 85% aortic constriction, respectively. Early changes in MAPK activity (2-120 min and 1 to 2 d) were analyzed by the in vitro kinase assay using kinase-specific antibodies for p38, JNK, and ERK2. The change in expression of hypertrophy marker genes was examined by Northern blot analysis. In VO hypertrophy, the activity of p38 was markedly increased (10-fold), without changing the activity of ERK and JNK. However, during PO hypertrophy, the activity of JNK was significantly increased (two- to sixfold) and depended on the severity of the load. The activity of p38 was not changed in MPO hypertrophy, whereas it was slightly elevated (50%) in hearts with SPO. Similarly, ERK activity was not changed in hearts with MPO, but a transient rise in activity was observed in hearts with SPO. The expression of ANF and beta-MHC genes was elevated in both PO and VO hypertrophy; however, this change was much greater in hearts subjected to PO than VO hypertrophy. Alpha-MHC expression was downregulated in PO but remained unchanged in VO hypertrophy hearts. Thus, these results demonstrate differential activation of MAPKs in two types of cardiac hypertrophy and this, in part, may contribute to differential expression of cardiac muscle gene expression, giving rise to unique cardiac phenotype associated with different hemodynamic overloads.

Animals↗

PubMed1996

Substrate metabolism, hormone interaction, and angiotensin-converting enzyme inhibitors in left ventricular hypertrophy.

Left ventricular hypertrophy is considered to be an independent risk factor giving rise to ischemia, arrhythmias, and left ventricular dysfunction. Slow movement of intracellular calcium contributes to the impaired contraction and relaxation function of hypertrophied myocardium. Myofibril content may also be shifted to fetal-type isoforms with decreased contraction and relaxation properties in left ventricular hypertrophy. Myocyte hypertrophy and interstitial fibrosis are regulated independently by mechanical and neurohumoral mechanisms. In severely hypertrophied myocardium, capillary density is reduced, the diffusion distance for oxygen, nutrients, and metabolites is increased, and the ratio of energy-production sites to energy-consumption sites is decreased. The metabolic state of severely hypertrophied myocardium is anaerobic, as indicated by the shift of lactate dehydrogenase marker enzymes. Therefore, the hypertrophied myocardium is more vulnerable to ischemic events. As a compensatory response to severe cardiac hypertrophy and congestive heart failure, the ADP/ATP carrier is activated and atrial natriuretic peptide is released to increase high-energy phosphate production and reduce cardiac energy consumption by vasodilation and sodium and fluid elimination. However, in severely hypertrophied and failing myocardium, vasoconstrictor and sodium- and fluid-retaining factors, such as the renin-angiotensin system, aldosterone, and sympathetic nerve activity, play an overwhelming role. Angiotensin-converting enzyme inhibitors (ACEIs) are able to prevent cardiac hypertrophy and improve cardiac function and metabolism. Under experimental conditions, these beneficial effects can be ascribed mainly to bradykinin potentiation, although a contribution of the ACEI-induced angiotensin II reduction cannot be excluded.

Adenosine Diphosphate↗

PubMed2003

Longitudinal change in left ventricular hypertrophy in the elderly on antihypertensive therapy.

