bluuebunny/crossref_metadata_2025 huggingface dataset:
AORTIC INVOLVEMENT IN FIBROMUSCULAR DYSPLASIA: REPORT FROM ARCADIA-POL
Authors: Talarowska Paulina , Canning Caitriona , Persu Alexandre , Januszewicz4 Andrzej , Gornicka Barabra , Colgan Mary-Paula , Matsko Pavlo , Sasin Dawid , Sterlinski Ignacy , Kruk Mariusz , Szkamruk Katarzyna , Prejbisz Aleksander , Dobrowolski Piotr , Michalowska Ilona , Litwin Mieczyslaw , Januszewicz Magdalena
Published: June 2023

Objective:

Fibromuscular dysplasia (FMD) affects the walls of medium-sized arteries. There are no described radiological characteristics pathognomonic of aortic FMD but pathological documentation of aortic FMD has been occasionally reported. The aims of this study were to investigate the characteristics of abdominal aorta in patients with FMD versus controls and to review the relevant literature.

Design and method:

We measured centreline abdominal aortic diameters on 136 patients with FMD (22 with focal disease) enrolled in the ARCADIA-POL study, 60 patients with carotid dissections but no evidence of FMD and 136 healthy controls.

Results:

The median abdominal aortic diameter did not differ between patients with FMD, patients with carotid dissections and no evidence of FMD and healthy controls. However, aortic diameter at the level of the diaphragm was smaller in patients with focal FMD compared to patients with multifocal FMD, patients with carotid dissections and healthy controls (ANOVA 0.015). Six patients with mid-aortic syndrome (MAS) were reported separately. All had radiological evidence of FMD in medium-sized aortic branches. In one in whom a sample of aortic wall was obtained, histology confirmed focal aortic FMD. A literature review found a further 31 reports of aortic histology with features of FMD.

Conclusions:

We found no difference in aortic diameters between individuals with or without FMD. Nevertheless, patients with focal FMD had smaller aortic diameters than those with multifocal FMD and controls. This represents another phenotypic difference between multifocal and focal FMD. Focal renal artery stenosis associated with MAS may represent an extreme presentation belonging to the same disease spectrum.
CAROTID-FEMORAL PULSE WAVE VELOCITY VARIABILITY: BEAT-TO-BEAT ASSESSMENT
Authors: Obeid Hasan , Tairi Amira , Fortier Catherine , Giudici Alessandro , Spronck Bart , Agharazii Mohsen
Published: June 2023

Objective:

Variability of carotid pulse wave velocity (CFPWV) measurements may be related to measurement errors, but also to physiological beat-to-beat variations in pulse transit time (TT). We aimed to 1) evaluate beat-to-beat variability of CFPWV on simultaneous non-invasive carotid and femoral waveforms without signal artefacts, and 2) explore its clinical and hemodynamic determinants.

Design and method:

In 44 adult patients (47±18 years; 50% men; 32% hypertensive, 27% with chronic kidney disease, 9% diabetic and 5% with cardiovascular disease), three 10 seconds-long acquisitions of carotid and femoral pressure waveforms were performed using Complior Analyse. Raw data of the three recordings were extracted, checked to be artefact-free, concatenated, and subjected to a custom 2nd derivative-based foot detection algorithm. Mean, beat-to-beat standard deviation (SD), and coefficient of variation (CV) of CFPWV (80% of direct distance) and heart rate were determined. Regression analysis was used to identify determinants of CV of CFPWV.

Results:

44 ± 3 (mean ± SD) beats per individual were analysed, and the mean CFPWV was 7.7±2.6 m/s. The SD and CV of CFPWV were 1.2±0.8 m/s and 13.9±6.5%, respectively. In multivariable regression analysis, age (standardized ß = 0.470, p<0.001) and intra-individual SD of heart rate (ß = 0.430, p<0.001) explained 63% of changes in CV of CFPWV. Systolic/diastolic blood pressures were not significant determinants of CV of CFPWV.

Conclusions:

There is a variability in beat-to-beat pulse transit time that is not explained by poor signal quality, but by higher physiological variations of beat-to-beat transit time, which is explained by advancing age and beat-to-beat heart rate variability.
AMBULATORY BLOOD PRESSURE MONITORING IN PATIENTS WITH MEDIAL ARTERIAL CALCIFICATION
Authors: Gaspar Ludovit , Mesarosova Dasa , Filipova Slavomira
Published: June 2023

Objective:

Several studies have shown that reduced ankle-brachial pressure index (ABI) is a reliable warning sign of increased cardiovascular risk. But also ABI values above 1.3 in the presence of medial arterial calcification (MAC) are associated with increased mortality due to cardiovascular causes. Aim of the study was in a group of patients with MAC using ambulatory blood pressure monitoring (ABPM) to document frequent occurence of arterial hypertension, with also frequent diurnal pattern loss, as significant factors in patients prognosis.

Design and method:

We examined 41 patients (25 men, 16 women) with identified MAC. Mean age 59 years (50-79 years). All patients have been treated for diabetes mellitus, type 2, most of them, 23 (56.1 %) with insulin. The mean duration of diabetes was 12.6 years. MAC was detected by the BOSO, ABI system 100 (Germany), using the oscillometric method of measuring blood pressure. ABI value was calculated as the ratio of the value of higher pressure in the leg to a higher pressure on the upper extremities. ABPM was performed with the Cardiosoft-Tonoport V, General Electric (USA).

Results:

35 patients (85,4 %) had arterial hypertension, most of them, 20 (48,8 %) grade 3 hypertension (according to ESC/ESH Guidelines). 14 patients (40 %) had a preserved diurnal rhythm (dipping), 18 (51.4 %) had it disturbed (non-dippers or risers). In 3 patients (8.6 %) we did not determine the diurnal sign for night vigil.

