Echocardiographic assessment of hypertensive patients with or without hyperhomocysteinemia

The study was designed to assess left ventricular (LV) systolic and diastolic function in hypertensive patients with or without Hhcy. The study participants consisted of 40 hypertensive patients with Hhcy, 40 hypertensive patients without Hhcy and 40 age-matched healthy control participants. Cardiac functions were determined using echocardiography and the Tei index was calculated for analysis. LAVI (left atrial volume index), IVST (interventricular septum thickness in diastole), PVST (posterior ventricular septum thickness in diastole), LVMI (left ventricular mass index), E/A (peak early and late diastolic transmitral filling flow velocities ratio), DT (deceleration time of the E wave), IRT (isovolumic relaxation time), and the Tei index were different in the hypertensive patient groups (hypertension with Hhcy and hypertension without Hhcy) compared with the controls. The Tei index was significantly higher in the hypertensive groups compared with the controls (0.62?±?0.05, 0.51?±?0.04, and 0.40?±?0.04, respectively, p?2), E/A (0.73?±?0.22 versus 0.92?±?0.14), DT (93.1?±?6.9 versus 84.3?±?8.1?ms), IRT (93.1?±?6.9 versus 84.3?±?8.1?ms) and the Tei index. Significant correlations were observed between serum homocysteine levels and LV diastolic function parameters (LAVI: r?=?0.39, E/A: r?=??0.32, DT: r?=?0.47, IRT: r?=?0.51, p?相似文献   

N-Terminal pro-brain natriuretic peptide levels and abnormal geometric patterns of left ventricle in untreated hypertensive patients

N-terminal pro-brain natriuretic peptide (NT-proBNP) predicts cardiovascular events and mortality in hypertensive patients. Relationship between NT-proBNP level and left ventricular (LV) hypertrophy is well known in hypertensive patients. However, the studies investigating relationship between LV geometric patterns and serum NT-proBNP level have conflicting results and are in a limited number. The goal of the present study is to investigate relation between NT-proBNP and abnormal LV geometric patterns in untreated hypertensive patients. Measurements were obtained from 273 patients with untreated essential hypertension (mean age?=?51.7?±?5.8 years) and 44 healthy control subjects (mean age; 51.3?±?4.7). Four different geometric patterns (NG: normal geometry; CR: concentric remodelling; EH: eccentric hypertrophy; CH: concentric hypertrophy) were determined according to LV mass index (LVMI) and relative wall thickness. NT-proBNP and other biochemical markers were measured in all subjects. The highest NT-proBNP levels were determined in the CH group compared with the control group and other geometric patterns (p?p?p?>?0.05). NT-proBNP was independently associated with LV geometry (β?=?0.304, p?=?0.003) and LVMI (β?=?0.266, p?=?0.007) in multiple linear regression analysis. Serum NT-proBNP level was independently associated with LVMI and LV geometry in untreated hypertensive patients with preserved ejection fraction.     

Comparison of subclinical left and right ventricular systolic dysfunction in non-dipper and dipper hypertensives: impact of isovolumic acceleration

Objectives: To evaluate subclinical left ventricular and right ventricular systolic impairment in dipper and non-dipper hypertensives by using isovolumic acceleration.

Methods: About 45 normotensive healthy volunteers (20 men, mean age 43?±?9 years), 45 dipper (27 men, mean age 45?±?9 years) and 45 non-dipper (25 men, 47?±?7 years) hypertensives were enrolled. Isovolumic acceleration was measured by dividing the peak myocardial isovolumic contraction velocity by isovolumic acceleration time.

Results: Non-dippers indicated lower left ventricular (2.2?±?0.4?m/s² versus 2.8?±?1.0?m/s², p?2 versus 3.5?±?1.0?m/s², p?=?0.012) compared with dippers. Left ventricular mass index (p?=?0.001), interventricular septal thickness (p?=?0.002) and myocardial performance index (p?p?=?0.002), mass index (p?=?0.001) and right ventricular myocardial performance index (p?Conclusion: The present study demonstrates that non-dipper hypertensives have increased left and right ventricular subclinical systolic dysfunction compared with dippers. Isovolumic acceleration is the only echocardiographic parameter in predicting this subtle impairment.     