Left ventricular hypertrophy is an independent risk factor for adverse cardiovascular events. Factors related to left ventricular hypertrophy progression or regression in the extremely elderly population including role of antihypertensive therapy, are not well recognized. We conducted a structured retrospective chart review analysis of a cohort of 100 homebound elderly, predominately female African American subjects. All persons had at least two 2-D echocardiograms interpreted by the same cardiologist prior to the initiation of this study. Information was collected on demographics, functional status, comorbid conditions, use of medication, and progression or regression of left ventricle hypertrophy between baseline and follow-up echocardiogram. At baseline and follow-up echocardiogram, 47% (n = 47) and 56% had evidence of hypertrophy, respectively. There was no association between treatment with beta-blocker, calcium channel-blocker, or diuretic therapy, and left ventricular hypertrophy at follow-up echocardiogram. Only angiotensin converting enzyme inhibitor therapy was associated with the progression of left ventricular hypertrophy in all subjects. Logistic regression analysis based on all subjects revealed that risk of left ventricular hypertrophy on follow-up echocardiogram was lower with increasing age (OR 0.95, CI 0.904-0.997) and higher with angiotensin converting enzyme inhibitor therapy (OR 3.27, CI 1.41-7.63). Among subjects with no evidence of left ventricular hypertrophy at baseline, only the presence of hypertension was associated with left ventricular hypertrophy (OR 4.4, CI 1.19-16.3). Treatment of hypertension in the elderly with angiotensin converting enzyme inhibitor seemed to worsen left ventricle hypertrophy in this patient population.

Adrenergic beta-Antagonists↗

PubMed1992

The relationship between capillarisation and fibre types during compensatory hypertrophy of the plantaris muscle in the rat.

Compensatory hypertrophy of the plantaris muscle was obtained by denervation of its synergists. This hypertrophy is characterised by a 32% increase in muscle mass. The muscle consists of type I and IIa (oxidative), and IIb (glycolytic) fibres. Fibres of all types were enlarged in hypertrophied muscles and the proportion of type I fibres was increased. We investigated the capillarisation after hypertrophy as related to fibre type. In order to obtain this information a new technique was used, capable of estimating not only the traditional overall capillary density (CD) but also an index of heterogeneity in capillary spacing (LogSD), the 'local capillary to fibre ratio' (LCFR), obtained separately for each muscle fibre type, and finally a capillary density for each respective fibre type, the 'capillary fibre density' (CFD). It was found in both control and hypertrophied muscles that CD was higher in the deep (few IIb fibres) than in the superficial part of the muscle (considerable number of IIb fibres). The LogSD was lower, indicating less heterogeneity, in the deep than in the superficial part of the muscle. The LCFR and CFD of each fibre type was greater in the deep than in the superficial region of both control and hypertrophied muscles. Furthermore the CFD and LCFR were larger in type I and IIa fibres than in IIb fibres in each region of control and hypertrophied muscles. In hypertrophied muscles the CD was not significantly different from that of control muscles. However, LCFR of all fibre types was increased significantly in hypertrophied muscles as compared with controls, demonstrating capillary proliferation. The decreased CFD of type I and IIa fibres in the deep region of hypertrophied muscles as compared with controls suggests that here the capillary proliferation lags behind the increase in muscle mass. Endurance training had no significant effects for any region in any of the indices that were used.

Animals↗

PubMed1991

[Ventricular hypertrophy as an expression of hypertensive damage].

Although left ventricular hypertrophy is an adaptative mechanism to increased load, its development represents a pathological state which can affect patients' health in many ways. Systemic hypertension is often associated to left ventricular hypertrophy; a correlation exists between ambulatory blood pressure monitoring daytime mean blood pressure values and left ventricular mass. Left ventricular hypertrophy is an independent risk factor for cardiovascular events, and the pattern of concentric left ventricular hypertrophy is associated with higher morbidity and mortality. The mechanism by which left ventricular hypertrophy impair life expectancy is not completely known; arrhythmias and ischemia may often develop in patients with secondary left ventricular hypertrophy and can contribute to worsen prognosis. Left ventricular mechanics is also affected by hypertrophy. Systolic function is usually normal at rest, but its response to exercise can be blunted when hypertrophy develops. Diastolic dysfunction is often present in patients with hypertension, even before left ventricular hypertrophy occurs, and it can impair systolic function by hampering filling resulting mostly in an impairment in the adjustment to exercise. Effective antihypertensive therapy leads to a decrease in left ventricular hypertrophy and an improvement in diastolic mechanics.

Cardiovascular Diseases↗

PubMed1995

Effect of angiotensin II blockade on cardiac hypertrophy and remodelling: a review.

