bluuebunny/crossref_metadata_2025 huggingface dataset:
EXTRACORONARY VASCULAR ABNORMALITIES IN SPONTANEOUS CORONARY ARTERY DISSECTION: PREVALENCE, CHARACTERISTICS, AND CLINICAL IMPLICATIONS
Authors: Nowicki Michal , Zalewska Joanna , Talarowska Paulina , Michalowska Ilona , Golebiewski Slawomir , Wojtkowska Izabela , Suminski Andrzej , Socko Gabriela , Januszewicz Andrzej , Witkowski Adam , Kadziela Jacek
Published: May 2024

Objective:

This study assesses the prevalence and characteristics of extracoronary vascular abnormalities (EVA) in patients with spontaneous coronary artery dissection (SCAD), a distinct form of acute coronary syndrome primarily affecting younger women. EVA include conditions like fibromuscular dysplasia (FMD) and aneurysms in non-coronary vessels.

Design and method:

A cohort of 87 patients (97.7% female, average age 44.5±9.1 years) with a history of SCAD enrolled in the SCAD-POL Registry was analyzed. The study included comprehensive reviews of medical records and angiographic imagery. All participants underwent head-to-pelvis computed tomography angiography for FMD and aneurysm screening, with EVA defined as the presence of any of these conditions in any vascular bed.

Results:

EVA was identified in 49.4% of the cohort, with 37.9% diagnosed with FMD and 23% with aneurysms. A minority (5.8%) presented with both conditions. FMD predominantly affected renal (23%) and cervical arteries (18.4%), while aneurysms were most prevalent in cervical (9.2%), intracranial and splenic arteries (6.9% each), with renal arteries less affected (5.7%). The EVA and non-EVA groups showed no significant laboratory differences. Concerning medical history, diabetes mellitus appeared in 1.2% EVA patient versus 5.8% non-EVA patients (p>0.05). Hyperlipidemia was noted in 20.9% EVA and 18.2% non-EVA patients (p>0.05). Hypertension was non-significantly more common in EVA patients (41.9% vs 29.5%, p=>0.05).

Treatment modalities, including conservative management, percutaneous coronary intervention, and coronary artery bypass grafting, showed no significant differences between the groups. SCAD characteristics and outcomes, like left ventricular ejection fraction (LVEF) at discharge and recurrence rates, were similar (53.7% LVEF in EVA vs. 52.4% in non-EVA; with 2 recurrences in each group).

Conclusions:

This study reveals a significant prevalence of EVA in SCAD patients, with aneurysms being more common than previously reported. These findings emphasize the need for comprehensive vascular assessment in SCAD patients, considering the variable prevalence of FMD, aneurysms. This study contributes to a deeper understanding of EVA in SCAD, potentially influencing clinical management strategies.
ARGININE METABOLISM AND ARTERIAL STIFFNESS IN HIGHLANDERS WITH HIGH ALTITUDE POLYCYTHEMIA
Authors: Li Yanan , Chen Xiaoping
Published: May 2024

Objective:

High altitude polycythemia (HAPC) is a health condition associated with hypoxemia and erythrocytosis. Patients with chronic hypoxemia often exhibit arterial stiffness. In the advanced stages of HAPC, patients can present changes in the pulmonary circulation, but limited information exists regarding arterial stiffness. Our study aims to investigate the relationship between HAPC and arterial stiffness, and explore the underlying mechanisms.

Design and method:

At an altitude of 3500m, we conducted a study examining arterial stiffness and vascular endothelial function in two groups of hypertensive highlanders with and without HAPC, each consisting of 30 participants. Plasma samples were measured using Ultra Performance Liquid Chromatography Tandem Mass Spectroscopy.

Results:

Hypertensive highlanders with HAPC exhibited notable vascular dysfunction, as indicated by significantly impaired flow-mediated dilation (FMD) (3.97±1.21% vs. 6.82±1.46%, P < 0.001), and higher brachial-ankle pulse wave velocity (BaPWV) (1556±239 cm/s vs. 1890±459 cm/s, P < 0.001). Metabolomics analysis revealed alterations in arginine/proline metabolism and the arginine biosynthesis pathway, involving L-arginine, L-ornithine, creatine and 4-guanidinobutanoic acid. The area under the curve (AUC) values for 4 metabolites and L-arginine/L-ornithine ratio were 0.753, 0.782, 0.720, 0.717 and 0.819, respectively. Pearson correlation analysis showed that L-arginine, L-ornithine, and L-arginine/L-ornithine ratio were associated with BaPWV (r=-0.4486, P=0.00032; r=0.3400, P=0.0078; r=0.3921, P=0.0019). L-arginine, L-ornithine, 4-guanidinobutanoic acid, creatine, and L-arginine/L-ornithine ratio were correlated with FMD. Multiple linear regression analysis revealed that L-arginine and L-arginine/L-ornithine ratio were independently correlated with BaPWV (beta= -0.370, t=-3.114, P=0.003; beta=-0.268, t=-2.211, P=0.032) and FMD (beta=0.434, t=3.114, P=0.003; beta= 0.457, t=3.445, P=0.001), but L-ornithine was not independently related to BaPWV and FMD.

Conclusions:

Our study indicates that HAPC may accelerate the progression of arterial stiffness in hypertensive patients. In fact, L-arginine takes an important role in the forming of NO in vascular endothelium. So The disorder of arginine metabolism may serve as the underlying metabolic mechanism.
HIGH ESTIMATED PULSE WAVE VELOCITY IS ASSOCIATED WITH EXAGGERATED BLOOD PRESSURE RESPONSE IN YOUNG AND MIDDLE-AGED ADULTS
Authors: Huang Gang , Xu Junbo , Wang Tianbo , Liu Xiaohan , Zhang Zhen , Wu Jin
Published: May 2024

Objective:

Estimated pulse wave velocity (ePWV) may be a simple alternative to carotid to femoral pulse wave velocity, which is currently considered as the gold-standard measure of aortic stiffness. This study aimed to investigate the relationship between ePWV and exaggerated blood pressure response (EBPR) during exercise test in young and middle-aged population.

