title: Association of ACE gene D polymorphism with left ventricular hypertrophy in patients with diastolic heart failure: a case-control study.
abstract: OBJECTIVE
  To explore the association between ACE gene insertion/deletion (I/D) polymorphism with left ventricular hypertrophy (LVH) in patients with hypertension who have developed heart failure with preserved ejection fraction (HFpEF). Being a major contributor to the development of diastolic heart dysfunction, the renin angiotensin aldosterone system and its genetic variations are thought to induce LVH in hypertensive hearts apart from haemodynamic factors.
  
  
  METHODS
  Case control study.
  
  
  METHODS
  An Iranian referral university hospital.
  
  
  METHODS
  176 patients with hypertension and a diagnosis of HFpEF on presence of symptoms of heart failure plus Doppler echocardiographic documentation of left ventricular (LV) diastolic dysfunction and/or elevated NT-proBNP levels. Those with significant coronary, valvular, pericardial and structural heart diseases were excluded as well as patients with atrial fibrillation, renal failure and pulmonary causes of dyspnoea. They were divided into two cohorts of 88 cases with and 88 controls without LVH, after determination of LV mass index, using two-dimensional and M-mode echocardiography. The I/D polymorphism of the ACE gene was determined using the PCR method.
  
  
  RESULTS
  The D allele was significantly more prevalent among cases with compared with controls without LVH (p=0.0007). Genotype distributions also differed significantly under additive (p=0.005, OR=0.53, 95% CI 0.34 to 0.84) and recessive (p=0.001, OR=0.29, 95% CI 0.13 to 0.66) models.
  
  
  CONCLUSIONS
  In patients with hypertension who develop HFpEF, the D allele of the ACE gene is probably associated with the development of LVH. With the detrimental effects of LVH on the heart's diastolic properties, this can signify the role of genetic contributors to the development of HFpEF in patients with hypertension and may serve as a future risk predictor for the disease.
authors: Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran Cardiology Departments, Fasa University of Medical Sciences, Fasa, Iran.
authors: Ehsan
authors: E
authors: Bahramali
authors: Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran.
authors: Mona
authors: M
authors: Rajabi
authors: Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran Medical Genetics Department, Fasa University of Medical Sciences, Fasa, Iran.
authors: Javad
authors: http://orcid.org/0000-0002-6607-418X
authors: J
authors: Jamshidi
authors: Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran.
authors: Seyyed Mohammad
authors: SM
authors: Mousavi
authors: Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran.
authors: Mehrdad
authors: M
authors: Zarghami
authors: Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran.
authors: Alireza
authors: A
authors: Manafi
authors: Pharmacology and Toxicology Department, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.
authors: Negar
authors: N
authors: Firouzabadi
mesh_terms: D016022:Case-Control Studies; D005260:Female; D054144:Heart Failure, Diastolic / Q000150:complications* / Q000235:genetics*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000235:genetics*; D007492:Iran; D008297:Male; D008875:Middle Aged; D007703:Peptidyl-Dipeptidase A / Q000235:genetics*; D011110:Polymorphism, Genetic / Q000235:genetics*
chemical_list: C488034:ACE protein, human; D007703:Peptidyl-Dipeptidase A
keywords: ACE; Heart failure with preserved ejection fraction; Polymorphism