BACKGROUND AND AIM:A certain degree of impaired kidney function is related to an increased cardiovascular risk. The cardiovascular protection exerted in the postmenopausal state by the hormone replacement therapy (HRT) is debated. No studies have so far explored the relationship between menopause, renal function and cardiovascular risk profile in healthy menopausal women in relation with HRT. SUBJECTS AND METHODS:A total of 362 postmenopausal healthy women with normal albumin excretion rate were recruited and divided into two groups (HRT+ and HRT-) according to the presence or absence of HRT. All participants underwent a complete routine biochemical analyses and an echocardiogram. RESULTS:Clinical characteristics of the two groups were similar, but HRT+ showed a significantly higher estimated glomerular filtration rate (GFR; by CKD-EPI formula). Regarding the heart ultrasonography, HRT+ had a significantly lower size of the aortic root and left atrium diameter (p = 0.038 and p = 0.012, respectively); no differences were found in the ejection fraction and Left Ventricular Mass Index (LVMI). In the whole study group, eGFR correlated inversely with LVMI and with the size of the aortic root (both p < 0.0001), being GFR the only determinant of the former by a stepwise regression. Dividing the study population according to an eGFR cut-off (> 80 and < 80 ml/min/1.73 m(2)); > 80 women, in comparison with < 80, showed a significantly lower LVMI and lower size of aortic bulb, further reduced in the HRT+. CONCLUSION:In a cohort of healthy, drug-naïve, postmenopausal women, HRT seems to positively affect glomerular filtration and is associated with lower values of left ventricular mass and aortic root size, thus offering a further mechanism through female hormones exert cardioprotection.

Objective: Cardiovascular risk in post-menopausal women is related not only to the prevalence of traditional risk factors but also to the incidence of alterations in cardiovascular function and structure. Arterial stiffness can represent a mechanism involved in development of cardiac alterations. The aim of this study is to evaluate the relationship between arterial stiffness and left ventricular diastolic function in a group of post-menopausal women entering the prevention program “Woman and Heart”. Design and Methods: In 149 women with no previous cardiovascular events (age 56 ± 6 years, blood pressure-BP 129 ± 17/76 ± 9 mmHg, 38% hypertensives, 30% smokers, 27% hypercholesterolemic, 20% obese, 8% with impaired glucose tolerance or diabetes), carotid-femoral pulse wave velocity (PWV) was measured by applanation tonometry (Sphygmocor, Atcor Medical). Moreover, a trans-toracic echocardiographic study was carried out to measure mitral inflow pattern, left ventricular mass index (LVMI) and relative wall thickness (RWT). Results: In the total population, carotid-femoral PWV was 7.2 ± 1.3m/s. Left ventricular hypertrophy (LVMI >51 g/m2,7) was found in 30% of the population, RWT was>0.42 in 12%, while impaired left ventricular relaxation (E/A ratio < 0.8, deceleration time>200ms) was found in 24%. An increased PWV was associated with the presence of impaired left ventricular relaxation (PWV 7.72 vs 7.15 m/s, p<0.01), but not with left ventricular hypertrophy or concentric remodeling. The only risk factors associated with increased PWV were age, hypertension and altered glucose tolerance. Logistic regression analysis, adjusted for these 3 risk factors, showed that a PWV greater than the median value of 7.1 m/sec was associated with a 2.9-fold greater risk (confidence limits 5–95% 1.11–7.79) of having impaired left ventricular relaxation. Conclusions: In a post-menopausal female population, evaluated in a primary prevention setting, carotid to femoral PWV is associated to mild diastolic dysfunction even after correction for the most important confounders. These data suggest that an increased aortic stiffness could contribute to left ventricular diastolic dysfunction and possibly to diastolic heart failure in post-menopausal women.

Microalbuminuria (UAE) may be considered a marker of systemic vascular dysfunction, while pulse pressure (PP) is an indicator of the stiffness of vascular conduits. Both these parameters, together with left ventricular hypertrophy (LVH), are linked to cardiovascular morbidity in hypertensive patients. The aim of this study was the analysis of the possible relationships among UAE, PP, and LVH with ultrasonic myocardial textural parameters, which are altered in hypertensives patients. A group of male (n = 70) essential hypertensive patients (mean age: 58 +/- 7 yr) was analyzed with a group of age-comparable normotensive healthy subjects as controls (n = 32). Ambulatory blood pressure monitoring (ABPM) was performed with an oscillometric monitor; UAE was measured by nephelometry. A conventional 2D-Doppler echocardiography (to analyze left ventricular mass: LVM) and a quantitative analysis of the echocardiographic digitized imaging with the use of a calibrated digitization system (to calculate the septum and the posterior wall textural parameters) were performed on all subjects. The myocardial mean gray level was calculated to derive the cyclic variation index (CVI). The CVI was significantly lower in hypertensives both for the septum (- 16.3 +/- 22.8 vs 34.7 +/- 15.3%; p < 0.001) and for the posterior wall (- 15.2 +/- 23.6 vs 38.2 +/- 15.4%; p < 0.001). A significant negative correlation was found between logUAE and the CVI of the septum (r = -0.42; p < 0.001), between the PP and the CVI of the septum (r = -0.40; p < 0.002) and between the CVI and the LVM (r = -0.38; p < 0.001). Multiple regression analysis having as dependent variable the CVI at septum level showed as significantly related independent variables: PP (p < 0.01), logUAE (p < 0.001), and LVM (p < 0.05) (multiple R: 0.76, squared multiple R: 0.57; p < 0.001). It was found that LVM, logUAE, and PP are all correlated with textural parameters, and the CVI can be considered a sensitive parameter in the identification of an abnormal myocardial texture in hypertension. A high level of arterial stiffness and the presence of vascular dysfunction in essential hypertension could participate in the determination of myocardial alterations and permit the identification of patients with the worst prognosis in terms of morbidity or mortality due to cardiovascular events.