Conclusions:

In patients with MAC, we found a high prevalence of arterial hypertension, and a diurnal rhythm disorder was also very frequent. This fact may also contribute to the worsened cardiovascular prognosis of these patients. Therefore ABPM in patients with MAC is highly recommended, since subsequent cardiology management can improve their prognosis.
COFFEE CONSUMPTION RELATES TO A REDUCTION OF AORTIC STIFFNESS BUT NOT ON MICROCIRCULATION IN WELL-CONTROLLED HYPERTENSIVES
Authors: Zotti Francesca , Marozzi Marialuisa Sveva , Vacca Antonio , Rignani Federica , Gramegna Davide , Amodio Gianfranco , Santoro Giuseppe , Benedittis Lorenzo De , Schirosi Gabriella , Brosolo Gabriele , Catena Cristiana , Cicco Sebastiano , Sechi Leonardo A. , Nazzaro Pietro
Published: June 2023

Objective:

Nutritional interventions potentially preventing hypertension-related organ damage are far to be fully defined. Coffee is one of the most used beverages all over the world. Many studies tried to define the optimal amount of coffee in order to understand whether coffee has a role in cardiovascular prevention. Thus, we evaluated vascular stiffness in well controlled hypertensives according to coffee consumption.

Design and method:

We evaluated well-treated 449 patients (225F, 224M, aged 62.56±11.49) with essential hypertension. All patients were checked for organ damage screening including carotid-femoral pulse wave velocity (cfPWV), Augmentation Index (AI), and ankle-brachial Index (ABI). To evaluate microcirculation, amydriatic retinography was performed. Arteriolar-to-Venular diameter Ratio (AVR). The number of coffee cups per day was asked during the visit. The median coffee consumption was 2 cups per day.

Results:

Patients were subdivided into three groups according to tertiles of cups consumed: Group 1, 0-1 cups 148 patients (87F, 61M; 63.66±12.94), Group 2, 2 cups, 159 patients (77F; 82M; 64.75±10.09), Group 3, >2 cups, 142 patients (60F; 82M; 58.96±10.54). No differences highlighted in BMI, in SBP/DBP, in cfPWV and in ABI. On the contrary, aortic stiffness evaluated as AI results significantly decreased in high coffee consumers compared to other groups (ANOVA p<0.0001). In particular, Group 3 was lower than Group 1 (Group 3 9.54±15.48 vs Group 1 17.49 ± 19.56, p<0.05) and (Group 3 9.54±15.48 vs Group 2 15.88 ± 16.57, p<0.05). AVR was higher in less coffee consumers compared to higher (Group 1 0.91 ± 0.10 vs group 3 0.87 ± 0.11, p<0.05), but no difference resulted between Group 2 and 3 or Group 1 and 2. Moreover, AVR did not correlate to Augmentation Index in any group.

Conclusions:

Coffee consumption may have a role in prevention of aortic remodelling and stiffness. Consumption of at least 3 cups of coffee per day reduces vascular stiffness and increase central vascular compliance, despite this effect is reduced in distal vascular circulation. Our findings need further analysis, mainly to the effects in distal/central hemodynamics due to different drug treatment.
RANDOMIZED PILOT STUDY ON THE EFFECTS OF SARCOCORNIA AS A SALTSUBSTITUTE IN ARTERIAL BLOOD PRESSURE AND VASCULAR FUNCTION INHEALTHY YOUNG ADULTS
Authors: Pereira Telmo , Caldeira Andreia , Caseiro Armando , Osorio Nadia , Silva Aida , Barroca Maria
Published: June 2023

Objective:

Previous studies have shown that excessive salt intake is strongly associated with highblood pressure (HT), vascular dysfunction, and the overall risk of cardiovascular diseases. The aimof this study was to evaluate Sarcocornia effectiveness as a salt substitute, addressing its effect oncardiovascular function in healthy young individuals.

Design and method:

Thirty healthy participants, aged 18 to 26 years,were randomized into two groups: the control group (CG) and the intervention group (IG). The IGused Sarcocornia powder as a salt substitute for cooking, and the CG used regular salt, during a periodof 1 month. A baseline evaluation was performed before the participants started the interventionphase, and was repeated after a 30-day intervention period. Each evaluation included blood pressure (BP) measurement, carotid-femoral pulse wave velocity (PWV), and carotid pulse wave analysis(PWA), and blood samples were also collected for analysis. Sodium excretion was measured atbaseline and after intervention through spot urine collection and analysis, a method suitable forthis population but with known limitations.

Results:

Baseline parameters were similar between groups and were within normal range. Sodium excretion remained unchanged in the two evaluations in the CG, but significantly decreased after intervention in the IG. The reduction in sodium excretion in the IG was followed by a significant reduction in brachial and aortic systolic (-7.0± 0.9 mmHg and -5.6 ± 1.0 mmHg, respectively; p<.001) and diastolic (-5.9 ± 1.0 mmHg; p<.001) blood pressure, with no differences observed in the CG. Also in the IG, PWV decreased from 6.0 ± 0.6 m/s at baseline to 5.7 ± 0.6 m/s after intervention (p = .042), with no significant changes in the CG.

Conclusions:

This preliminary study conveys positive results in favor of Sarcocornia as a dietary substitute for regular salt, providing added evidence on the negative cardiovascular effects of high salt intake in young and healthy adults. The overall nutritional value of Sarcocornia, also known for its high phenolic content, may also add to the observed benefits.
DIETARY SODIUM/POTASSIUM INTAKE AND COGNITIVE IMPAIRMENT IN ELDERLY PATIENTS WITH HYPERTENSION: DATA FROM NHANES 2011-2014
Authors: Kou Chengkun , Zhao Xu , F Xin , Lin Xin , Wang Qiongying , Jing Yu
Published: June 2023

Objective:

This study aimed to assess the relationship between dietary sodium/ potassium intake and cognition in elderly individuals with hypertension.