Association between essential hypertension and three vasoactive peptides,urotensin II,endothelin and adrenomedullin

Abstract

Aim: The aim of the study is to measure the vasoactive peptides, urotensin II (UII), endothelin (ET) and adrenomedullin (ADM) in a well-characterized population of normal controls and patients with essential hypertension, and to study their association with this disease. Methods: The contents of plasma UII, ET and ADM were measured by radioimmunoassay in 40 normal controls and 120 patients with essential hypertension. Echocardiographic examinations were performed using an ultrasonic system, and the left ventricular end diastolic diameter (LVEDd) along with the left ventricular posterior wall thickness (LVPWT) and interventricular septal thickness (IST) were determined. The left ventricular mass index (LVMI) was calculated according to the method reported by Devereux et al. Results: Plasma UII, ET and ADM contents were increased in patients than healthy controls (3.28?±?1.257?pmol/L vs. 1.80?±?0.639?pmol/L, p?<?0.01), and correlated with the severity of hypertension in patients. Besides, all the three vasoactive peptides in plasma had significant correlations with SBP, IST, LVPWT, LVMI (p?≤?0.05), while they showed insignificant associations with LVEDd (p?>?0.05). UII was remarkably associated with ADM content, while the association of UII level with LVEDd and ET content were not significant. Conclusion: The vasoactive peptides UII, ET and ADM may be involved in the pathophysiologic process of essential hypertension, and function as the indicators for severity of this disease.     

Renal functions in obstructive sleep apnea patients

Purpose

The aim of this study is to investigate possible factors influencing glomerular filtration rate (GFR) in obstructive sleep apnea (OSA).

Methods

Data of OSA patients admitted to Gaziantep University sleep clinic from January 2005 to January 2010 were retrospectively evaluated. GFR is calculated with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Patients younger than 18 years old were excluded.

Results

The mean age of OSA (n?=?634) and control group (n?=?62) were 51.13?±?11.61 and 50.69?±?13.88 years, respectively (p?=?0.81). The mean estimated GFR (eGFR) was 90.73?±?19.59 ml/min/1.73 m² in OSA patients and 94.14?±?18.81 ml/min/1.73 m² in control subjects (p?=?0.19). GFR was 84.25?±?20.87 ml/min/1.73 m² in patients with left ventricular hypertrophy (LVH) while it was 93.94?±?18.44 ml/min/1.73 m² in patients without LVH (p?=?0.00). GFR of male subjects was 92.1?±?19.23 in OSA and 95.84?±?20.08 ml/min/1.73 m² in controls (p?=?0.33). GFR of female and male patients in the OSA were 87.45?±?20.10 and 92.91?±?18.02 ml/min/1.73 m², respectively (p?=?0.13). Serum creatinine was higher in OSA patients compared to controls (p?=?0.01). GFR was 92.30?±?19.27 in male and 88.33?±?19.84 ml/min/1.73 m² in female subjects (p?=?0.01). GFR was 84.86?±?19.95 in hypertensive patients while it was 95.11?±?18.20 ml/min/1.73 m² in normotensive subjects (p?=?0.00). GFR was 89.30?±?19.96 in patients with metabolic syndrome (MetS) and it was 93.46?±?18.68 ml/min/1.73 m² in patients without MetS (p?=?0.00).

Conclusions

GFR values were lower in sleep apneic patients with MetS as well as in patients with hypertension and LVH.

     

Mean platelet volume and left ventricular geometry in patients with aortic valve stenosis

Abstract

Background: Mean platelet volume (MPV) is a well-established marker of platelet activation. In the current study, we compared MPV between patients with aortic valve stenosis (AS) and control subjects. We also assessed the association between MPV and left ventricular geometry in patients with AS. Methods and results: The study population consisted of 75 patients with AS and 38 age- and sex-matched control subjects. In patients with AS, peak pressure gradient was 83.0?±?30.8?mm?Hg. MPV was significantly larger in patients with AS than control subjects (10.57?±?1.05 fl versus 9.72?±?0.66 fl, p?<?0.001). There was a significant association between peak pressure gradient and MPV in 75 patients with AS and 38 control subjects (r?=?0.35, p?<?0.001). Among the patients with AS, there were 12 patients with normal geometry, 10 patients with concentric remodeling, 14 patients with eccentric hypertrophy and 39 patients with concentric hypertrophy. There was no significant difference in MPV among the four groups. There was no significant association between MPV and LVM index. Conclusions: Our data suggested that MPV increased in patients with AS, but did not reflect left ventricular geometry.     