Design and method:

This study enrolled 2,884 adults between the ages of 20-49 years from the National Health and Nutrition Examination Survey (1999-2004). ePWV was calculated by using a regression equation for age and mean blood pressure (MBP). EBPR was defined as systolic peak blood pressure >210 mmHg in men, >190 mmHg in women. Multivariate logistic regression model was constructed to explore the associations between ePWV and EBPR. The potential nonlinear correlations were explored using restricted cubic spline, and a two-piecewise logistic regression model for both sides of the a two-piecewise logistic regression model for both sides of the inflection point was constructed was conducted.

Results:

Totally, 224 (7.4%) individuals among 2,884 participants had EBPR. After adjusting for age, sex, race/ethnicity, education, smoking, drinking, physical activity, body mass index, and history of hypertension, diabetes, hyperlipidaemia and chronic kidney disease, multivariable logistic regression analysis has revealed that the risk of EBPR increased 1.3-fold (OR: 2.32,95%CI: 1.58-3.40, p<0.001) as the ePWV increased every one meter per second. Subgroup analyses have found that this association was more obviously in individuals with current drinking(OR: 2.81, 95%CI:1.87-4.24, p<0.001) or without physical activity (OR: 2.45, 95%CI:1.63-3.70, p<0.001). The restricted cubic spline has revealed a nonlinear association between ePWV and EBPR. Moreover, two-piecewise logistic regression analysis has further found that the ePWV value lower than the inflection point (<=6.04) was not associated with the increase of EBPR (OR: 3.52, 95%CI: 0.18-69.85, p=0.388). In contrast, the ePWV value higher than the inflection point (>6.04) was significantly associated with the increase of EBPR (OR: 2.35, 95%CI: 1.50-3.68, p< 0.001).

Conclusions:

Higher ePWV is positively associated with EBPR in young and middle-aged population of United States,especially in individuals with current drinking or without physical activity.
SELECTED ECHOCARDIOGRAPHIC AND BLOOD PRESSURE PARAMETERS INCLUDING VENTRICULAR-ARTERIAL COUPLING IN PREDICTING ATRIAL FIBRILLATION RECURRENCE AFTER PULMONARY VEIN ISOLATION
Authors: Gaczol Mateusz , Olszanecka Agnieszka , Bednarek Agnieszka , Kusiak Aleksander , Kielbasa Grzegorz , Moskal Pawel , Jastrzebski Marek , Sondej Tomasz , Stolarz-skrzypek Katarzyna , Rajzer Marek , Wojciechowska Wiktoria
Published: May 2024

Objective:

Ventricular–arterial coupling (VAC) plays a pivotal role in cardiac and aortic adaptation to pathophysiological conditions. The aim of the study was to evaluate whether VAC features have an impact on the atrial fibrillation (AF) recurrence after the pulmonary vein isolation (PVI) procedure.

Design and method:

The study included patients who were admitted for elective PVI and met the following criteria: aged 40 to 75 years, without established cardiovascular diseases, with paroxysmal atrial fibrillation (AF) and sinus rhythm on admission, preserved left ventricular (LV) ejection fraction and normal carotid-femoral pulse wave velocity (PWV). Clinical and echocardiographic data were collected at baseline and follow-up visit. The following VAC parameters were analysed: arterial elastance (Ea) and left ventricular elastance (Ees) calculated as the ratio of end-systolic pressure to stroke volume and end-systolic pressure to end-systolic volume, respectively. Two-dimensional speckle tracking was used to derive left ventricular global longitudinal strain (LV GLS), and then the ratio of PWV to LV GLS was calculated.

Results:

49 patients (mean age 57.9 years) who had undergone their first PVI, after mean 13.0±2.5-month follow-up, reported engaging in more regular physical activity, experiencing EHRA class improvement (p=0.001), and using antiarrhythmic drugs less frequently (p=0.003). They had lower NT-proBNP level while blood pressure remained within normal range throughout the observation period. Following PVI, there was a decrease in LV end-diastolic (p=0.002) and end-systolic (p=0.003) volumes, as well as a decrease in left atrial volume indexed to body surface area (LAVI) (41 vs 37.6 (ml/m2); p=0.012). Additionally, there was an increase in the following: LV GLS (p=0.036), Ea (p=0.021) and Ees (p=0.002). During the study follow-up, 24.5% of patients experienced AF recurrence. In a multivariable adjusted model, only higher baseline LAVI predicts AF recurrence.

Conclusions:

Left atrial enlargement was found to be the independent predictor of PVI efficacy. Significant changes in VAC parameters at stable level of blood pressure were observed at one-year follow-up after the ablation procedure. However, further study is required to determine whether VAC is suitable for predicting the efficacy of AF ablation.
ALDOSTERONE MIGHT BE AN INITIATING FACTOR AND INTERVENTION TARGET IN AORTIC ANEURYSM AND AORTIC DISSECTION
Authors: Dang Yujie , Li Nanfang , Zhu Qing , Wu Ting , Wang Menghui , Yuan Yujuan , Zhang Xin , Shen Di , Yang Mei , Hong Jing , Zhang Delian
Published: May 2024

Objective:

Previously, we demonstrated that aldosterone (ALD) is associated with aortic aneurysm (AA) or aortic dissection (AD). However, the underlying pathological mechanisms for ALD triggering AA or AD remain elusive. Furthermore, whether ALD antagonists are potential targeted drugs remains unclear.

Design and method:

Nine-month-old male C57BL/6J mice received ALD and salt for 4 weeks for AA/AD modeling. The ALD antagonist treatment group received spironolactone or finerenone by gavage the morning after ALD osmotic minipump implantation. Immunofluorescence and enzyme-linked immunosorbent assay were performed to evaluate ALD function in AA/AD.