Design and method:

We designed a cross-sectional study based on the 2011–2014 National Health and Nutrition Examination Survey (NHANES). Cognitive performance was assessed using the Digit Symbol Substitution Test (DSST), Consortium to Establish a Registry for Alzheimer's Disease test (CERAD), and Animal Fluency Test (AFT). Multivariate logistic regression and restricted cubic spline (RCS) was used to assess the relationship between dietary sodium/ potassium intake and cognition.

Results:

After excluding participants with incomplete data, 1670 out of 2276 participants had confirmed hypertension. Compared with the lowest quartile of dietary sodium, the lowest weighted odds ratio (OR) of cognitive impairment in DSST was observed in Q4 (OR = 0.45, 0.29–0.70), and a similar trend was observed in AFT (OR = 0.34, 0.18–0.65). After adjusting the covariates, the lowest weighted multivariate adjusted OR of cognitive impairment in DSST were also observed in Q4 (OR = 0.47, 0.26–0.84) compared with the lowest quartile of dietary sodium. The RCS results showed that dietary sodium was U-shaped and associated with the risk of cognitive impairment in the DSST (Pnon–linearity = 0.0067). No significant association was observed between dietary potassium and cognitive performance.

Conclusions:

Too high and too low dietary sodium levels were associated with impairment of specific processing speed, sustained attention, and working memory for hypertension among the elderly in the United States. However, no association was observed between the dietary potassium intake and cognition.
CHIOS MASTIC IMPROVES NIGHT-TIME DIASTOLIC PRESSURE IN WELL-CONTROLLED PATIENTS WITH HYPERTENSION; PRELIMINARY RESULTS OF THE HYPER-MASTIC CLINICAL TRIAL
Authors: Kalafati Ioanna Panagiota , Korovesi Anastasia Areti Kyriazopoulou , Papaioannou Maria , Konstantaki Christina , Angelidakis Lasthenis , Pachi Vassiliki K. , Maneta Eleni , Bampatsias Dimitrios , Petropoulos Ioannis , Manios Efstathios , Smyrnioudis Ilias , Georgiopoulos Georgios , Dedoussis George V. , Stamatelopoulos Kimon
Published: June 2023

Objective:

Chios mastic is a natural nutritional supplement consisting of several bioactive compounds and it possesses antioxidant and anti-inflammatory activities. Preliminary recent evidence suggests an anti-hypertensive effect of mastic. HYPER-MASTIC is a double-blind, randomized and controlled clinical trial, with the aim of investigating the additional effect of a three-month supplementation with Chios mastic on arterial hypertension of Greek patients with well-managed cardiovascular risk factors.

Design and method:

Patients with well controlled hypertension are being consecutively recruited and randomly allocated into three groups of supplements: 1500mg of mastic, 2800 mg of mastic and placebo in this ongoing study. For the current analyses, the two mastic groups were merged. Blood pressure measurements, using both office and 24h blood pressure measurement, and blood tests were performed at baseline and at 3 months. Flow-mediated dilatation (FMD) at the level of the brachial artery was measured in all patients as a measure of endothelial function. Patients reported no recent history of acute myocardial infarction or stroke and no history of heart failure. Herein, the preliminary results of the study are presented.

Results:

At the time of analysis, twenty one patients [48% females, age: 62 (14)] were consecutively recruited and randomized, with available data at 3 months. Thirteen volunteers were allocated to mastic and eight to placebo. No difference was found regarding age, sex distribution, BMI levels, personal or family history of hyperlipidemia and hypertension, diabetes mellitus type 2 and coronary artery disease between the two groups. Patients in the mastic group reduced their night-time diastolic blood pressure compared to placebo [-5 (10) vs -2.5 (16.3) mmHg | p = 0.025, respectively]. No other differences from placebo were observed on the effect of mastic on BP parameters. FMD dropped with time in the placebo group, whereas in the mastic group it was preserved [-1.2 (2.7) vs -0.2 (0.8) | pinteraction = 0.010].

Conclusions:

Chios mastic supplementation leads to improved night-time diastolic blood pressure and preserved endothelial function in patients with well-controlled hypertension, suggesting that it may incrementally exert anti-hypertensive and vasculoprotective properties over anti-hypertensive medication.
PROLONGED NOCTURNAL HYPOXEMIA PREDICTS WORSE PROGNOSIS IN PATIENTS WITH CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION UNDERGOING PULMONARY ENDARECTOMY
Authors: Xu Hang , Song Wu , Liu Sheng
Published: June 2023

Objective:

Obstructive sleep apnea (OSA) and/or nocturnal hypoxemia is prevalent in patients with chronic thromboembolic pulmonary hypertension (CTEPH), yet the pathological determinants of adverse outcomes remain ambiguous. We aimed to investigate the prognostic significance of various sleep parameters for poor prognosis in patients with CTEPH undergoing pulmonary endarterectomy (PEA).

Design and method:

Consecutive patients diagnosed with CTEPH who underwent overnight cardiorespiratory polygraphy for the assessment of OSA were enrolled. Time-to-event analysis was performed investigating cardiorespiratory indices (eg, apnea-hypopnea index [AHI], time percentage with oxygen saturation below <90% [T90]) and clinical worsening using the log-rank test and multivariable Cox proportional hazard models adjusted for multiple confounders.

Results:

Of 71 operable CTEPH patients, 36 (50.7%) had OSA (AHI = 5 or above) and 32 (45.1%) had nocturnal hypoxemia (T90 no less than 30%). A 10% increase in T90 was associated with a nearly 27% greater risk of being classified as a high-risk group (odds ratio: 1.27, 95% confidence interval [CI] 1.07-1.50, P = 0.006), as quantified by mean pulmonary artery pressure over 46 mmHg. Over a median follow-up of 39.0 months, 19 (26.8%) patients experienced CW events. AHI did not predict a higher risk of incident CW (hazard ratio [HR]: 1.00, 95% CI: 0.93-1.06, P = 0.906). By contrast, Compared with normoxemic patients, patients with nocturnal hypoxemia had a higher cumulative incidence of CW (43.8% vs. 12.8%, log-rank P = 0.017). Notably, nocturnal hypoxemia was associated with an increased risk of CW events (HR: 3.27, 95% CI 1.17-9.13, P = 0.024), and these associations persisted even after covariate adjustment.