Activation of the renin-angiotensin system both systemically and locally seems to be of importance for cardiovascular hypertrophy and remodelling. The octapeptide angiotensin II definitively plays a central role. In the reversal, for example, of left ventricular hypertrophy, so far the most important independent risk factor for an adverse outcome, blocking of the renin-angiotensin system with ACE inhibition has been shown to be particularly effective. In cardiac tissue, however, ACE inhibition has been suggested to inhibit only a fraction of angiotensin II formed, indicating that other enzymatic pathways can be of importance. From a theoretical point of view a more complete blockade of the angiotensin II type 1 receptor would offer a more effective attenuation of the unfavourable effect of angiotensin II. Experimentally, losartan, a novel selective angiotensin II receptor type 1 antagonist has been shown to decrease cardiac hypertrophic response in models of both hypertension and volume cardiac hypertrophy as well as reverse hypertrophy in spontaneously hypertensive rats. TCV-116, another selective angiotensin II antagonist, also effectively reverses cardiac hypertophy and interstitial fibrosis in the rat. The only report so far regarding the effect of angiotensin II blockade on cardiac hypertrophy in essential hypertension suggests a more favourable short-term effect on cardiac hypertrophy for the same blood pressure reduction with losartan compared with atenolol in a small population of mild to moderate hypertensives. In the perspective of the well-established positive effects of ACE inhibition on the remodelling process in the remaining viable myocardium after myocardial infarction, involving myocyte hypertrophy, interstitial fibrosis and progressive dilatation, it is reassuring that angiotensin II blockade has been shown to perform equally well as ACE inhibition after experimental coronary ligation. In summary, the development of cardiovascular hypertrophy in hypertension is a serious prognostic indicator and selective angiotensin II blockade is a new anti-hypertensive treatment modality with promising properties, especially for prevention and reversal of cardiac hypertrophy including pathological fibrosis and cardiac remodelling after myocardial infarction. Thus, taking into account the shortcomings of today's anti-hypertensive treatment to achieve normalisation of excessive cardiovascular morbidity and mortality, as well as the seemingly great importance of the renin-angiotensin system for hypertension-induced functional and structural abnormalities, a therapy based on a specific All antagonist could offer obvious advantages in a high risk hypertensive patient with cardiovascular hypertrophy. This hypothesis will be investigated in a large prospective trial (Losartan Intervention For End-point reduction in hypertension: The LIFE Study).

Angiotensin II↗

PubMed1998

The effects of barium, dofetilide and 4-aminopyridine (4-AP) on ventricular repolarization in normal and hypertrophied rabbit heart.

The density of potassium channels, including the inward rectifying current (IK1), the delayed rectifying current and the transient outward current have been reported to be decreased in cardiac hypertrophy. However, it is not known whether the effects of specific ionic channel blockers are altered in this setting. The effects of barium chloride, which inhibits IK1, of dofetilide, which inhibits the rapidly activating component of the delayed rectifying current, and 4-aminopyridine, which inhibits the transient outward current, were studied in isolated perfused working rabbit hearts. Cardiac hypertrophy was induced in rabbits by aortic banding. Hearts were removed 43 +/- 8 days after surgery, and electrophysiologic parameters were measured at low (30 cm H2O) and high (100 cm H2O) afterload at base line and during perfusion of barium, dofetilide or 4-aminopyridine. The hearts from banded rabbits weighed more (13.0 +/- 2.3 g) than those from the sham controls (10.0 +/- 1.6 g; P < .001). The action potential duration at 90% repolarization (APD90) was greater in hypertrophied hearts (198 +/- 16 msec) at base line than in control hearts (182 +/- 20 msec; P < .01). Barium (0.025 mM) caused greater prolongation of APD90 in hypertrophied hearts than in control hearts at both low afterload (214 +/- 9 msec vs. 195 +/- 20 msec) and high afterload (200 +/- 10 msec vs. 166 +/- 22 msec, P < .01). This interaction of barium's effects on APD90 and hypertrophy was highly statistically significant (P < .001). In contrast, dofetilide (15 nM) and 4-aminopyridine (1.0 mM) caused similar changes in APD90 in hypertrophied hearts and in control hearts at low afterload and high afterload (P = NS). In isolated ventricular myocytes, IK1 and transient outward densities, but not the rapidly activating component of the delayed rectifying current were decreased in hypertrophied cells compared with control cells (P < .05). Thus the increased effects of barium on prolongation of APD in hypertrophy are probably due to the decreased density of IK1 in hypertrophy and perhaps, in part, to a change in the balance of repolarizing currents that occurs in hypertrophy.