Results:

The ALD-induced AA/AD specimens had significantly upregulated inflammatory markers (ICAM-1, macrophage-derived LGMN) and oxidative stress marker (ROS) levels compared to healthy aortic tissues. Furthermore, the ALD-induced AA/AD model had significantly upregulated extracellular matrix (ECM) marker (MMP-2) levels. The aortas and plasma of ALD-induced AA and AD mice had reduced vascular smooth muscle (VSMC) contractile markers (CNN1 etc). The ALD antagonist reversed this result.μ

Conclusions:

This study addressed ALD participation in the main and important pathophysiology mechanisms of AA/AD, including inflammation, oxidative stress, VSMC phenotypic transformation, and ECM degradation. ALD might be the initiating factor for AA/AD and a new intervention target.
INTERCELLULAR COMMUNICATION IN THE VASCULAR WALL THROUGH EXOSOMES: A FOCUS ON ENDOTHELIAL-SMOOTH MUSCLE INTERACTION IN HYPERTENSION
Authors: Brewster Lizzy , Perrotta Ida , Taherzadeh Zhila , Van Montfrans Gert
Published: May 2024

Objective:

Extracellular vesicles are increasingly recognized to be central in intercellular communication, delivering messages through their content, including DNA, RNAs, proteins, and lipids, expelled particularly under cellular activation or stress. While microparticles are 100-1000 nm in size and bud of the cytoplasmic membrane, exosomes are distinct nano-sized particles (<100 nm) originating from intracellular multivesicular bodies via exocytosis. These structures are increasingly recognized to regulate biological processes including vascular repair and angiogenesis, and are seen as targets for therapeutic interventions, but their role in hypertension is little understood.

We previously showed that hypertension is associated with loss of myofibrils and migration of smooth muscle cells (SMCs) towards and across the intima of the vascular wall. Cell-to-cell communication is thought to be essential in orchestrating these functional and structural adaptions to mechano or other stresses of the vessel wall. Therefore, we analyzed the differences in exosomes in the vessel wall of resistance-sized arteries from normotensive vs hypertensive patients.

Design and method:

We assessed with transmission electron microscopy the ultrastructure of resistance-sized arteries (200-400 μm), isolated from omental samples obtained during fibroid surgery from 17 women (8 hypertensive), mean age 42 y (SE 1).

Results:

Endothelial cells (ECs) and SMCs from normotensives showed few multivesicular bodies (MVBs; (mean 0.45 (0.6) per cell) containing on average 5.0 (0.7) exosomes/MVB. The number of MVBs and exosomes progressively increased with blood pressure increase, in both ECs and SMCs, to a mean of 5 MVBs (0.9)/cell) and 8.8 (1.1) exosomes/MVB in hypertensive patients (a 20-fold increase in exosomes/cell), displaying a prominent basal (abluminal) location in ECs of hypertensives (Figure).

Conclusions:

Our study demonstrates that blood pressure increase is associated with intensified intercellular communication in resistance arteries. The increases in MVBs and exosomes at the abluminal side of the endothelium suggest a possible autocrine and paracrine role in mediating EC-to-SMC communication during vascular remodeling. Exosomes released just beneath the endothelial layer can be internalized by SMCs, transferring bioactive materials that may affect SMC phenotype and function. Our study might inform further studies on intercellular communication in the vascular wall with increasing blood pressure.
AMYLOID-BETA 40 ADVERSELY INFLUENCES LARGE ARTERY STIFFNESS AND CUTANEOUS MICROVASCULAR FUNCTION IN OLDER ADULTS WITH DIVERSE CARDIOVASCULAR RISK
Authors: Aizawa Kunihiko , Casanova Francesco , Gooding Kim M , Gates Phillip E , Strain W David , Shore Angela C , Tuharska Zofia , Meakin Paul J , Ashford Michael Lj , Khan Faisel
Published: May 2024

Objective:

Amyloid-beta (Aβ) peptides are considered to play a prominent role in Alzheimer's disease, but emerging experimental and clinical observations link Aβ40 with adverse extracerebral vascular manifestations and cardiovascular disease events. However, it is unclear if Aβ40 adversely influences both large artery stiffness and cutaneous microvascular function in humans. We sought to determine whether Aβ40 was associated with large artery stiffness and cutaneous microvascular function in older adults with diverse cardiovascular risk.

Design and method:

This cross-sectional study analysed data from 610 older adults (65.7±8.7 yrs, 242F). Large artery stiffness was assessed by carotid-femoral pulse wave velocity (CFPWV) using a SphygmoCor device, and cutaneous microvascular function was assessed by measuring acetylcholine (endothelium-dependent) and sodium nitroprusside (endothelium-independent) responses following iontophoresis. Plasma Aβ40 concentration was measured using a human Aβ40 assay kit (Simoa Human A β40).

Results:

One standard deviation increase in Aβ40 was significantly associated with 0.74 (0.52, 0.96) m/s greater CFPWV in an age- and sex-adjusted model (Model-1, p<0.001), which remained significant after further adjustments for conventional cardiovascular disease risk factors [Model-2, 0.46 (0.26, 0.66) m/s, p<0.001]. Additionally, one standard deviation increase in Aβ40 was significantly associated with lower cutaneous acetylcholine [-27.3 (-38.9, -15.7) au] and sodium nitroprusside [-27.0 (-38.1, -15.9) au] responses in Model-1 (both p<0.001). Further adjustments for conventional cardiovascular disease risk factors did not modify the inverse association [Model-2, acetylcholine response, -20.7 (-32.5, -8.8) au: sodium nitroprusside response, -21.1 (-32.3, -9.9) au: both p<0.001]. Subgroup analyses found an indication of interaction effect whereby female sex influenced more on the association between Aβ40 and CFPWV, and type 2 diabetes influenced more on the association between Aβ40 and cutaneous acetylcholine responses (both p<0.05).