Conclusions:

Among patients with operable CTEPH, nocturnal hypoxemia quantified by T90 was a robust risk predictor of both short-term and long-term CW events. Investigation of nocturnal hypoxemic burden in CTEPH may aid in the early risk-stratification.
NOCTURNAL HYPOXIA INDEXES ARE ASSOCIATED WITH LEFT VENTRICULAR REMODELING AND DIASTOLIC DYSFUNCTION IN OBSTRUCTIVE SLEEP APNEA PATIENTS
Authors: Maiolino Giuseppe , Bisogni Valeria , Maggi Michael , Carlucci Silvia , Federici Giacomo , Soranna Davide , Zambon Antonella , Pengo Martino F. , Lombardi Carolina , Busetto Luca , Vettor Roberto , Parati Gianfranco
Published: June 2023

Objective:

Echocardiography features of obstructive sleep apnea (OSA) are heart derangements as higher left ventricular mass index (LVMI) and left ventricular end-diastolic diameter, lower left ventricular ejection fraction (LVEF), and impaired diastolic function. The apnea/hypopnea index (AHI), the parameter currently used to define diagnosis and severity of OSA, poorly predicts cardiovascular damage, cardiovascular events, and mortality. Thus, we aimed to assess, if, in addition to AHI, other polygraphic indices of OSA presence and severity might serve as better predictors of echocardiographic cardiac remodeling.

Design and method:

We enrolled two cohorts of subjects referred for suspected OSA to the outpatient facilities of the IRCCS Istituto Auxologico Italiano, Milano, and of the Clinica Medica 3, Padova. All patients underwent home sleep apnea testing and echocardiography. Based on the AHI the cohort was divided into no-OSA (AHI<15 events/hour) and moderate-severe OSA (AHI> = 15 events/hour).

A stepwise multiple regression analysis was used to identify the covariates among age, gender, body mass index, past medical history, and polygrapic variables, independently associated to four echocardiographic variables, e.g., LVMI, LVEF, left ventricular end-diastolic volume (LVEDV), early and late ventricular filling velocity ratio (E/A).

Results:

We recruited 162 patients and found that compared to patients with no-OSA, those with moderate-severe OSA showed higher LV remodeling [LVEDV 48.4±11.5 ml/m2 vs. 54.1±14.0 ml/m2, respectively, p = 0.005] and lower LVEF (65.3±5.8 % vs. 61.6±7.8%, respectively, p = 0.002), whereas we could not find any difference in LVMI and E/A.

At multivariate linear regression analysis, the only polygraphic independent predictor of LVEDV was the percentage of time with SatO2 < 90% (↓ = 0.262), whereas, the independent predictors of E/A were AHI (↓ = -0.379) and oxygen desaturation index (↓ = -0.422).

None of the polygraphic variables was associated to LVMI and LVEF at multivariate linear regression analysis.

Conclusions:

Our study shows that nocturnal hypoxia-related indexes were associated with left ventricular remodeling and diastolic dysfunction in OSA patients. If confirmed in future studies with a wider sample of patients included, these results support the adoption of hypoxia indexes in the evaluation of OSA patients, particularly those at a greater cardiovascular risk.
CHREBP/ CHREBP BETA EXPRESSION MEDIATES THE PARADOXICAL EFFECT OF FRUCTOSE ON BODY WEIGHT OF FRUCTOSE-FED RATS BY BROWN ADIPOSE TISSUE ACTIVATION
Authors: Khashab Rawan , Sharabi Yehonathan , Shabtai Zehava , Grossman Ehud , Leibowitz Avshalom
Published: June 2023

Objective:

Western diet fructose content is a neglected nutrition component, with significant devastating metabolic effects like metabolic syndrome (MeS) and obesity. The data suggest that Food-induced thermogenesis is a contributing factor for regulating body weight. Carbohydrate Responsive Element Binding Protein-beta (ChREBP beta) is recognized now as the regulator of fructose metabolism. Brown adipose tissue (AT) which plays essential role as a thermoregulatory organ, is recognized now also as an endocrine tissue that participates in glucose and lipids metabolism. ChREBP expression is associated with activating of BAT and improve metabolic status. On the other hand, increased ChREBP beta seems to have a deleterious metabolic effect on BAT.

Design and method:

Sprague-Dawley male rats, 8 weeks old were fed High Fructose Diet (HFRD) or match regular chow for 6 weeks (n = 8). Body weight (BW) and precise food intake were measured weekly. Brown (peri-aortic and interscapular, PA and IS respectively) and white (mesenteric) AT were collected for further molecular studies.

Results:

HFrD fed rats gain significantly less weight than the control group (from 236±2 to 397±8 vs. 233±2 to 430±9 gr. P<0.05) despite eating an equal food amount (28±1vs.29±1.5 g/rat/week). The expression of uncoupling 1 (UCP1) mRNA, a BAT activation marker, was significantly higher in BAT than in WAT. Fructose consumption increased its BAT expression compared to regular chow. However, the expression of ChREBP and ChREBP beta in BAT was significantly lower in HFrD fed rats.