4-Aminopyridine↗

PubMed1993

Effect of angiotensin converting enzyme inhibitor on regression in cardiac hypertrophy.

Cardiac hypertrophy in rats was produced by aortic banding for 6 weeks and regression of hypertrophy in these experimental animals was induced by administration of angiotensin converting enzyme inhibitor, enalapril (10 mg/kg/day) for 6 weeks. The left ventricular muscle mass and systolic pressure were decrease upon treating the hypertrophied rats with enalapril. This drug also decreased the number of alpha 1-adrenoceptors in hypertrophied myocardium without any changes in beta-adrenoceptors. The regression of cardiac hypertrophy in spontaneously hypertensive rats by enalapril for 10 weeks was not associated with any alterations in alpha 1-adrenoceptors in hypertrophied myocardium, but was decreased in beta-adrenoceptors. Effects of enalapril on extracellular matrix in the myocardium was also observed in regression of hypertrophy in which the type III collagen mRNA expression and collagen contents were reduced in comparison with those of hypertrophied myocardium. These results indicate that regression of cardiac hypertrophy is not always associated with a decrease in the number of alpha 1-adrenergic receptors and that the beneficial effects of enalapril in the hypertrophied heart in aortic banding animals may be of some specific nature.

Animals↗

PubMed2004

Modulation of atrial contraction by PKA and PKC during the compensated phase of eccentric cardiac hypertrophy.

Calcium homeostasis is intimately regulated by protein kinase phosphorylation cascades that are also involved in the induction and maintenance of cardiac hypertrophy. In addition, the development of cardiac hypertrophy has been associated with alteration in the activation of the adrenergic system. Therefore, we investigated the specific role of protein kinase A (PKA) and C (PKC) on cardiac muscle contractile activity in the presence and absence of adrenergic stimulation. Isolated left atrial preparations from sham- and volume overload-induced cardiac hypertrophied rats were superfused with Tyrode and electrically stimulated at 0.75 Hz. Contraction was assessed in the basal and pre-stimulated (norepinephrine, 10(-9)M) states. Specific inhibitors, KT 5720 for PKA and Ro-32-0432 for PKC, were used. Peak tension development in left atria from sham-operated rats was more sensitive to PKC- than PKA-inhibition, whereas this differential sensitivity was abolished in the hypertrophied hearts. This difference was mainly due to an increase in the role of PKA in the contractile response. Developed peak tension by left atria from shunt rats was higher than that from sham rats, but when expressed to relative tissue mass, hypertrophied muscle showed weaker contraction than that from the sham group. In addition, the left atrial velocity of contraction in the sham is PKA-sensitive, while that of the shunt is PKC-sensitive. Furthermore, the velocity of relaxation shows dependency on both protein kinases, with PKC having a greater effect than PKA in the hypertrophied group. NE increased the PTD and the velocity of contraction (+dT/dt) through PKA and PKC dependent mechanisms, without affecting the velocity of relaxation (-dT/dt) in atrial muscle from sham rats. In contrast, during eccentric hypertrophy NE effectively reduced PTD as well as the -dT/dt through a PKC-dependent mechanism. The present study demonstrates that during early development of moderate eccentric cardiac hypertrophy there is: (1) a reduced specific peak tension developed due to an imbalance in the PKA and PKC activation; (2) a change in the protein kinase dependence of the velocity of contraction and relaxation from PKA to PKC with atrial hypertrophy; and (3) a negative inotropic response to adrenergic receptor stimulation. These functional responses may play a critical role in the cardiac performance during the progression of eccentric cardiac hypertrophy into the decompensated phase and heart failure.