Conclusions:

Aβ40 was associated with increased large artery stiffness and decreased cutaneous microvascular function in older adults with diverse cardiovascular risk. These findings suggest a potential mechanistic link between Aβ40 deposition in the systemic circulation and previously observed adverse cardiovascular disease outcomes.
CORRELATION BETWEEN RETINAL MICROCIRCULATION, ECHOCARDIOGRAPHIC PARAMETERS AND MYOCARDIAL CORONARY FLOW RESERVE
Authors: Rosei Claudia Agabiti , Muzi Giorgia , De Ciuceis Carolina , Bressa Stefano , Cherubini Fabio , Rossini Claudia , Petroboni Beatrice , Stassaldi Deborah , Capellini Sara , Bertacchini Fabio , Bertoli Mattia , Cerudelli Elisabetta , Salvetti Massimo , Paini Anna , Buso Giacomo , Rosei Enrico Agabiti , Bertagna Francesco , Muiesan Maria Lorenza
Published: May 2024

Objective:

Arterial hypertension causes cardiac functional and structural alterations. In hypertensive patients without flow-limiting epicardial coronary artery disease, we investigated the possible relationship between retinal microcirculation, positron emission tomography myocardial blood flow (MBF) and echocardiographic parameters of left ventricular (LV) performance, including mechano-energetic efficiency indexed for myocardial mass (MEEi)

Design and method:

Nineteen hypertensive patients (mean age 65 ± 11, 10 F) without flow-limiting epicardial coronary artery disease underwent patients wall-to-lumen ratio (WLR) and the cross-sectional area of the vascular wall (WCSA) of retinal arterioles by an Adaptive Optics (AO) retinal camera, echocardiography, including MEEi computation, and cardiac 13NH3 positron emission tomography (13NH3 PET) with assessment of myocardial coronary flow reserve (CFR). A positive 13NH3 PET was defined as a ratio of stress (regadenoson) myocardial blood flow (MBF)/mass and resting MBF/mass lower than 2.

Results:

No significant differences of demographic parameters were observed between patients with positive (n=6) vs negative (n=13) 13NH3 PET. In all patients WLR was significantly related to BMI (0,50, p=0.02), age (r=0.49, p=0.03)and LVMi (r=0.48, p=0.03) at univariate analysis. A negative correlation was also observed between WLR and total CFR (-0.64, p=0.003) and MMEi (-0.35, p=0.13). The relationship between WLR and CFR remained significant after adjustment for age and BMI (r=-0.49, p=0.047).

Conclusions:

In hypertensive patients without flow-limiting epicardial coronary artery disease, retinal WLR could reflect the presence of structural alterations in coronary microcirculation, possibly contributing to an impairment of CFR and to early LV dysfunction, as detected by low values of MEEi.
HIGH-INTENSITY INTERVAL TRAINING DOES NOT AFFECT THE EXPRESSION OF ENDOTHELIAL GENES IN SPONTANEOUSLY HYPERTENSIVE RAT
Authors: Pacagnelli Francis , Camillo Helen Louisi , Ferreira Natália Zamberla , Freitas Ananda Brito , Carvallho Ana Paula Fleury , Okoshi Katashi , Giometti Ines Cristina , Freire Paula Paccielli , Carvalho Robson Francisco , Aguiar Andreo Fernando , Gomes Mariana Janini , Vechetti Ivan J
Published: May 2024

Objective:

Hypertension and the aging process result in changes to the endothelial-related muscular system that may negatively impact exercise capacity. Research has shown that high-intensity interval training(HIIT) may be beneficial for individuals with hypertension.However, there are currently no studies that compare the effects of this type of exercise on endothelial markers in the skeletal muscles of aging rats.In order to examine the effects of HIIT on muscular microcirculation markers in hypertension, we assessed the genes encoding proteins related to vasomotor function (NOS3 and ET-1) and angiogenesis (VEGF and PIK3R2) in the soleus and diaphragm muscles of old spontaneously hypertensive rats. To corroborate our results, we analyzed the expression of these genes in samples from individuals who participated in HIIT for 6 weeks (GSE 109657).

Design and method:

Male 12-month-old spontaneously hypertensive rats were randomly assigned to either a sedentary group (n=10) or a high-intensity interval training (HIIT) group (n=10). The HIIT group underwent training on a rodent treadmill for 50 minutes per day, five times per week, for a period of eight weeks. Systolic blood pressure (SBP), functional capacity, and expression of endothelial gene-encoding proteins associated with NOS3, ET-1, VEGF, and PIK3R2 were analyzed. We retrieved a transcriptomic dataset (GSE109657) of human muscle biopsies collected from the vastus lateralis pre- and post-HIIT (a total of 22 samples, 11 pre-HIIT and 11 post-HIIT) for differential expression analysis. The relative expressions of NOS3, PIK3R2, VEGF were displayed through a heatmap using the MORPHEUS tool. In this dataset, ET-1 expression was not detected thus, we only represented the ET-2 transcriptional variant in the heatmap

Results:

Our findings indicated that that 8-week of HIIT led to a statistically significant reduction in SBP (p=0.001) and improvement in functional capacity (p<0.001) without affecting the expression of NOS3, PIK3R2, VEGF, or ET-1 in the soleus and diaphragm muscles. Additionally, our reanalysis of vastus lateralis muscle biopsy revealed no differences in the genes of interest, corroborating our results.

Conclusions:

These findings suggest that 8-week of HIIT may promote decreased arterial pressure and enhanced physical condition without interfering with the expression of mRNA-encoding vasomotor and angiogenic factors in different skeletal muscles.
IMPACT OF MODERATE TO VIGOROUS PHYSICAL ACTIVITY ON SYSTEMIC VASCULAR RESISTANCE IN RECENTLY DIAGNOSED TYPE 2 DIABETES: A CROSS-SECTIONAL STUDY
Authors: Olesen Thomas , Vo Son , Stidsen Jacob , Hojlund Kurt , Olsen Michael
Published: May 2024

Objective:

To investigate if moderate to vigorous physical activity (MVPA) was negatively associated with high systemic vascular resistance (SVR) among adults with Type 2 Diabetes (T2DM). Additionally, we assessed associations between other cardiometabolic risk factors and SVR.

Design and method:

We estimated cross-sectional associations between MVPA and SVR and other selected risk factors and SVR using logistic multivariate regression models. SVR was assessed using thoracic electrical bioimpedance; high SVR was defined as 20% above normal. MVPA was calculated using accelerometer data. Insulin resistance was assessed using the Homeostasis Model Assessment 2-Insulin Resistance (HOMA2-IR). Results from adjusted analyses controlled for age, sex, MAP, BMI, HOMA2-IR, medication, and smoking are reported

Results:

The study population consisted of 824 adults (mean age = 61.6 years) with recently diagnosed T2DM (mean diabetes duration = 3.6 years). 41% were females. Median MVPA was 10.7 minutes/day, and 50.5% had high SVR.