Conclusions:

In the HFrD rat model of MeS, fructose consumption leads to lesser weight gain for the same caloric intake. This BW difference is accompanied by the activation of BAT in the HFrD group. This paradoxical effect may be regulated by decreased ChREBP/ChREBP beta expression in response to fructose.
THE IMPACT OF OBESITY ON THE CONTROL OF TREATED HYPERTENSIVE PATIENTS
Authors: Hamdani Achref , Bayar Mohamed Fehmi , Ajra Zaineb , Gheni Refaat , Rashikou Lamia , Hmida Riadh Ben , Ounissi Taha , Elhadj Zied Ibn
Published: June 2023

Objective:

Obesity is as a risk factor for hypertension, but there are few studies evaluating its impact on the response to antihypertensive drug and on the control of hypertensive patients. The aim of our study was to determine the effect of obesity on the control of treated hypertension.

Design and method:

We analyzed recordings of ambulatory blood pressure measurement (ABPM) in 84 treated hypertensive patients aged > 18 years, in the cardiology department of Mohamed Taher Maamouri University hospital in Nabeul. Patients were stratified into two groups: obese (Body Mass Index (BMI) >30 kg/m2) and non-obese. Hypertension control is defined by 24-hour ambulatory blood pressure (BP) = < 130/80 mmHg, daytime = < 135/85 mmHg and nighttime = < 120/70 mmHg.

The comparisons of percentages were carried out by the Chi-square test.

Results:

Our Population was composed of 33 obese and 51 non-obese patients. The mean age of our population was 59.37±13.1 years. BMI in obese was significantly higher than in non-obese (34.47±5.4 versus 25.36±2.5; p<0.001). The prevalence of uncontrolled patients was significantly higher in obese patients detected in 24-hour ABPM (75.8% versus 51%; p = 0.039), in daytime ABPM (69.7% versus 41.2%; p = 0.014) and in night-time ABPM (90.9% versus 68.6%; p = 0.018) than in normal weight patients.

Conclusions:

Prevalence of uncontrolled hypertension was higher with higher BMI values. The level of blood pressure control in our sample remains relatively insufficient. To achieve a better control of hypertension, we must insist on therapeutic compliance and on the correction of risk factors, particularly obesity, which is significantly associated with an increase in BP.
APNEA-HYPOPNEA INDEX AND CAROTID ATHEROMATOSIS
Authors: Mateus Sónia , Cavaco Mariana , Rocha Daniela , Carvalho Lucinda , Coelho Patricia , Rodrigues Francisco , Pires Joana
Published: June 2023

Objective:

Verify the relationship between degrees severity of the apnea-hypopnea index and carotid atheromatous disease; identify risk factors in individuals with pathological apnea-hypopnea index and carotid atheromatous disease.

Design and method:

Observational, longitudinal, retrospective and quantitative study of a non-probabilistic convenience sample consisting of 67 adult individuals with diagnosed sleep apnea, submitted to a polysomnographic study and cervical triplex scan, in two years in a district hospital.

Results:

In a sample of 67 individuals, 37 male and 30 female, aged between 35 and 82 years, with an average age of 61.90 ± 12.594 years.

In the degrees severity of the apnea-hypopnea index, it was observed that 14 individuals had mild degree (20.9%), 23 moderate degree (34.3%) and 30 severe degree (44.8%).

One-fifth of the sample (n = 20, 29.9%) had intima-media thickening (>1mm). In the relationship between the intima-media index and the degrees of severity of the apnea-hypopnea index, it was found that of the 20 individuals (29.9%) with thickening, more than half (n = 11, 16.4%) had an severe apnea index - hypopnea. With moderate degree, 6 individuals (9.0%) and mild degree 3 individuals (4.5%) (p = 0.523).

In cervical triplex scan results, 39 individuals (58.2%) had carotid atheromatosis without hemodynamic repercussions, 2 (3%) had severe stenosis and 1 (1.5%) had pre-occlusive stenosis.

From the total number of individuals with atheromatous disease, 25 (37.3%) had a severe apnea - hypopnea index, 17 (25.4%) had a moderate apnea - hypopnea index and 4 (6.0%) had apnea - hypopnea index mild (p = 0.029).

The most frequent risk factor in the 46 individuals with the two pathologies under study were arterial hypertension (n = 36, 53.7%), dyslipidemia (n = 26, 38.8%) and diabetes mellitus (n = 20, 29.8%).

Conclusions:

Individuals with moderate and severe degrees of the apnea-hypopnea index have a significant relationship with the phases of more advanced atheromatous disease, however, there is an increase in the frequency of more severe degrees of the apnea-hypopnea index in individuals with atheromatous disease in the early stages.

The most prevalent risk factors in individuals with sleep apnea and carotid atheromatous pathology are male gender, arterial hypertension, dyslipidemia and diabetes mellitus.
LEGACY OF ARTERIAL HYPERTENSION OF WOMEN WITH A PAST HISTORY OF PREECLAMPSIA
Authors: Ouankou Christian Ngongang , Koubouratou Oumy Aboubacar Hawa , Njonnou Sylvain Raoul Simeni , Kuate Liliane Meufeu , Wandji Boris Kom , Danwe Dieudonne , Tebeu Pierre Marie , Choukem Simeon Pierre
Published: June 2023

Objective:

Preeclampsia increases the longterm risk of cardiovascular disease. Some of the women affected by this condition remain hypertensive after delivery. Hypertensive phenotypes can be detected with ambulatory BP monitoring (ABPM). This study aimed to determine the prevalence of hypertension using ABPM and office measurements.

Design and method:

We conducted a cross- sectional study which included women who delivered between January 2015 and June 2021 and were diagnosed and followed up for preeclampsia in three major obstetrical and gynaecologic units in Yaounde. We excluded from the study all women who had a history of chronic hypertension or a known Cardiopathy. Sociodemographic data and past history were recorded, a physical exam,ecg, an ultrasound and ABPM was performed to all participants.