Adaptation, Physiological↗

PubMed1984

Reevaluation of electrocardiographic criteria for left, right and combined cardiac ventricular hypertrophy.

Cardiac chamber weight was determined at necropsy in 323 men to develop correlative studies of electrocardiographic criteria for ventricular hypertrophy. Thirty recommended criteria for left ventricular (LV) hypertrophy, 10 for right ventricular (RV) hypertrophy, and combinations of both criteria for combined hypertrophy were evaluated. Four methods for electrocardiographic diagnosis of LV hypertrophy were derived: (1) a modification of the Romhilt-Estes point system; (2) the presence of any 1 of 3 criteria: (a) S V1 + R V5 or V6 greater than 35 mm, (b) left atrial abnormality, or (c) intrinsicoid deflection in lead V5 or V6 greater than or equal to 0.05 second; (3) a combination of any 2 criteria or of 1 criterion (above) plus at least 1 of the following 3 additional criteria: (a) left-axis deviation greater than -30 degrees, (b) QRS duration greater than 0.09 second, or (c) T-wave inversion in lead V6 of 1 mm or more; and (4) the use of a single criterion--left atrial abnormality. Sensitivity varied from 57 to 66% and specificity from 85 to 93% among these 4 methods. Myocardial infarction increased sensitivity of the foregoing methods, but the specificity was reduced. Method 2 is preferred for the electrocardiographic diagnosis of LV hypertrophy. Two methods were useful for right ventricular (RV) hypertrophy: (1) the use of any 1 of 4 criteria: (a) R/S ratio in lead V5 or V6 less than or equal to 1; (b) S V5 or V6 greater than or equal to 7 mm; (c) right-axis deviation of more than +90 degrees, or (d) P pulmonale; and (2) use of any 2 combinations of the foregoing criteria. Sensitivity ranged from 18 to 43% and specificity from 83 to 95%. Combined hypertrophy was best diagnosed using left atrial abnormality as the sole criteria of LV hypertrophy, plus any 1 of 3 criteria of RV hypertrophy: (a) R/S ratio in lead V5 or V6 less than or equal to 1, (b) S V5 or V6 greater than or equal to 7 mm, or (c) right axis deviation greater than +90 degrees.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1988

Cardiac function in systemic hypertension before and after reversal of left ventricular hypertrophy.

In 3 age- and sex-matched groups of subjects--15 normotensives, 15 hypertensives without left ventricular (LV) hypertrophy and 15 hypertensives with LV hypertrophy--the slopes of the regression line obtained by plotting the individual values of LV fractional shortening against the corresponding values of echocardiographic end-systolic stress were compared. The first 2 groups were studied only in control conditions while the third group was restudied after a 20% reduction in LV mass index induced by a long-term antihypertensive treatment and after a 3-week washout period. A significant relation between fractional shortening and end-systolic stress was found in all instances. The slope of this correlation was higher in normotensives (-0.251) and in hypertensives without LV hypertrophy (-0.232) (both p less than 0.01) than in hypertensives with ventricular hypertrophy (-0.079). In this latter group, the slope increased after the reversal of LV hypertrophy (-0.230, p less than 0.01) and remained unchanged (-0.202) at the end of the washout period. No difference was detectable between the slopes obtained in these patients after reversal of LV hypertrophy, both with the antihypertensive treatment on and off, and those of normotensives and hypertensives without LV hypertrophy. Thus, LV hypertrophy attenuates the influence of changes in afterload on LV function. Reversal of LV hypertrophy restores a fractional shortening end-systolic stress relation quite comparable to that found both in normotensives and in hypertensives before the development of LV hypertrophy.