The variability and burden of severe sleep apnea and the relationship with atrial fibrillation occurrence: analysis of pacemaker-detected sleep apnea

Study objectives

This was a pilot study to evaluate the long-term variability and burden of respiratory disturbance index (RDI) detected by pacemaker and to investigate the relationship between RDI and atrial fibrillation (AF) event in patients with pacemakers.

Methods

This was a prospective study enrolling patients implanted with a pacemaker that could calculate the night-to-night RDI. The mean follow-up was 348?±?34 days. The RDI variability was defined as the standard deviation of RDI (RDI-SD). RDI burden was referred to as the percentage of nights with RDI?≥?26. The patient with RDI?≥?26 in more than 75% nights was considered to have a high sleep apnea (SA) burden. An AF event was defined as a daily AF duration?>?6 h.

Results

Among 30 patients, the mean RDI of the whole follow-up period was 24.5?±?8.6. Nine (30%) patients were diagnosed with high SA burden. Patients with high SA burden had a higher BMI (26.7?±?4.8 vs 23.2?±?3.9, p?=?0.036), a higher prevalence of hypertension (86% vs 39%, p?=?0.031), and a larger left ventricular diastolic diameter (49.2 mm vs 46.7 mm, p?=?0.036). The RDI-SD in patients with a higher burden was significantly greater than that in the patients with less burden (10.7?±?4.9 vs 5.7?±?1.4, p?=?0.036). Linear regression showed that participants with a higher RDI tended to have a higher SD (R?=?0.661; p?<?0.001). The mean RDI (OR?=?1.118, 95%CI 1.008–1.244, p?=?0.044) was associated with AF occurrence.

Conclusion

Using a metric such as burden of severe SA may be more appropriate to demonstrate a patient’s true disease burden.

     

Evaluation of Tp-e interval and Tp-e/QT ratio in patients with non-dipper hypertension

Aims: Non-dipper hypertension is associated with increased cardiovascular morbidity and mortality. Several studies have suggested that the interval from the peak to the end of the electrocardiographic T wave (Tp-e) may correspond to the transmural dispersion of repolarization and that increased Tp-e interval and Tp-e/QT ratio are associated with malignant ventricular arrhythmias. The aim of this study was to evaluate ventricular repolarization by using Tp-e interval and Tp-e/QT ratio in patients with non-dipper hypertension.

Materials and method: This study included 80 hypertensive patients. Hypertensive patients were divided into two groups: 50 dipper patients (29 male, mean age 51.5?±?8 years) and 30 non-dipper patients (17 male, mean age 50.6?±?5.4 years). Tp-e interval and Tp-e/QT ratio were measured from the 12-lead electrocardiogram. These parameters were compared between groups.

Results: No statistically significant difference was found between two groups in terms of basic characteristics. In electrocardiographic parameters analysis, QT dispersion (QTd) and corrected QTd were significantly increased in non-dipper patients compared to the dippers (39.4?±?11.5 versus 27.3?±?7.5?ms and 37.5?±?9.5 versus 29.2?±?6.5?ms, p?=?0.001 and p?=?0.01, respectively). Tp-e interval and Tp-e/QT ratio were also significantly higher in non-dipper patients (97.5?±?11.2 versus 84.2?±?8.3?ms and 0.23?±?0.02 versus 0.17?±?0.02, all p value <0.001).

Conclusion: Our study revealed that QTd, Tp-e interval and Tp-e/QT ratio are prolonged in patients with non-dipper hypertension.     