Results:

101 participants were included. The mean age was 30.56 years. 40.6% of women had hypertension (sustained hypertension, with sometime masked hypertension) with ABPM. Sustained hypertension was most common (26.7%), followed by masked hypertension (11.9%) and white-coat hypertension (2%). With office BP measurement, only 28.7% of women would have been diagnosed hypertensive. 29.8% of women had a disadvantageous dipping pattern. Among those that develop chronic hypertension, 18.8% had LVH at electrocardiography, 7.9% had both LVH and an abnormal left ventricular geometry on ultrasound while in normotensive women 1.9% had LVH at Ecg with 1% having both LVH and abnormal geometry at ultrasound. 20.8% of these women were obese during the follow up compared to 11.9% in the normotensive group. We had 26 patients (25,74%) with severe office hypertension and 32,3% were obeses. The fundus was normal in the majority of cases and we had no signs of neurological deficits or impaired cognition. Renal function was always normal or subnormal. Finally, we had two cases of heart failure.

Conclusions:

Many women affected by preeclampsia remain hypertensive after delivery. Masked hypertension and white-coat hypertension are risk factors for future cardiovascular disease and can only be diagnosed with ABPM. It is important to provide adequate follow-up for these women in order to intervene on the factors leading to this outcome.
GESTATIONAL HYPERTENSION AND PERIPARTUM CARDIOMYOPATHY: EPIDEMIOLOGICAL, CLINICAL AND EVOLUTIONARY PROFILE IN THE REFERENCE HOSPITALS OF YAOUNDE
Authors: Ouankou Christian Ngongang
Published: June 2023

Objective:

peripartum objective (CMPP) is a primary dilated cardiomyopathy responsible for congestive heart failure that occurs during the last two months of pregnancy or during the first five months of postpartum. However, little is known about the data in Cameroon, justifying our descriptive study.

Our main objective was therefore to describe the epidemiological, clinical and progressive symptoms of women with peripartum cardiomyopathy and the influence of gestational hypertension.

Design and method:

We conducted a prospective descriptive study over a six-month period. It was conducted in six referral hospitals in Yaoundé. The study population consisted of pregnant women with dyspnoea and women who had given birth with dyspnoea. All pregnant or postpartum women (from month 32 GA to month 5 postpartum) who had LVEF <45% and/or FS <30% with or without left ventricle dilatation were included. They were placed on treatment with a follow-up over 3 months, where they had a second cardiac ultrasound to highlight the evolutionary profile.

Results:

We recruited 10 patients from 26 women. The mean age was 25.9 years ± 4.9 years. The average parity was 1.6 ± 1.17 (extreme 0-3). Multiparas were the most represented. History of gestational hypertension was the main predisposing factor (50%); followed by multiparity (30%), twin pregnancy and advanced maternal age (20%). Heart failure was the clinical expression in 60% of cases. The echocardiographic regimen described hypokinetic dilated cardiomyopathy (mean LVEDD 61.2 ± 8.6 mm) with mean systolic function of 27.1 ± 10.6%. The main complications were acute pulmonary oedema (60%), thromboembolic events including pulmonary embolism (10%), ischemic stroke (10%) and death (10%). Treatment is mainly based on the use of diuretics, ACE inhibitors, beta-blockers, Aldactone (1/3 of patients) without forgetting anticoagulation performed with Rivaroxaban (n = 4) for some and aspirin (n = 6); and bromocriptine (initiated in 3 patients).

Conclusions:

MPPC is a serious disease because of its (significant morbidity and mortality rate) and its complications, both hemodynamic and thromboembolic.
MATERNAL LEFT VENTRICULAR ADAPTATION IN TWIN PREGNANCY
Authors: Pellegrino Alessio , Toncelli Loira , Pasquini Lucia , Masini Giulia , Mecacci Federico , Pedrizzetti Gianni , Modesti Pietro Amedeo
Published: June 2023

Objective:

During pregnancy, a maternal left ventricular (LV) remodeling occurs to face significant hemodynamic changes. Although twin pregnancy can require greater modifications than in singleton, limited data are currently available. The aim of the study was to longitudinally investigate maternal changes of LV function and compliance in twin pregnancy.

Design and method:

35 uncomplicated twin pregnancy women underwent transthoracic echocardiography at first (T1, 10-15 weeks) and third trimester (T3, 30-35 weeks) of gestation. Left atrial (LA) and LV dimensions, LV volumes, systolic and diastolic function were measured, LV mass was calculated. Speckle-tracking imaging was used to evaluate global longitudinal strain (GLS). Non-invasive pressure-volume curves (PV loops) were reconstructed using a dedicated software.

Results:

Maternal LA and LV dimensions, LV volumes and mass increased from T1 to T3. Ejection fraction and GLS showed no changes between visits. Assessment of diastolic function (at pulsed wave Doppler and tissue Doppler) showed no changes in E/A ratio, while E/e’ ratio was higher at T3. At PV loops analysis, ventricular-arterial coupling (VAC) was stable due to the reduction of both LV end-systolic elastance (Ees) and arterial elastance (Ea). An increase in stroke work was observed. The increase in LV end-diastolic volumes from T1 to T3 with no changes in LV end-diastolic filling pressure suggested enhanced LV cavity compliance (rightward shift of the end-diastolic pressure-volume relationship, EDPVR).

Conclusions:

Maternal heart in uncomplicated twin pregnancy adapts to the increased hemodynamic load with an increase in stroke work and enhancement of LV volumes without altering ventricular filling pressure.
EARLY DETECTION AND TREATMENT OF IMPAIRED GLUCOSE AND HYPERINSULINEMIA IN EARLY PREGNANCY TO PREVENT DIABETES AND CARDIOVASCULAR DISEASE IN ADULTS
Authors: Jain Rajesh , Seshiah Veeraswamy , Chandeshekar Anjalakshi , Shanmugam A , Balaji Vijayam , Geethalakshmi A , K Kalaivani , Dharmarajan P , Meena S , Prabhu Karthiga , Paneerselvam Arunachalam , Bhavatharini N , Saxena Pickee , Yadav Akshama , Chawla Rajeev , Jaggi Shalini , Sharma Puja , Mishra Archana , Agarwal Shally , Tiwari Sadhana
Published: June 2023

Objective:

So far, no attempt has been made the Prevention of Diabetes and CVD in the community. There is a concept that GDM is the mother of Non-Communicable Diseases. Hence, the aim is to decide the glycemia level which predicts the development of GDM.