Increments of 14.4 min/day in MVPA were independently associated with a lower risk of high SVR (OR=0.69, [0.57;0.83]). Other main determinants of high SVR were female sex (OR=2.06, [1.49;2.86]), BMI and HOMA2-IR in increments of 6.16 kg/m2(OR=2.20, [1.76;2.73]) and 1.79(OR=2.33, [1.09;4.96]), respectively. BMI had a notably greater impact on explained variability of SVR than MVPA when comparing the coefficient of determination (pseudo-R2, 35.0% vs. 7.9%).

Conclusions:

Increased levels of MVPA are associated with a reduced risk of high SVR, although BMI appears to have a more pronounced effect on SVR. MVPA could serve a dual purpose in managing both SVR and promoting weight loss in T2DM.
EPIDEMIOLOGY AND ASSOCIATED RISK FACTORS OF ISCHEMIC STROKE TREATED AT THE UNIVERSITY HOSPITAL CENTER OF TLEMCEN (ALGERIA)
Authors: Abdrebbi Samira Benbekhti
Published: May 2024

Objective:

Determine the epidemiological profile of ischemic strokes treated at the University Hospital center of Tlemcen and describe the associated risk factors.

Design and method:

Descriptive study with prospective collection, involving patients with ischemic stroke at the University Hospital center of Tlemcen. A questionnaire was administered by interview to patients. The data were entered and analyzed by Epi-info 6 software.

Results:

The study involved 184 patients with ischemic stroke treated at the University hospital center of Tlemcen. A female predominance was noted, affecting 96 women and 88 men (sex ratio (m/f): 0.9). The average age was 63.75±14.34 years; with age extremes of 15 and 93 years. Subjects aged over 65 represented 47.28% of cases. The socio-economic characteristics of the study subjects were: 78.8% of patients were married; 86.4% had a low level of education; 54.3% were unemployed, 18.5% retired and 27.2% civil servants. A low socio-economic level was noted in 67.6% of cases. The associated risk factors were distributed as follows: Hypertension was the major risk factor, found in 114 subjects, or 62% of cases; with an average duration of 05.27± 5.76 years, reaching a maximum of 30 years. Obesity (BMI >30 kg/m2) was found in 27.2% of cases, with an average body mass index (BMI)of 27.1± 4.4 kg/m2 with extremes of [16.8 -39.9]. Diabetes was found in 40 subjects, or 21.73% with average duration: 7.6± 8.8 years; going to a maximum of 35 years. Dyslipidemia: 28%; Tobacco: 26.1%; Heart diseases: 13%. The notion of hypertension in the family was noted in 51.1% of cases.

Conclusions:

Ischemic stroke is the most common neurological disorder. It's causes are multiple and vary in frequency. Primary prevention measures are necessary with management of risk factors, particularly hypertension, regardless of age.Other measures are essential for promoting the management of strokes, among others: the creation of a neurovascular unit dedicated to the management of strokes in an early and adequate manner and the establishment of a register of strokes, locally and nationally;
STATINS PREVENT THE DELETERIOUS CONSEQUENCES OF PLACENTAL CHEMERIN UPREGULATION IN PREECLAMPSIA
Authors: Tan Lunbo , Kluivers Ans C.M. , Cruz-lopez Edwyn O. , Broekhuizen Michelle , Chen Zhongli , Neuman Rugina I. , Schoenmakers Sam , Ruijgrok Liesbeth , Van De Velde Daan , De Winter Brenda C.M. , Van Den Bogaerdt Antoon J. , Lu Xifeng , Danser A.H. Jan , Verdonk Koen
Published: May 2024

Objective:

Chemerin, an inflammatory adipokine, is upregulated in preeclampsia, and its placental overexpression results in preeclampsia-like symptoms in mice. Statins may lower chemerin.

Design and method:

Chemerin levels were determined in a prospective cohort study in women suspected of preeclampsia evaluating the predictive value of the soluble Fms-like tyrosine kinase-1/placental growth factor (sFlt-1/PlGF) ratio. Chemerin release was studied in perfused placentas and placental explants with or without the statins pravastatin and fluvastatin. We also addressed statin placental passage, and the effects of chemerin in chorionic plate and coronary arteries.

Results:

Serum chemerin was elevated in women with preeclampsia, and its addition to a predictive model yielded significant effects on top of the sFlt-1/PlGF ratio to predict preeclampsia and its fetal complications. Perfused placentas and explants of preeclamptic women released more chemerin and sFlt-1 and less PlGF than those of healthy pregnant women. Statins reversed this. Both statins entered the fetal compartment, and pravastatin's fetal/maternal concentration ratio was twice that of fluvastatin. Chemerin constricted plate arteries, and this was blocked by a chemerin receptor antagonist and pravastatin. Chemerin did not potentiate endothelin-1 in chorionic plate or coronary arteries. In explants, statins upregulated low-density lipoprotein receptor (LDLR) expression, which relies on the same transcription factor as chemerin, and NO release.

Conclusions:

Chemerin is a biomarker for preeclampsia, and statins both prevent its placental upregulation and effects, in an NO- and LDLR-dependent manner. Combined with their capacity to improve the sFlt-1/PlGF ratio, this offer an attractive mechanism by which statins may prevent or treat preeclampsia.
GENDER DIFFERENCES IN ARTERIAL STIFFNESS IN YOUNG PATIENTS WITH PRIMARY HYPERTENSION
Authors: Prelevic Vladimir , Jelakovic Ana , Gasparovic Kristina , Bazadona Danira , Radunovic Danilo , Josipovic Josipa , Jelakovic Bojan
Published: May 2024

Objective:

Influence of sex hormones on regulation of arterial stiffness (AS) include different mechanisms where changes in extracellular matrix, smooth and endothelial cells, and influence on oxidative stress and chronic inflammation are highlighted. In women after puberty AS decreases what confirm selective and fluctuating effect of sex hormones, primarly estrogen. In older men, hypogonadism is associated with incresed AS, while testosterone replacement reduce pulse wave velocity (PWV). Our aim was to analyze difference in central hemodynamic parameters between men and women with stage 1 hypertension.

