高血压病患者大动脉功能改变与血管弹性的研究

目的 探讨高血压病患者动脉弹性功能变化情况及其影响因素.方法 应用脉搏波速度自动测量系统对62例健康人和232例高血压病患者进行颈动脉-股动脉脉搏波速度(CFPWV)检测,并分析与收缩压(SBP)、舒张压(DBP)、平均压(MBP)、脉压(PP)、体重指数、年龄等指标的相关性.结果 高血压病患者的CFPWV显著高于健康人(P＜0.01).高血压病患者CFPWV显著高于健康人(P＜0.01),并与年龄、SBP、DBP、MBP、PP呈显著的负相关(P＜0.01).结论 高血压病患者的动脉弹性明显降低,检测CFPWV可观察动脉早期功能改变,对临床早期干预治疗具有重要意义.     

Is Premature Thelarche in the First Two Years of Life Transient?

Objective: Premature thelarche (PT) refers to isolated onset of thelarche in girls younger than 8 years of age. Most cases have an onset under 2 years of age. We aimed to establish whether the onset of thelarche under 2 years of age certifies a transient clinical course, as suggested by several authors.Methods: Sixty-seven girls with an onset of PT under 2 years of age were classified as having early puberty (EP) or classical PT after one year of follow-up. Progression of pubertal findings or absolute growth velocity (GV) standard deviation score (SDS) above 1 SDS constituted the criteria for a diagnosis of EP. Results: Twenty (29.1%) girls were classified as having EP and 47 (70.1%) girls as having classical PT. Basal serum luteinizing hormone (LH; ICMA) values at a cut-off level of 0.3 IU/L were found to be a significant risk factor for having an atypical course [OR=7.8; CI (95%): 2.04– 30.4, p=0.003]. Conclusions: Onset of thelarche under 2 years of age does not assure a transient course in a remarkable proportion of girls with PT. An absolute GV value of >1 SDS or a basal LH level ≥0.3 IU/L are suggested as indicators for close follow-up. Conflict of interest:None declared.     

Assessment of Arterial Stiffness in Female and Male Gout Patients

The aim of this study was to investigate the relationship between central blood pressures (BP), pulse wave velocity (PWV) meaurements, and biochemical parameters in female and male gout patients and controls. This study included 12 (23.5%) females and 39 (76.5%) males with gout disease. 24-hour diastolic BP, day diastolic BP and day diastolic exceeding limit value were higher in male gout patients than female gout patients. In male gout patients, more prominent inflammatory changes in the vascular wall may be an explanation for the result of this our study, because history of hypertension and smoking habits were frequent in this group.     

Low Achieved Diastolic Pressure in Tightly Controlled Mid-Older Hypertensive Subjects Is Associated With Favorable Arterial Properties

Low diastolic blood pressure (DBP) is commonly seen in well-controlled hypertensive subjects. We evaluated arterial properties in 53 hypertensive subjects with low on-treatment DBP (<70 mm Hg; LODP), 54 subjects with normal BP and spontaneously low DBP (SLDP), and 52 treated hypertensive subjects with DBP ≥70 mm Hg (HNDP). The two measures of large artery rigidity, pulse wave velocity and augmentation index, were similar in LODP and SLDP groups. In contrast, the HNDP group had higher PWV and the lowest large and small artery compliance in comparison with all other groups. Low on-treatment DBP is associated with favorable arterial properties in mid-older hypertensive patients.     

Investigation of the Aortic Pulse Wave Velocity in Patients with Gilbert’s Syndrome

Arterial stiffness is currently the “gold standard” measure of aortic (carotid-femoral) pulse wave velocity (PWV), which is an important independent predictor of risk of developing a cardiovascular event. Gilbert’s syndrome is a congenital disorder characterized by intermittent and non-hemolytic elevation of indirect bilirubin levels due to the deficiency of the enzyme UDP-glucuronyl transferase in the liver and many prospective studies found an inverse relationship between bilirubin levels and cardiovascular events in these patients. We aimed to investigate serum bilirubin levels and arterial stiffness parameters in patients with Gilbert’s syndrome in this study. A total of 53 cases, consisting of 26 patients with a diagnosis of Gilbert’s syndrome and 27 healthy control subjects, were included in the study. Serum bilirubin levels, other routine blood chemistry, and arterial stiffness measurements were recorded. The mean ages of Gilbert’s syndrome and the control group were 31.5 ± 9.7 and 36.8 ± 11.1 years, respectively. PWV measurements were significantly lower in Gilbert syndrome patients (6.68 and 7.3 m/s in patients and controls; respectively) (P < .05). In correlation analysis in Gilbert’s syndrome patients, PWV had a significant correlation with total and indirect bilirubin levels (r = ?0.370, P = .009/r = ?0.495, P = .003, respectively). Gilbert’s syndrome patients have lower PWV measurements compared to healthy subjects, and the total and indirect bilirubin levels are also associated with PWV measurements. These findings may indicate the decreased atherosclerotic disease incidence in Gilbert’s syndrome patients.     

Current Use of Fractional Flow Reserve: A Nationwide Survey

Major medical society guidelines recommend the measurement of fractional flow reserve (FFR) as an aid in choosing percutaneous coronary intervention in patients with stable coronary artery disease. We investigated the measurement of FFR among interventionalists, analyzing operators'' attributes and decision-making processes to reveal differences in their applications of FFR and the reasons for those differences. An electronic survey study of 1,089 interventionalists was performed from 2 February through 6 March 2012, yielding 255 responses. Most respondents were >45 years old (58%), worked primarily in a community hospital (59%), and performed 10 to 30 cases per month (52%). More than half (145/253, 57%) used FFR measurement in less than one third of cases, and 39 of 253 (15%) never used it. There were no differences in use of FFR by age, practice location, or angiogram volume (P >0.05 for all). Respondents used FFR measurement more frequently than intravascular ultrasonography (73% vs 60%) to help guide the decision to stent (P <0.01). Operators reported that their primary reasons for not using FFR were lack of availability (47%) and problems with reimbursement (39%). There was no difference in FFR use by operator age, practice setting, or case volume.     

Radial augmentation index is related to cardiovascular risk in hemodialysis patients

Cardiovascular accidents related to atherosclerosis are the leading cause of death among hemodialysis patients, which makes continuous monitoring of their cardiovascular status crucial. Recently, a handy device for monitoring the augmentation index (AIx) in the radial artery was introduced in Japan, enabling the use of the AIx in addition to pulse wave velocity (PWV) in the management of hemodialysis patients. In this study the AIx, PWV, abdominal aortic calcification index (ACI), and left ventricular mass index (LVMI) were serially assessed in 108 hemodialysis patients. The radial AIx was monitored using a newly introduced tonometer (HEM-9010AI), and the interrelationships among the measured parameters and their contributions to the risk of cardiovascular accidents were evaluated. The radial AIx was significantly higher in hemodialysis patients than in healthy subjects (N = 50) and was well correlated with risk markers such as LVMI (r = 0.30, P = 0.019) and ACI (r = 0.38, P < 0.001), but not with PWV. Multiregression analysis showed that radial AIx was also significantly associated with LVMI, ACI and blood pressure; PWV was associated with other parameters such as age, blood pressure, and ACI. The AIx and ACI were both significantly increased in patients with cardiovascular complications. Although PWV was strongly increased in the hemodialysis patients, it failed to discriminate between these subgroups of high-risk patients. The radial AIx is closely associated with aortic calcification, cardiac hypertrophy, and a history of cardiovascular accidents in hemodialysis patients, and could be a useful marker for management of these patients.