The suggestion is that HbA1C of more than 5.3 (110mg/dl) during the 10th week of pregnancy predicts GDM. HBA1C 5.7 during pregnancy establishes GDM in Asian ethnicity, and HbA1c measured in the first trimester is helpful for early prediction of GDM.

A blood test performed at the 10th week of pregnancy and if PPBS >110 mg% may help identify a pregnant woman at risk of GDM. Hence in the 8th week itself, PPBS has to be estimated. If the PPBS is >110 mg%, a grace period of two weeks is available to maintain PPBS<110mg% at the 10th week.

Another essential physiology is that at the 11th week, Fetal beta cell insulin secretion starts. If PPBS remains, more than 110 mg% fetal hyperinsulinemia occurs, which is undesirable.

Design and method:

Testing for PPBS at the 8th week with 110mg/dl so that enough time is available before fetal insulin secretion starts in the 11th week. If PPBS more than 110mg/dl in the 8th week, the PPBS should be controlled with MNT and Exercise and, if necessary, with Metformin so that PPBS should be maintained at less than 110mg/dl (99 +/- 10) till the 12th week. At the 16th week, 75gm OGCT (DIPSI Test) should be done to know whether she develops GDM and, if negative, be repeated at the 24th and 32nd weeks.

Points to Remember:PPBS more than 110mg/dl around the 10th week predicts GDM Fetal Beta Cell starts secreting insulin in the 11th week. The maternal PPBS should be less than 110mg/dl till the 12th week.

Results:

The Pregnant woman is unlikely to develop Gestational Diabetes if 2-hour PPBS around the 10th Week is less than <110 mg/dl with MNT or Metformin

Conclusions:

Early Pregnancy hyperglycemia at 8th Weeks detection and treatment may prevent future Diabetes and NCDs especially CVD.
DEVELOPMENT OF A MULTIANALYTE MASS SPECTROMETRY METHOD FOR QUANTITATION OF ANTIHYPERTENSIVES IN MILK
Authors: Bernieh Dennis , Larwood Louise Ann , Gill Henry , Lane Dan , Jones Don , Gupta Pankaj
Published: June 2023

Objective:

Hypertension in pregnancy is common and affects about 10% of women. One third of cases persist into the postnatal period requiring treatment with antihypertensive medications to control blood pressure. However, there is a lack of quality evidence to quantify the transfer of antihypertensives into human milk and to therefore recommend their safe use during breastfeeding. Current reviews on this subject are opinion driven or formed upon recommendations from expert working groups based on anecdotal case reports. No antihypertensives are licensed for use during breastfeeding in the UK and many have not been tested during pregnancy or breastfeeding.

Design and method:

A multi-marker liquid chromatography coupled with triple quadrupole mass spectrometry (LC-MS/MS) assay was developed and optimised to simultaneously quantify 24 antihypertensives and their metabolites (enalapril (and enalaprilat), lisinopril, perindopril, ramipril (and ramiprilat), trandolaprilat, azilsartan, candesartan, irbesartan, olmesartan, telmisartan, valsartan, atenolol, bisoprolol, carvedilol, labetalol, metoprolol, propranolol amlodipine, diltiazem, dehydronifedipine, eplerenone and bumetanide) in milk.

Whole, unpasteurised cow's milk was used as surrogate matrix for method development. Analytes were extracted from milk by protein precipitation. Chromatographic analyses were performed on an Agilent Technologies Zorbax Rapid Resolution C18 column using gradient elution. Identification and quantitation were carried out using electrospray ionisation (positive) on an Agilent Technologies 6410 Triple Quad Mass Spectrometer by monitoring specific precursor and fragment ions in multiple reaction monitoring mode using internal standards. The “Standard Practices for Method Validation in Forensic Toxicology” criteria was used for validation.

Results:

The method passed validation with accuracy (relative error) and precision (coefficient of variation) values were within the pre-defined limits of < or = 15% at all tested concentrations for the analytes. The assay sensitivity of 10ng/ml was sufficient to detect the analytes in milk.

Conclusions:

To the best of our knowledge, this is the first assay that permits simultaneous quantitation of 24 commonly prescribed antihypertensives and their metabolites from milk to enable safe use in breastfeeding. The results could be used to guide research on which antihypertensives are safe to use whilst breastfeeding and which require an abstinence period prior to continuation of breastfeeding.
ASSOCIATION BETWEEN A HISTORY OF CHRONIC DISEASES AND AMBULANCE USE AT THE ONSET AMONG FIRST-EVER STROKE PATIENTS. THE SHIGA STROKE AND HEART ATTACK REGISTRY STUDY
Authors: Kiyohara Maiko , Miyamatsu Naomi , Harada Akiko , Takashima Naoyuki , Tanaka-Mizuno Sachiko , Tsuji Atsushi , Urushitani Makoto , Nakagawa Yoshihisa , Miura Katsuyuki , Nozaki Kazuhiko
Published: June 2023

Objective:

It is essential to immediately call an ambulance and visit the medical institution specializing stroke. This study aimed to examine the differences in ambulance utilization at the onset of stroke, depending on the pre-stroke history of hypertension, diabetes, dyslipidemia, and atrial fibrillation.

Design and method:

First-ever stroke patients over 20 years old enrolled in part of the Shiga Stroke and Heart Attack Registry, the Shiga Stroke Registry from January 1 to December 31, 2011, were analyzed. A logistic regression analysis was performed using the presence or absence of a history of each disease (hypertension, diabetes, dyslipidemia, atrial fibrillation), the independent variable (with the no history group as the reference group), and ambulance use at the onset of stroke as the dependent variable, and odds ratios (ORs) and 95% confidence intervals (95%Cis) for ambulance use in the no history group as the reference group was calculated.