Cardiomegaly↗

PubMed1992

Long-term prognosis after acute myocardial infarction in patients with left ventricular hypertrophy on the electrocardiogram. SPRINT Study Group.

Among 4,720 consecutive hospital survivors from acute myocardial infarction (AMI) treated in 13 coronary care units between July 1981 and August 1983, the estimated prevalence of electrocardiographic left ventricular (LV) hypertrophy was 6.1%. The prevalence of electrocardiographic LV hypertrophy increased with age and was higher in patients with previous myocardial infarction, angina and systemic hypertension. Mean age of patients with electrocardiographic LV hypertrophy was 67.2 vs 61.4 years in counterparts free of electrocardiographic LV hypertrophy. Patients with electrocardiographic LV hypertrophy had a higher rate of congestive heart failure on admission, or developing during their stay in coronary care units. The 1- and 5-year mortality rates were 19.7 and 46.6% among patients with electrocardiographic LV hypertrophy versus 8.7 and 26.2%, respectively (p less than 0.001) in patients without this finding. The covariate-adjusted odds ratio of 1-year mortality was 1.88 for the presence of electrocardiographic LV hypertrophy when age alone was adjusted for, and 1.51 (90% confidence interval, 1.09 to 2.10) when multiple covariate adjustment was undertaken. After multiple covariate adjustment for 5-year mortality after discharge, the relative risk associated with electrocardiographic LV hypertrophy was 1.51 (90% confidence interval, 1.26 to 1.80). The results of the present study showed that the presence of electrocardiographic LV hypertrophy on the discharge electrocardiogram of survivors from AMI is associated with a 1.5-fold increase of short- and long-term mortality. Patients with electrocardiographic LV hypertrophy, potentially at an increased post-discharge risk, may be candidates for early noninvasive testing and more intensive follow-up after recovering from AMI.

Aged↗

PubMed1992

Reduced isotonic sarcomere shortening in rabbit right ventricular pressure overload hypertrophy.

We found previously that sarcomere shortening was reduced in hypertrophied rabbit right ventricular (RV) trabeculae, even when total isometric force and damaged end compliance were the same as normal. Here we studied isotonic shortening of similar preparations force-clamped with a servomotor. A force clamp holds the length of damaged end compliance constant. Sarcomere length (SL) was measured with laser diffraction in twitches with single and optimally paired stimuli. delta SL was sarcomere shortening divided by SL at the onset of shortening. Muscle shortening divided by unloaded muscle length (ML) at the onset of shortening was delta ML. RV hypertrophy was produced with pulmonary artery constriction in 11 rabbits and there were eight normal rabbits. delta SL was smaller than normal in hypertrophy, but delta ML was unchanged from normal. delta SL/delta ML in hypertrophy, 0.90 +/- 0.02, was significantly less than normal, 2.40 +/- 0.07 (mean +/- S.E.M.) (P less than 0.01). delta SL/delta ML did not depend on sarcomere shortening, load, time during shortening or stimulus pattern. Therefore, the reduced delta SL in hypertrophy was independent of contractile state parameters. The ratio was also independent of resting SL (normal = 2.29 +/- 0.07 microns; hypertrophy = 2.23 +/- 0.03 microns; P greater than 0.05) or where diffraction was sampled along central muscle length. One explanation for the findings includes reduced compliance of series viscoelastic elements within the central undamaged region of a hypertrophied muscle. This explanation is consistent with changes from normal in myocardial mechanics and connective tissue in cardiac hypertrophy. Ventricular function remains adequate in hypertrophy without heart failure perhaps because reduced delta SL/delta ML in hypertrophy results in less sarcomere work at any level of muscle work.

Animals↗