Background: Left ventricular hypertrophy which realizes in athlete's heart could create some problems of acoustic reflection related to the increase of myocytic and not-myocytic elements of the heart. The aim of the present study was to analyze the ultrasonic backscatter myocardial indexes both as peak end-diastolic signal intensity and as its cardiac-cyclic variation in athlete's heart, compared to healthy sedentary controls. Methods: Two groups of ten subjects each, all males of mean age (31.6+/-3.5), and of comparable weight and height were analyzed: group (A) comprised ten cyclists of good professional level and group (C) included ten healthy subjects acting as controls. A 2D-color Doppler echocardiography with a digital echograph Agilent Technologies (AT) Sonos 5500 was carried out on all subjects in the study for the conventional analysis of the left ventricular mass and function. The ultrasonic myocardial integrated backscatter signal (IBS) was analyzed with an "Acoustic Densitometry" module implemented on an AT echograph. The signal was also sampled with a R.O.I. placed at interventricular septum and at posterior left ventricular wall level. The systo-diastolic variation of the backscatter was also considered as Cyclic Variation Index (CVl(ibs)). Results: The left ventricular mass was significantly higher in athletes in comparison with controls (LVMbs: A: 154.5 +/- 18.7; C: 101.4 +/- 12.4; p < 0.001). The end diastolic IBS signal did not show significant statistical differences between the two groups. The CVl(ibs) both at septum (A: 30.5+/-5.3; C: 27.2+/-7.3; p<0.002) and posterior wall level (A: 43.7+/-9.1; C: 40.7 +/-9.1; p < 0.001) though was comparable in both groups. Conclusion: The conclusions reached in the present study confirmed the physiology of the left ventricular hypertrophy of the athlete's heart evaluated with an ultrasonic integrated backscatter tissue characterization, in particular through the cyclic variation of integrated backscatter myocardial signal. This finding is probably the expression of a preserved intramural myocardial function in the athlete's heart: despite the increase of left ventricular mass induced by physical training.

Di Bello, V.; Pedrinelli, R.1; Bertini, A.; Giorgi, D.; Talini, E.; Moretti, L.; Pallini, M.; Precisi, S.; Caputo, M. T.; Dell'Omo, G.1; Giusti, C. Author Information

Background Left ventricular hypertrophy (LVH) and the geometric shape of the left ventricle are well-established important risk factors for cardiovascular morbidity and mortality in the hypertensive population.Videodensitometry is an alternate echocardiographic approach to the study of myocardial structural and functional alterations in essential hypertension.Objectives To analyze the behavior of the ultrasonic videodensitometric parameter for various subgroups of a hypertensive population; first according to the severity of LVH (group A, without LVH; group B, with mild-to-moderate LVH; and group C, with severe LVH) and second according to geometric adaptation of left ventricle to pressure-volume overload of essential hypertension (group NG, normal geometry; group CR, concentric remodeling; group CH, concentric hypertrophy; and group EH, eccentric hypertrophy).Methods For 70 male, essential hypertensive patients and 32 normotensive healthy subjects matched for age (58 +/- 7 years) and sex as controls (group N) we performed ambulatory blood pressure measurements for the evaluation of 24 h mean systolic and diastolic blood pressures, conventional two-dimensional Doppler echocardiography to evaluate left ventricular performance and left ventricular mass index, and digitization of left ventricular parasternal long-axis echocardiographic images. For regions of interest selected within the septum and the posterior wall, the mean gray levels were calculated at end-systole and end-diastole. The resulting values were used to estimate the percentage cyclic variation index (CVI).Results The results according to left ventricular mass index were CVI for septum group N 34.7 +/- 16.3%; group A - 0.18 +/- 16%, group B - 13 +/- 19%, and group C - 22 +/- 12% (P < 0.001); and CVI of posterior wall, group N 38.2 +/- 15.4%, group A - 0.75 +/- 16%, group B - 16 +/- 16% and group C - 16 +/- 13% (P < 0.001). According to left ventricular geometry CVI for septum were group NG 0.6 +/- 24%, group CR 1.9 +/- 17%; group CH - 25.4 +/- 18%, and group EH - 17.1 +/- 20% (P < 0.01). CVI of posterior wall were group NH - 5.8 +/- 24%, group CR 6.4 +/- 23%, group CH - 29 +/- 20%, group EH - 20 +/- 21 (P < 0.01).Conclusions Our results demonstrate that subjects with high left ventricular masses and those with concentric hypertrophy, which have the worst prognostic impacts, have the most significant changes in CVI. Furthermore, videodensitometric findings are quite different even among the subgroups with mild-to-moderate left ventricular hypertrophy and eccentric hypertrophy. Therefore this videodensitometric approach could provide some useful information for better definition of cardiovascular risk in hypertension. Coron Artery Dis 11:513-521 (C) 2000 Lippincott Williams & Wilkins.