Results:

Of the 2054 first-ever stroke patients analyzed, 1212 (59.0%) used an ambulance. The prevalence of each disease (percentage of patients who used an ambulance according to whether they had the disease or not, %) was 45.5% for hypertension (56.3%, 61.3%), diabetes 14.0% (46.7%, 61.0%), dyslipidemia 12.5% (51.0%, 60.2%), and atrial fibrillation 7.3% (68.5%, 58.3%). The multivariate-adjusted odds ratios and 95% confidence intervals for ambulance use at the onset of stroke for each disease were hypertension (ORs and 95% CI: 0.91, 0.73-1.12), diabetes (0.61, 0.45-0.81), and dyslipidemia. (0.90, 0.66-1.21) and atrial fibrillation (1.35, 0.89-2.04).

Conclusions:

From this regional stroke registry survey, it was not observed that patients with a history of hypertension, diabetes, dyslipidemia, and atrial fibrillation tend to use an ambulance at the onset of a stroke compared with those without it. Our study indicated that patient education regarding appropriate reaction/ response at the stroke onset might not be efficient among patients with chronic diseases, including hypertension. In addition to the information for primary disease control, information on the importance of requesting an ambulance at the onset of a stroke should be provided.
ANGIOTENSIN II INDUCES MITOCHONDRIAL OXIDATIVE STRESS IN PODOCYTE
Authors: Ha Tae Sun
Published: June 2023

Objective:

Oxidative stress induced by non-hemodynamic effects of angiotensin II in podocyte participates in the development of glomerular injury and proteinuria. We studied the pathophysiologic roles of oxidative stress in angiotensin II-induced podocyte apoptosis.

Design and method:

Mouse podocytes were incubated in media containing various concentrations of angiotensin II and at different incubation times and transfected by Nox4 or negative control scrambled siRNA for 24 h. The changes of the intracellular and mitochondrial ROS production were measured using respective assays and observed by confocal imaging and western blotting according to the presence of angiotensin II.

Results:

Angiotensin II increased NADH/NADPH oxidase 4 protein and expression in a transcriptional mechanism that was also reversed by probucol. In addition, the suppression of NADH/NADPH oxidase 4 by siRNA reduced the oxidative stress induced by angiotensin II. Angiotensin II also significantly increased the generation of superoxide anions and suppressed the superoxide dismutase (SOD) activity that were significantly recovered with probucol. Furthermore, angiotensin II increased the intracellular ROS levels in dose- and time-dependent manners that were also recovered with probucol.

The quantitative data of MitoSOX index demonstrated that mitochondrial superoxide production was significantly higher in angiotensin II -treated condition compared with that in untreated conditions with or without probucol at 24 h. When angiotensin II increased mitochondrial superoxide production by more than 2-fold, it was significantly recovered with probucol. We also found that cytoplasmic 8-oxo-dG immunoreactivity was significantly increased in angiotensin II -treated condition by 2-fold compared with that in untreated conditions with or without probucol at 24 h that was significantly recovered with probucol.

Conclusions:

Our findings suggest that angiotensin II increased the generation of mitochondrial superoxide anions and ROS levels via the downregulation of the SOD activity and via the upregulation of NADH/NADPH oxidase 4 that were reversed by an antioxidant, probucol.
RESISTANT HYPERTENSION AS A RISK FACTOR FOR CARDIOVASCULAR EVENTS IN PATIENTS WITH HYPERTENSIVE CRISES AFTER 12-MONTH FOLLOW-UP: A GREEK REGISTRY
Authors: Fragoulis Christos , Thomopoulos Costas , Polyzos Dimitrios , Mavroudis Andreas , Tsioufis Panagiotis , Leontsinis Ioannis , Sakalidis Athanasios , Mantzouranis Emmanouil , Kouremeti Maria , Drogkaris Sotirios , Tatakis Fotis , Kachrimanidis Ioannis , Vlachakis Panayotis K. , Manta Eleni , Siafi Eirini , Dimitriadis Kyriakos , Konstantinidis Dimitrios , Tsioufis Konstantinos
Published: June 2023

Objective:

Currently, evidence on the prognosis of patients with hypertensive crises (HC) and resistant hypertension (RH) is limited. The purpose of our study was to register the prevalence, and clinical phenotype of patients with HC admitted to the emergency department (ED) and a 12-month follow-up to record cardiovascular outcomes in a Greek tertiary hospital.

Design and method:

The study population included patients visiting the ED with acute an increase in blood pressure (BP) (systolic BP > or = 180mmHg and/or diastolic BP > or = 120mmHg). HC patients were classified as hypertensive emergencies or urgencies depending on the presence or absence of acute hypertension-mediated organ damage, respectively. In all patients, the baseline characteristics were registered for 12 consecutive months. After stratification of the HC population by RH (excluding non-adherence to medication as a cause for HC), we created two subgroups, those with and without RH. Finally, we compared outcomes (composite endpoint of deaths or hospitalizations from cardiovascular causes) by RH during a 12-month follow-up.

Results:

Out of 38,589 patients assessed in the ED, 353(0.91%) had HC, of whom 256 had hypertensive urgencies, and 97 had emergencies. The clinical status of 81 patients was not available during follow-up. The mean age of the remaining HC patients was 68±13 years, 49.6% were males, and 80.3% had a history of hypertension (58 patients had RH). More patients with RH had composite events (27.6% vs. 12.8%, p<0.001), deaths (10.3% vs. 0.6%, p = 0.002), and hospitalizations (27.6% vs. 12.1%, p<0.001) from a cardiovascular cause. RH vs. non-RH phenotype was associated with OR 1.437 (95% CI 1.006-2.012) after adjustment for confounders.

Conclusions:

RH is an independent risk factor of increased cardiovascular risk in patients with HC.