Detection of atrial electrical and mechanical dysfunction in non-dipper pre-hypertensive subjects

Introduction: A relationship between atrial conduction time and hypertension was shown in previous studies. Increased atrial electromechanical intervals used to predict atrial fibrillation by measured tissue Doppler imaging (TDI). So we aimed to search if there was any association between the non-dipping status and atrial electromechanical intervals in pre-hypertensive patients.

Methods: Forty-one non-dipper and 33 dipper pre-hypertensive subjects enrolled in the study. Systolic and diastolic blood pressures were measured with a mercury sphygmomanometer. Twenty-four hours blood pressure was measured with cuff-oscillometric method. All patients were evaluated by transthoracic echocardiography. Using tissue Doppler imaging (TDI), atrial electromechanical coupling (PA) was measured from the lateral mitral annulus (PA lateral), septal mitral annulus (PA septum) and right ventricular tricuspid annulus (PA tricuspid).

Results: Systolic and diastolic blood pressures were significantly higher in subjects with non-dipper phenomenon than dipper ones at night. Twenty-four hours average systolic and diastolic blood pressures were higher in non-dipper pre-hypertensive subjects, but this elevation was not significant. Left and right intraatrial (PA lateral-PA septum and PA septum-PA tricuspid) and interatrial (PA lateral-PA tricuspid) electromechanical coupling intervals were measured significantly higher in non-dipper pre-hypertensive patients (31.3?±?3.9 versus 24.1?±?2.3, p?=?0.001; 19.5?±?4.3 versus 13.8?±?2.1, p?=?0.001; and 11.4?±?2.8 versus 8.8?±?1.5, p?=?0.001). Also, interatrial electromechanical delay was negatively correlated with dipping levels.

Conclusion: This study showed that prolonged atrial electromechanical intervals were related non-dipper pattern in pre-hypertensive patients. Prolonged electromechanical intervals may be an early sign of subclinical atrial dysfunction and arrhythmias’ in non-dipper pre-hypertensive patients.     

The myocardial contraction fraction is superior to ejection fraction in predicting survival in patients with AL cardiac amyloidosis

Cardiac amyloidosis is a cause of diastolic heart failure in which ejection fraction (EF) remains “normal” despite progression of disease. The myocardial contraction fraction (MCF) is an index of myocardial function, defined as stroke volume (SV) over myocardial volume (MV). We hypothesized that MCF would be superior to EF, the conventional measure of left ventricular function, in predicting survival among patients with cardiac amyloidosis. Sixty-six subjects (mean age?=?67?±?12 years; 20% women) with cardiac amyloidosis (34 with light-chain amyloid and 32 with transthyretin amyloid) underwent two-dimensional echocardiography to determine left ventricular structure and function. Cox proportional hazard modeling was used to determine the association of MCF and EF with survival. Over a mean follow-up of 1.86?±?1.78 years (range 0.03–7.36 years), 37 subjects (56.1%) died. Mean EF of the study population was 51?±?13%. There was no significant difference in EF between patients who survived the study period and those who died (54?±?11% versus 49?±?14%; p?=?0.1196) while there was a significant difference in MCF (35?±?19% versus 23?±?10%, p?=?0.0065). Using Cox proportional hazards modeling, MCF was associated with death (HR?=?0.953, 95% CI of 0.932–0.984, p?=?0.0031) while EF was not (HR?=?0.991, 95% CI of 0.968–1.014, p?=?0.4320). In a multivariate model, amyloid light-chain (AL) amyloid type was an independent risk predictor of death with a HR of 2.841 (95% CI of 1.214–6.648, p?=?0.0161) along with a MCF?<?30 with a HR of 2.567 (95% CI of 1.197–5.508, p?=?0.0155), which was driven by a higher risk in AL subjects with a MCF?<?30, HR of 3.39 (95% CI of 1.20–9.55, p?=?0.021) than TTR subjects with a MCF?<?30, HR of 1.26 (95% CI of 0.36–3.28, p?=?0.87). In conclusion, MCF, a novel measure of myocardial chamber function, is superior to EF in predicting overall survival among patients with AL cardiac amyloidosis.     