Design and method:

This study included 154 patients with the primary hypertnsion (69.5% women, mean age 38.5). In all of them we collected different data and antroplogical paramaters using medical records. Parameters of AS were measured with the office tonometric system (SphygmoCor) and 24h ambulatory blood pressure monitoring system using Mobil-o-Graph and Arteriograph, but also estimated PWV was calculated using validated equation (ePWV).

Results:

There were no statistically significant gender differences in PWV values measured in the office oCor, measured during 24 hours (using Arteriograph and Mobil-O-Graph), and ePWV. There were no statistically significant gender differences in the values of 24 hours systolic and diastolic central aortic pressure (CAP) (Arteriograph or Mobil-O-Graph). Women had significant higher office CAP Men, on average, had statistically significantly higher amplified pulse pressure (APP) values than women (144.20 vs. 128.94, t = 3.275, p < 0.01), while women had statistically significantly higher office augumentation index (AiX) values (t = -6.118, p < 0.001), as well 24 hours (Mobil- O-Graph (t = -5.940, p < 0.001;Arteriograph (t = -5.580, p < 0.001).

Conclusions:

Possible explanation of no statistically significant differences in PWV values between men and women is average age of our group. A possible gender difference in AiX can be consequence of the increased reflection of pulse waves, which is increased in women. Longitudinal study should be conducted with monitoring of patients at longer time intervals in order to determine the further hormonal influence on structure of the arteries and for the assesment of total CV risk.
INCREASED RISK FOR DEVELOPPING HYPERTENSION IN WOMEN AFTER PREECLAMSIA WITH ESTROGEN CONTAINING ORAL CONTRACEPTIVES
Authors: Polonia Jorge , Silva Jose A , Belchior Helena , Bertoquini Susana
Published: May 2024

Objective:

High cardiovascular risk and hypertension (HT) are common in women with previous preeclampsia (PE). Some women (5%) show an increased risk of HT under hormonal contraceptives containing oestrogens (EC-OC). We retrospectively reevaluated previous data suggesting that women with previous PE were more prone to develop HT while receiving EC-OC after delivery.

Design and method:

We reexamined data from 49 women normotensives before pregnancy but with previous PE (PE-WO and 71 normotensive women (NT-WO) with normal BP levels during last pregnancy. BP of all women were <140/90 at least at 6 months after pregnancy. Diabetic (DM) or gestational diabetic were not included. Then all (ageing 25-38 yrs) received (at baseline) EP-OC. Revaluation was between at 3-4 yrs after.

Results:

At baseline, age was NT-Wo = 25.6 ± 4.3 and PE-Wo = 28.0 ± 4.2 yrs and for BP, NT-Wo = 124.4/77.2 ± 5.1/4.4 and PE-Wo = 125.3/77.6 ± 4.2/4.6 mm Hg (p>0.2 between groups). Under EP-OC, BP was significantly lower in NT-Wo = 125.9/77.3 ± 9.1/6.1 than in PE-Wo = 131.5/83.6 ± 11.7/6.9 mm Hg (p<0.01). After EP-OC, relative risk (RR) (Odds Ratio CI-95%) for developing HT (BP >=140/or 90 mmHg) in PE-Wo (10/49) vs NT-Wo (5/71) was 3.38 (1.08-10.63), p<0.03; RR for increasing systolic BP (SBP) >=15 mm Hg after EP-OC in PE-Wo (9/49) vs NT-Wo (4/71) was 3.38 (1.09-13.04), p<0.03 and RR for increasing >=10 mm Hg SBP after EP-OC in PE-Wo (17/49) vs NT-Wo (11/71) was 2.90 (1.22-6.93), p<0.04.

Conclusions:

Women with previous PE are at a 3.4 fold increased risk for development of HT after estrogenic containing oral contraceptives. Careful BP monitoring and alternative contraceptive methods other than EP-OC should be considered in women after PE while submitted to EP-OC.
NON-INVASIVE ASSESSMENT OF HEMODYNAMIC FORCES AND PRESSURE-VOLUME RELATION ANALYSIS IN TWIN PREGNANCY
Authors: Pellegrino Alessio , Toncelli Loira , Pasquini Lucia , Masini Giulia , Mecacci Federico , Pedrizzetti Gianni , Modesti Pietro Amedeo
Published: May 2024

Objective:

This aim of the study was to prospectively investigate pattern of intraventricular Hemo-Dynamic Forces (HDF) associated with Left Ventricular (LV) function and remodeling in women with uncomplicated twin pregnancy.

Design and method:

Prospective, cohort study. Transthoracic echocardiography was performed on 35 women (aged 35.9±4.7 years) during gestation (<14 w, T1; 14–27 w, T2; >28 w, T3), and 6–7 months after delivery (T0). LV HDF were computed from echocardiography long axis data sets using a novel technique based on endocardial boundary tracking, both in apex-base (A-B) and latero-septal (L-S) directions. HDF distribution was evaluated by L-S over A-B HDF ratio (L-S/A-B HDF ratio).

Results:

At T1, L-S/A-B HDF ratio was higher than in T0 (p<0.05) indicating HDF misalignment. At T2, a slight impairment of cardiac function was then recorded with a reduction of Global Longitudinal Strain (GLS) and left ventricular End-Systolic Elastance (Ees) at pressure-volume relationship analysis versus T1 (both p<0.05). Finally, at T3, when HDF misalignment and LV contractility reduction (GLS and Ees) were all restored, a rightward shift of the End Diastolic Pressure-Volume Relationship (EDPVR) with an increase of ventricular capacitance were documented.

