title: Left ventricular hypertrophy in Turner syndrome: a prospective echocardiographic study.
abstract: BACKGROUND
  Cardiovascular risk stratification in Turner syndrome (TS) is difficult. Increased left ventricular mass associates with an adverse prognosis in several settings, and this study aimed to elucidate this risk marker in relation to metabolic and cardiovascular status in TS.
  
  
  METHODS
  An echocardiographic follow-up study (4.8 years) of 82 adult females with TS. Left ventricular mass was the primary outcome parameter. Metabolic status (glucose, Hemoglobin A1c, lipids), aortic valve function and morphology, and 24-hour ambulatory blood pressure were secondary outcome parameters. Healthy age-matched females served as baseline controls (n = 55).
  
  
  RESULTS
  Left ventricular mass was increased in TS (TS vs. controls: 88 ± 21 g/m(2) vs. 77 ± 12 g/m(2), P < 0.05). More participants were treated for hypertension at follow-up (32% at baseline vs. 55% at follow-up). This coincided with a reduction of left ventricular mass in TS (84 ± 20 g/m(2) at follow up, P < 0.05) and favorable remodeling with a contrasting increase in left atrial size. In a baseline multiple regression model, left ventricular mass (r(2) = 0.28, P < 0.05) increased with body surface area, age and the presence of a bicuspid aortic valve. In another model, left ventricular mass increased with blood pressure, ongoing estrogen treatment and body surface area (r(2) = 0.26, P < 0.05). No single factor reached statistically significant levels for prediction of prospective left ventricular mass changes.
  
  
  CONCLUSIONS
  The increased left ventricular mass in TS was associated with aortic valve disease, age, hypertension, physical stature and metabolic status. During follow-up left ventricular mass was only slightly reduced along with blood pressure, whereas the diastolic dysfunction did not seem to improve.
authors: Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark. kristian.havmand@ki.au.dk
authors: Kristian Havmand
authors: KH
authors: Mortensen
authors: Claus Højbjerg
authors: CH
authors: Gravholt
authors: Britta Eilersen
authors: BE
authors: Hjerrild
authors: Kirstine
authors: K
authors: Stochholm
authors: Niels Holmark
authors: NH
authors: Andersen
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D004452:Echocardiography / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014424:Turner Syndrome / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D055815:Young Adult