Aortic remodelling following the treatment and regression of hypertensive left ventricular hypertrophy: a cardiovascular magnetic resonance study

Abstract

Background: Increased arterial stiffness independently predicts adverse prognosis. While different antihypertensive strategies produce different magnitudes of left ventricular hypertrophy (LVH) regression, there are no comparative data on how these strategies affect arterial stiffness. The aim was to determine the longitudinal change in aortic stiffness following the treatment of essential hypertension with two mechanistically different antihypertensive treatment strategies. Methods and results: Forty-two patients with essential hypertension and CMR confirmed with LVH were randomly assigned to antihypertensive regimes for 6 months. Treatment strategies were designed either to inhibit the renin–angiotensin–aldosterone system (RAAS) and the sympathetic nervous system (SNS) (valsartan and moxonidine, group VM) or to have neutral effect on these systems (bendroflumethiazide and amlodipine, group BA). Both treatment groups underwent identical baseline and a 6-month follow-up CMR and were compared with a healthy age-matched control group. Baseline aortic distensibility (AD) was lower in both hypertensive groups compared with controls (2.8?×?10^?3?mmHg^?1 in group VM (p?=?0.001) and 3.3?×?10^?3?mmHg^?1 group BA (p?=?0.039) compared with 4.5?×?10^?3?mmHg^?1 in the control group). AD increased after antihypertensive therapy (VM: 2.8?×?10^?3?mmHg^?1–4.2?×?10^?3?mmHg^?1 (p?=?0.001); BA 3.3?×?10^?3?mmHg^?1–4.6?×?10^?3?mmHg^?1 (p?<?0.01)). In both treatment groups AD returned to a level comparable with the normal control group (p?=?0.81) after 6 months. Conclusions: In patients with essential hypertension and LVH, AD was lower than in matched normal controls. Despite the opposing pharmacological mechanisms utilised across the treatment groups, the improvement in AD was similar, suggesting that blood pressure reduction per se may be more important than RAAS and SNS inhibition for the improvement of aortic remodelling.     

Gender,clamped hyperglycemia and arterial stiffness in patients with uncomplicated type 1 diabetes mellitus

Background: Diabetes mellitus (DM) reduces female gender-mediated protection against the development of renal disease possibly through effects on hyperglycemia. Women with DM also exhibit increased arterial stiffness, which may promote renal disease progression. The mechanisms responsible for increased arterial stiffness in women and the possible role of acute changes in ambient glycemia remain unknown.

Methods: Blood pressure, augmentation index (AIx), pulse wave velocity (PWV) and circulating mediators of the renin angiotensin system and nitric oxide (cGMP) were measured in men (n?=?22) and women (n?=?19) with uncomplicated type 1 DM under clamped euglycemic and hyperglycemic conditions.

Results: At baseline, men exhibited higher levels of angiotensin II (p?=?0.030) and lower cGMP levels (p?=?0.004), higher systolic blood pressure (124?±?2 versus 109?±?2?mmHg, p?p?p?p?p?=?0.853). In response to clamped hyperglycemia, systolic blood pressure increased in women (109?±?2 to 112?±?2?mmHg, p?=?0.005) but not men. Serum aldosterone increased and cGMP declined in women but not in men. Clamped hyperglycemia did not influence arterial stiffness in either group and radial and carotid AIx remained higher in women.

Conclusions: Arterial stiffness is higher in women with type 1 DM. This effect is not dependent on the effects of clamped hyperglycemia or neurohormonal activation.     

The velocity of home blood pressure reduction in response to low-dose eplerenone combined with other antihypertensive drugs determined by exponential decay function analysis

Background/objective: Eplerenone is a highly selective aldosterone blocker, which has the potential to lower blood pressure (BP) in patients with hypertension. The objective of this study was to assess the hypotensive effects of low-dose eplerenone (25?mg) using home BP measurements. We also assessed the time required to reach 95% of the maximum antihypertensive effect (stabilization time) by analyzing exponential decay functions using home BP measurements.