Conclusions:

In twin pregnancy, HDF misalignment in the first trimester precedes the slight temporary decrease in left ventricular systolic function in the second trimester; at the third trimester a rightward shift of the EDPVR was associated with a realignment of HDF and normalization of ventricular contractility indexes. These coordinated changes that occur in the maternal heart during twin pregnancy suggests the role of HDF in cardiac remodelling.
GESTATIONAL HYPERTENSION AND PERIPARTUM CARDIOMYOPATHY: EPIDEMIOLOGICAL, CLINICAL AND EVOLUTIONARY PROFILE IN THE REFERENCE HOSPITALS OF YAOUNDE
Authors: Ouankou Christian Ngongang , Mfeukeu-kuate Liliane , Njonnou Raoul Sylvain Simeni , Zangue Carrel Raspaïl Founou , Choukem Simeon Pierre
Published: May 2024

Objective:

Peripartum cardiomyopathy (PPCM) is a rare primary dilated cardiomyopathy responsible for congestive heart failure. Our objectives was to derermine the clinical and prognosis of PPCM et the risk factors.

Design and method:

We carried out a prospective descriptive study over a period of six months. It was conducted in six reference hospitals in Yaounde. The study population was made of pregnant women with dyspnoea and women who had given birth with dyspnoea. Were included all pregnant or postpartum women (from the 32nd WA to the 5th months of postpartum) who had a LVEF <45% associated or not with left ventricle dilation. 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 enrolled 10 patients from 26 women who were pregnant or had given birth and presented with dyspnoea within 6 months. The average age was 25.9 ± 4.9 years (range: 16-33 years). The average parity was 1.6 ± 1.17 (extreme 0-3). Multiparas were the most represented. The history of gestational hypertension was the main predisposing factor found (50%); followed by multiparity (30%), the notion of twin pregnancy and advanced maternal age (20%). Heart failure was the clinical expression in 60% of cases. Sinus tachycardia was constant; followed by signs of left ventricular hypertrophy and repolarization disorders on ECG assessment. The echocardiographic pattern depicted a hypokinetic dilated cardiomyopathy (mean LVEDD 61.2 ± 8.6 mm) with an average systolic function of 27.1 ± 10.6%. The main complications were acute pulmonary edema (60%), thromboembolic events including pulmonary embolism (10%), ischemic stroke (10%) and one death (10%). The treatment mostly based on the use of diuretics, ACE inhibitors, beta-blockers, Aldactone (1/3 of the patients) without forgetting the anticoagulation made with Rivaroxaban(n=4) for some and aspirin (n=6); and bromocriptine (initiated in 3 patients).

Conclusions:

PPCM is a cause of heart failure during pregnancy. It primarily arises during the postpartum period regardless of maternal age. It is a serious disease due to its (important morbi-mortality rate) and its complications, both hemodynamic and thromboembolic.
DISTURBANCES OF UTEROPLACENTAL BLOOD FLOW DURING EXCESSIVE WEIGHT GAIN IN PREGNANT WOMEN WITH CHRONIC ARTERIAL HYPERTENSION
Authors: Kerimkulova Aiman , Medubayeva Madina , Latypova Natalia , Khodzhaeva Zulfiya , Markabayeva Akbayan , Nurpeissova Riza
Published: May 2024

Objective:

To evaluate the effect of excess weight gain on the development of uteroplacental blood flow disorders in pregnant women with chronic arterial hypertension.

Design and method:

A retrospective study was conducted to observe 257 pregnant women with chronic hypertension (CAH) and 200 pregnant women without hypertension and other conditions leading to increased blood pressure (control group). The study was conducted on the basis of perinatal centers in Astana (Kazakhstan) for 2018-2019. The average weight gain during pregnancy and its possible impact on the development of UPC disorders were studied.

Results:

The main goal of managing pregnant women with arterial hypertension is to prevent the development of complications in the mother and fetus. One of the reasons for an unfavorable prognosis for the fetus is a violation of the uteroplacental circulation (UPC). When comparing pregnant women with CAH and the control group, a violation of UPC was detected in 28.1% and 1.0% of cases, respectively (p <0.001). The average age of pregnant women with CAH was 32.9±5.7 years, in the control group 31.6±5.6 (p=0.059). The average weight gain was found to prevail in the CAH group of pregnant women with CAH (16.86±3.68 kg) compared to the control group (12.91±2.36 kg, p=0.004). Using binary logistic regression, we analyzed the effect of excess weight gain on the development of UPC impairment. In the control group, excessive weight gain was observed in 21 (10.5%) pregnant women, only 2 (1.0%) in the group with normal weight gain (n=179) subsequently developed UPC. Of the 257 pregnant CAH women, 125 (48.7%) had excessive weight gain and 71 (27.6%) developed UPC abnormalities. However, 131 (50.9%) had normal weight gain and only 1 (0.4%) pregnant women with normal weight gain later developed a UPC disorder.

Conclusions:

To prevent disturbances of uteroplacental blood flow in pregnant women with chronic arterial hypertension, weight gain is important and therefore strict control of weight gain during pregnancy is necessary, compared with the control group.
PREGNANCY OUTCOMES IN WOMEN WITH UNTREATED AND TREATED HYPERTENSION IN THE CZECH REPUBLIC BETWEEN 2012-2022
Authors: Jan Vaclavik , Zdenek Ramik , Jarkovsky Jiri , Pohlova Radka , Jirova Jitka , Zouharova Anna
Published: May 2024

Objective:

Arterial hypertension affects about 5-10% of pregnancies and has detrimental effects on pregnancy outcomes in both the mother and fetus. The study aimed to analyse the outcomes of pregnancy in women with untreated and treated arterial hypertension in pregnancy in the Czech Republic during the past decade.

Design and method:

Nationwide data on all births and abortions in the period 2012-2022 in the Czech Republic were obtained from the National Registry of Reproductive Health (NRRZ) and the National Registry of Reimbursable Health Services (NRHZS). Women who had the diagnosis I10 within one year before pregnancy and were prescribed any antihypertensive drug from selected ATC groups (C02, C03, C07, C08, C09) were classified as pre-existing hypertension. Women diagnosed with O13 or I10 during pregnancy were classified as pregnancy induced hypertension. Hypoxia in the new-born was defined as pH <7.1 or Apgar score <8 present after delivery. We used descriptive statistics to evaluate the outcomes.