Di Bello, V.; Pedrinelli, R.1; Bertini, A.; Giorgi, D.; Cioppi, A.; Talini, E.; Moroní, L.; Caputo, M. T.; Pallini, M.; Precisi, S.; Khabirinejad, J.; Dell'Omo, G.1; Giusti, C. Author Information

Aim of the study is to analyze the ultrasonic backscatter myocardial indexes both as peak signal intensity and as cyclic variation in these two models of left ventricular hypertrophy and in a group of sedentary healthy controls. We have studied three groups of 10 subjects, all males of mean age (31.6±3.5), with comparable weight and height: athlete's group (A) (all cyclists); hypertensive group (I) and control group (C). Hypertensives are selected on the basis of ambulatory blood pressure monitoring results, according to ISH-WHO guidelines. All subjects have performed 2D-color Doppler echocardiography with a digital echograph Hewlett-Packard Sonos 5500, for the conventional analysis of left ventricular mass and function. With “Acoustic Densitometry” module implemented on HP echograph, we have analyze the ultrasonic myocardial integrated backscatter (IB) signal, sampled with a R.O.I. placed at interventricular septum and at posterior left ventricular wall level. We also have considered the systo-diastolic variation of backscatter as Cyclic Variation Index (CVIbs): Left ventricular mass is comparable between the A and I groups, by inclusion criteria, and significantly higher in comparison with group C (LVMbs: A: 154.5±18.7; I: 146.8±25.5; C: 101.4±12.4; p<0.001). The end diastolic IB signal doesn’t show significant statistical differences between the three groups. While the CVIbs both at septum (A: 30.5±5.3; I: 13.2±13.1; C: 27.2± 7.3; p < 0.002) and posterior wall level (A: 43.7±9.1; I: 16.5±12.1; C: 40.7±9.1; p < 0.001) is significantly lower in the hypertensives in comparison with athletes and controls, who are comparable. The present study confirms the physiology of left ventricular hypertrophy of the athlete's heart, evaluated with the ultrasonic integrated backscatter tissue characterization; in the hypertensive model we have demonstrated a significant alteration of myocardial CVIbs (both for septum and posterior wall), probably expression of an alteration of intrinsic myocardial function.

BACKGROUND:Recent bioptical data have shown that in weight-lifters (WL) under the pharmacological effects of anabolic-androgenic steroids (AAS), a focal increase in myocardial collagen content might occur as a reparative mechanism against a myocardial damage.OBJECTIVE:The aim of this study was to investigate whether by using videodensitometry an early identification of the changes in myocardial texture is possible or a potential sign of myocardial damage, which can potentially occur in WL who have used AAS.METHODS:Ten males WL (mean age: 32+/-6 yr) who had regularly used AAS (users), were compared with 10 male WL at same training level (nonusers), who had not used any drugs and with 10 healthy sedentary controls (controls). The three groups were age and sex-matched. Echocardiographic parietal, septal thickness, and left ventricular mass (LVMbs) were evaluated. Left ventricular systolic and diastolic functions were evaluated with Doppler examination. Quantitative analysis of echocardiographic digitized data was carried out with a calibrated 256 gray level digitization system, in order to calculate the mid-septum and the mid-posterior mean gray level (MGL) and to derive the cyclic variation index (CVI), i.e., the percent MGL variation during cardiac cycle.RESULTS:The weight and relative body mass index were significantly higher in WL (P<0.001); also the diastolic blood pressure was slightly but significantly higher in users in comparison both with nonusers and controls (P<0.01). Systolic and diastolic functional parameters overlapped in the three groups. LVMbs was significantly higher in users (145+/-17) and in nonusers (122+/-27) vs. C (104+/-18 g x m(-2)) (p<0.001). CVI at septum level showed significant differences: users: (2.3+/-31%) vs nonusers: (23+/-8) and controls (29+/-5) (P<0.005); although no significant difference was found between nonusers and controls. CVI at posterior wall level followed a similar pattern. No relationship was found between CVI and LVMbs or wall thickness.DISCUSSION:As brought out by videodensitometry, despite an increase in septal and parietal thickness and consequently in LVMbs, the physiological pressure overload that happens in WL during sport activities, in absence of any drugs, does not modify the myocardial ultrasonic texture. The abuse of AAS in WL, on the other hand, determines some alterations of the myocardial textural parameters. The real significance of these changes of myocardial texture detected with videodensitometry in WL who use anabolic-androgenic steroids, present also in the absence of other systolic and diastolic left ventricular functional indexes alterations, needs to be further explored with a larger population through the comparison with endobioptical data and with a follow-up study approach.