Methods: We reviewed the medical records of 83 hypertensive patients who were taking eplerenone 25?mg (age, 68.6?±?11.8?years; men, 36.1%) in addition to other antihypertensive agents. Home BPs were averaged in each patient for the last 5?days of each observation period. The morning versus evening effect (M/E ratio) and the evening versus morning effect (E/M ratio) were calculated to assess the duration of action of eplerenone.

Results: The mean home systolic/diastolic BPs at baseline were 136.8?±?8.8/77.2?±?9.3?mmHg, respectively. After 8?weeks of treatment with eplerenone, home systolic/diastolic BP significantly decreased by ?7.1?±?10.1/?2.6?±?5.0?mmHg (p?p?=?0.006) and 16.5 days (p?=?0.001), respectively. When eplerenone was administered in the morning, the M/E ratio was 1.1?±?0.3. The corresponding E/M ratio for evening administration was 0.9?±?0.6. Although no nocturia was observed, there was a slight but significant increase in serum potassium levels (p?=?0.03).

Conclusions: Our data suggest that the combination of eplerenone with other antihypertensive drugs may be a promising therapeutic strategy for the treatment of essential hypertension.     

Children with untreated coeliac disease have sub-clinical cardiac dysfunction: a longitudinal observational analysis

Introduction: We assessed cardiac function (CF) in celiac disease (CD) patients and the effect of gluten-free diet (GFD) on CF.

Methods: Prospective evaluation of CF using conventional and tissue doppler echocardiography in 50 CD patients (age 4.2?±?1.1 years) at diagnosis and after a year of GFD (group 1), 100 CD children (group 2; 47 compliant and 53 non-compliant) in follow-up and 25 healthy controls.

Results: Untreated CD (n?=?50) children had larger left ventricle end diastolic dimension (35.33?±?0.87 vs. 32.90?±?0.91 mm; p?=?.04), reduced (<55%) left ventricular ejection fraction (20% vs. 0%; p?=?.01) and a higher (>0.6) myocardial performance index (MPI, 66% vs. 0%; p ≤ .01) as compared to controls. Re-evaluation after one year with good dietary compliance showed changes in isovolumic relaxation time (72.5?±?4.2 vs. 50.62?±?2.69; p?=?.0001) and deceleration time (121.05?±?10.1 vs. 99.87?±?8.5; p?=?.02), reflecting improved cardiac diastolic function. GFD compliant patients had lower MPI than non-compliant (0.60?±?.03 vs. 0.66?±?.08; p?=?.04), reflecting improvement in load-independent echocardiographic parameters.

Conclusions: Subclinical cardiac dysfunction is common in CD children at diagnosis. Improvement

in echocardiographic parameters occurs with GFD and non-compliant children continue to have

persistent cardiac dysfunction.     

Effectiveness of using long-acting angiotensin II type 1 receptor blocker in Japanese obese patients with metabolic syndrome on morning hypertension monitoring by using telemedicine system (FUJIYAMA Study)

Aim: Recently, obesity patients have been diagnosed as metabolic syndrome. The aim of this study was to evaluate which angiotensin type 1 receptor blockers (ARBs), telmisartan or candesartan, is superior for the control of home blood pressure (BP) in the morning when the outpatient clinic BP was well controlled in the patients with metabolic syndrome.

Methods: The patients with metabolic syndrome were enrolled. Home BP was monitored by using a telemedicine system. After a 2- to 4-week control period to establish baseline home BP values, these patients were randomly divided into telmisartan (20–80?mg) and candesartan (4–12?mg) groups. These end points were evaluated by using the telemedicine system during steady-state active therapy. A total of 356 patients attending 60 outpatient Japanese centers were recruited.

Results: On a day of active therapy, telmisartan significantly lowered both systolic and diastolic home BP in the morning to a greater extent compared to candesartan. At the end of the study, reductions in systolic and diastolic home BP in the morning, in telmisartan group were significantly larger compared to the changes in the candesartan group (systolic; Tel: 12.0?±?8.9 versus Can: 8.1?±?17.1?mmHg, p?=?0.0292, diastolic; Tel: 7.4?±?6.1 versus Can: 3.7?±?6.8?mmHg, p?=?0.0053). Additionally in the telmisartan treated group, LDL-cholesterol showed significant reduction (p?=?0.037), but candesartan did not.