Results:

There were total of 1,154,648 deliveries in the 11-year period. The proportion of women with hypertension in pregnancy was 8.24% and their mean age was 31±5 years. Mean age of women without hypertension was 30±5 years. 77,121 women (77.9%) had untreated hypertension, 21,094 (22.1%) women were treated with antihypertensive drugs during pregnancy. Women with treated hypertension (TH) had higher proportion of delivery by Caesarean section (43.8%) compared to women with untreated hypertension (UTH; 34.3%) and women without hypertension (NH; 23.9%). Women with TH and UTH also had higher proportion of pre-term deliveries in earlier gestational ages (please see the Table). Hypoxia in the new-born occurred in 10.6% women without hypertension, in 13.0% with UTH and 14.8% with TH.

Conclusions:

Women who require antihypertensive treatment during pregnancy have worse pregnancy outcomes than women with untreated hypertension and women without hypertension in pregnancy. The necessity of pharmacological treatment may be a proxy of more severe hypertension.
SEX RELATED DIFFERENCES IN BLOOD PRESSURE VARIABILITY IN HYPERTENSIVE PATIENTS: CV-PREVITAL STUDY
Authors: Croce Alessandro , Bilo Grzegorz , Pengo Martino , Soranna Davide , Sucapuca Richard , Amato Franca , Favè Marta , Marino Antonietta , Pellegrinelli Veronica , Molteni Serena , Nardin Elisa , Parisi Marco , Romeo Claudia , Losa Lorenzo , Saccà Angelo Maria , De Virgiliis Giorgia , Colella Chiara , Zambon Antonella , Ferrara Pietro , Parati Gianfranco
Published: May 2024

Objective:

Blood pressure (BP) regulation is influenced by biological effects of sex chromosomes, sex hormones and reproductive events. Gender-associated BP differences in humans are well known, with men having higher BP than age-matched pre-menopausal women, while after menopause higher prevalence of hypertension was observed in women. Less information is available on gender differences in BP variability (BPV), a BP-related feature known to independently predict cardiovascular outcomes. Aim of this study was to assess the differences in BPV between genders in participants of an ongoing prospective cardiovascular prevention trial (CV-PREVITAL).

Design and method:

The study included hypertensive patients without previous major cardiovascular events who responded to the advertisement campaign in outpatient facilities of Istituto Auxologico Italiano. In addition to clinical history, physical examination, standard routine blood tests, EKG and conventional office BP measurement, 24-hour ambulatory BP monitoring (validated oscillometric device TM2430, A&D, Japan) was performed at baseline. Short-term (24-hour) BPV was assessed as daytime and night-time standard deviation (SD) or average real variability (ARV).

Results:

The sample included 581 patients, with a mean age of 61.3±8.6 years and balanced gender distribution. Women had slightly lower BMI and 24-hour DBP and slightly higher 24-hour SBP then men. In most cases BPV estimates were higher in women. Principal BP and BPV variables in male and female participants are reported in Table 1.

In multiple regression analysis gender remained independently associated with higher values of systolic (p<0.001 for day SD, p=0.022 for night SD and p=0.002 for ARV) and diastolic BPV (p<0.001 for day SD, p=0.004 for ARV 0.15, p<0.006) after adjusting for age, BMI, mean systolic and diastolic 24-hour BP and for 24-hour heart rate. We did not observe differences in BPV variables between pre- and postmenopausal women.

Conclusions:

In hypertensive patients female gender is independently associated with higher values of most short-term BPV estimates, regardless of menopausal status. Mechanistic and prognostic implications of this difference should be better understood.
NIGHTTIME ARTERIAL PRESSURE PHENOTYPES AND THEIR PROGNOSTIC VALUE IN PREGNANT WOMEN AS PREDICTORS FOR FUTURE MATERNAL AND NEONATAL EVENTS
Authors: Aguiar Tiago , Cruz Inês , Costa Carlos , Carvalho Simão , Pacheco Adriana , Carvalho Diana , Barbosa Eliana , Bastos José
Published: May 2024

Objective:

We have previously demonstrated that some ambulatory blood pressure monitoring (ABPM) values can predict maternofoetal evens in hypertensive pregnant women. The analysis of the different nighttime blood pressure (BP) phenotypes in pregnant women is still an unknown topic.

Design and method:

A retrospective cohort study which followed a sequential number of 274 hypertensive pregnant patients (mean age of 32 years) from 2007 to 2022, who underwent ABPM made with a Spacelabs 90207. Data was collected and analysed in SPSS Statistics through different parametric tests. Nocturnal BP phenotypes were defined for both systolic and diastolic values as: reverse dipper (RD); non-dipper (ND); dipper (DP); and extreme dipper (ED). An event was defined as the composite endpoint of multiple adverse events: preeclampsia or eclampsia, foetal or neonatal death, prematurity, low weight at birth, gestational diabetes, and maternal death.

Results:

A Kaplan-Meier survival curve analysis was performed between systolic DP and ND groups, with ND showing a worse survival with a long rank of 11.331 (p<0.001); and for diastolic DP and ND groups, again with ND showing a worse survival with a long rank of 15.335 (p<0.001).

In a further systolic nocturnal phenotypes Kaplan-Meier analysis, RS (n=6) showed the worse survival, followed by ND (n=87), while DP (n=162) and ED (n=19) showed better survival, with a log rank of 8.4 (p=0.038). For the diastolic nocturnal phenotypes Kaplan-Meier analysis, ND (n=33) showed the worse survival, followed by DP (157), while ED (81) showed better survival, with a log rank of 21.3 (p<0.001). Diastolic RD showed no events, likely due to the small sample size (n=3). (Fig 1)

Conclusions:

This study further exemplifies the importance of ABPM in the evaluation of hypertensive pregnant women, both for its major role in diagnosis as well as prognostic value. Different nocturnal phenotypes show different survival rates, and patients without systolic or diastolic dipping seem to be at a major risk.