Conclusion: The present study by using the telemedicine system clearly demonstrated that telmisartan has a strong effect on reducing morning home BP, and a good effect on lipid metabolism in patients with metabolic syndrome.     

Left and right ventricular function and volume assessment in young thalassemia major patients with no related myocardial iron overload

Thalassemia major (TM) patients have altered ventricular volumes and ejection fraction compared to normals, although evidence for these findings stem from restricted patient groups and has never been reproduced. We sought to evaluate cardiac parameters by cardiovascular magnetic resonance (CMR) in a group of young TM patients not covered by previous studies that are more representative of the TM population in many countries. Seventy patients including 40 TM with normal myocardial iron concentrations, and 30 age- and gender-matched normal (NL) volunteers underwent a CMR study for assessment of left and right ventricle volumes and function using a 1.5-T scanner. Left and right ventricle ejection fraction, indexed systolic and diastolic volumes, and indexed mass were compared between the two groups. Mean age of TM patients was 18.2?±?7.1 versus 17.5?±?8.5?years in NL with no significant differences (P?=?0.73). There was no difference in left ventricular (LV) ejection fraction between the groups (TM 64.9?±?5.7?%, NL 64.9?±?5.2?%; P?=?0.97). LV normalized end-diastolic and end-systolic volumes were significantly higher in patients with TM compared to NL volunteers (76.8?±?19.4 versus 66.6?±?11.7?mL/m², P?=?0.008, and 27.0?±?8.8 versus 23.6?±?5.0?mL/m², P?=?0.045). LV indexed mass was also higher in TM patients compared to NL (51.2?±?11.9 versus 42.0?±?8.5?g/m², P?<?0.001). No significant differences were observed in right ventricular parameters. In conclusion, younger patients with TM do not present different left or right ventricular function values compared to normal controls despite having increased left ventricular volumes and mass.     

Negative association between plasma aldosterone concentration/plasma renin activity and morning blood pressure surge in never-treated hypertensive patients

Morning blood pressure (BP) surge (MS) has been known to be a predictor of cardiovascular events. Currently, few studies have evaluated the underlying mechanism underlying MS, which may include neurohormonal factors and the renin–angiotensin–aldosterone system (RAAS). This study aimed to examine plasma aldosterone concentration (PAC) and plasma renin activity (PRA) and BP parameters with or without MS in never-treated subjects with essential hypertension. This cross-sectional study included a total of 261 patients (mean age: 48.8 years; 60.5% male) with never-treated essential hypertension who were registered in a working group at The Catholic University of Korea. The patients were divided into the MS group, which was defined as having the highest quartile of morning BP increase from sleep (>31?mmHg; n?=?66) and the non-MS group (≤31?mmHg; n?=?195). We collected 24-h ambulatory BP, pulse wave velocity, ankle brachial index, PAC and PRA from all patients. The measured PAC and PRA were lower in the MS group than in the non-MS group (PAC: 9.0?±?5.4?ng/dl versus 12.2?±?8.7?ng/dl, p?p?=?0.002). The MS group had greater variations in daytime, nighttime and 24-h systolic blood pressure (SBPs) than the non-MS group (24-h SBP: 15.6?±?4.4?mm Hg for the non-MS group and 18.9?±?4.9?mmHg for the MS group; p?相似文献   

Incidence,predictors, and clinical course of atrial tachyarrhythmias in patients with pulmonary hypertension

Background

The prevalence and predictors of atrial tachyarrhythmias (ATa) in patients with pulmonary hypertension (PH) is less well understood.

Methods

We performed a retrospective study including 311 patients with PH, confirmed by right heart catheterization in our center between 2007 and 2011. Baseline characteristics, clinical, echocardiographic, and hemodynamic data were collected and compared between patients with and without ATa.

Results

The mean age was 61?±?13 years with 64 % females. The mean pulmonary artery pressure (mPAP) was 46?±?20 mmHg, mean left ventricular ejection fraction (LVEF) was 55?±?13 %, and mean pulmonary capillary wedge pressure (PCWP) was 19?±?9 mmHg. Of the 311 patients with PH, 121 (39 %) patients had ATa. Patients with ATa were older (p?p?=?0.03), diabetes (p?=?0.015), coronary artery disease (p?p?p?=?0.001), impaired LVEF (p?=?0.02), and left atrial enlargement (p?p?=?0.022). In multivariate analysis using Cox-proportional hazard model, the independent predictors of mortality were age (HR 1.05; p?=?0.003), coronary artery disease (HR 2.34; p?=?0.047), LVEF (HR 0.793; p?=?0.023), and mPAP (HR 1.023; p?=?0.003).

Conclusion

ATa are common in patients with PH. Left heart disease, left atrial enlargement, and elevated PCWP but not right atrial enlargement or mPAP predict the occurrence of ATa in patients with PH.     

Anti-Ro/SSA antibodies are associated with severe mitral valve regurgitation in patients with systemic lupus erythematosus

Objective: To assess whether anti-Ro/SSA antibodies are associated with cardiac valve disease in lupus.

Methods: A single-center, medical chart review was performed. Lupus patients were divided according to its anti-Ro/SSA status and subgroups were compared for valvular abnormalities and other characteristics. Dependence of anti-Ro/SSA reactivity to anti-Ro52/TRIM21 antibodies was also evaluated.

Results: Eighty-nine lupus patients were analyzed. The most common valvular abnormalities were tricuspid (60%), mitral (41%) and pulmonary (14%) regurgitation. Thirty-six patients were positive and 53 negative for anti-Ro/SSA antibodies. In patients positive to anti-Ro/SSA, a difference was noted for anti-dsDNA (67 versus 45%; p?=?0.04) and anti-La/SSB (19 versus 2%; p?=?0.004) antibodies. An association between anti-Ro/SSA antibodies and severe mitral regurgitation was observed; indeed, 4/15 patients with anti-Ro/SSA and mitral regurgitation had severe forms of valvulopathy as compared to only 1/22 patients with mitral regurgitation but negative to such antibody (27 versus 5%; p?=?0.02). Anti-Ro/SSA antibodies significantly elevated the risk of severe mitral regurgitation (OR?=?5). Anti-Ro52/TRIM21 levels (103?±?29 versus 42?±?43?U/mL; p?=?0.03) and anti-Ro52/TRIM21:?anti-Ro/SSA ratios (0.88?±?0.02 versus 0.35?±?0.37; p?=?0.03) were higher in patients with mitral valve regurgitation than in those with no valvulopathy.

Conclusion: Anti-Ro/SSA antibodies, mainly against Ro52/TRIM21 antigens, may be pathologically involved in lupus-associated mitral valve regurgitation.     

Arterial stiffness is associated with left ventricular dysfunction in patients with rheumatoid arthritis

Arterial stiffness (AS) has a detrimental effect on cardiovascular system particularly on left ventricle (LV). The aim of the study was to evaluate the impact of AS on LV functions in patients with rheumatoid arthritis (RA). Forty patients with RA and 25 age-sex matched control subjects (mean age 48.5?±?6.3 vs. 45.1?±?6.9 years, respectively, p?=?0.06) were enrolled in study. AS was assessed by carotid-femoral pulse wave velocity (CF-PWV) and heart rate corrected augmentation index (AIx@75) measured by applanation tonometry (SphygmoCor). LV function was evaluated using tissue Doppler-derived myocardial performance index (MPI) from lateral mitral annulus. CF-PWV (28.3?±?10.3 vs. 21.8?±?9.3 m/s, p?=?0.03), AIx@75 (10.2?±?2.3 vs. 9.2?±?1, %, p?=?0.01) and MPI (0.46?±?0.12 vs. 0.36?±?0.1, p?<?0.001) were significantly higher in patients with RA than in controls. LV MPI was found to be significantly positive correlated with CF-PWV, AIx@75, and ESR (r?=?0.360, p?=?0.005; r?=?0.334, p?=?0.009; r?=?0.293, p?=?0.023, respectively). Arterial stiffness parameters including CF-PWV and AIx@75 are associated with subclinical left ventricular dysfunction in patients with RA.