Heart rate variability and target organ damage in hypertensive patients

Background: We evaluated the association between linear standard Heart Rate Variability (HRV) measures and vascular, renal and cardiac target organ damage (TOD). Methods: A retrospective analysis was performed including 200 patients registered in the Regione Campania network (aged 62.4 ± 12, male 64%). HRV analysis was performed by 24-h holter ECG. Renal damage was assessed by estimated glomerular filtration rate (eGFR), vascular damage by carotid intima-media thickness (IMT), and cardiac damage by left ventricular mass index. Results: Significantly lower values of the ratio of low to high frequency power (LF/HF) were found in the patients with moderate or severe eGFR (p-value < 0.001). Similarly, depressed values of indexes of the overall autonomic modulation on heart were found in patients with plaque compared to those with a normal IMT (p-value <0.05). These associations remained significant after adjustment for other factors known to contribute to the development of target organ damage, such as age. Moreover, depressed LF/HF was found also in patients with left ventricular hypertrophy but this association was not significant after adjustment for other factors. Conclusions: Depressed HRV appeared to be associated with vascular and renal TOD, suggesting the involvement of autonomic imbalance in the TOD. However, as the mechanisms by which abnormal autonomic balance may lead to TOD, and, particularly, to renal organ damage are not clearly known, further prospective studies with longitudinal design are needed to determine the association between HRV and the development of TOD

ESC core curriculum for the general cardiologist (2013)

[No abstract available

Multimodality carotid plaque tissue characterization and classification in the artificial intelligence paradigm: a narrative review for stroke application

Cardiovascular disease (CVD) is one of the leading causes of morbidity and mortality in the United States of America and globally. Carotid arterial plaque, a cause and also a marker of such CVD, can be detected by various non-invasive imaging modalities such as magnetic resonance imaging (MRI), computer tomography (CT), and ultrasound (US). Characterization and classification of carotid plaque-type in these imaging modalities, especially into symptomatic and asymptomatic plaque, helps in the planning of carotid endarterectomy or stenting. It can be challenging to characterize plaque components due to (I) partial volume effect in magnetic resonance imaging (MRI) or (II) varying Hausdorff values in plaque regions in CT, and (III) attenuation of echoes reflected by the plaque during US causing acoustic shadowing. Artificial intelligence (AI) methods have become an indispensable part of healthcare and their applications to the non-invasive imaging technologies such as MRI, CT, and the US. In this narrative review, three main types of AI models (machine learning, deep learning, and transfer learning) are analyzed when applied to MRI, CT, and the US. A link between carotid plaque characteristics and the risk of coronary artery disease is presented. With regard to characterization, we review tools and techniques that use AI models to distinguish carotid plaque types based on signal processing and feature strengths. We conclude that AI-based solutions offer an accurate and robust path for tissue characterization and classification for carotid artery plaque imaging in all three imaging modalities. Due to cost, user-friendliness, and clinical effectiveness, AI in the US has dominated the most

Arterial ischaemic stroke from 2010-2015: Incidence, risk factors, atherosclerosis and 5-year outcome : The Norwegian Stroke in the Young Study, a three-generation research program

“Norwegian Stroke in the Young Study” (NOR-SYS) er en tre generasjoners studie, som har inkludert hjerneinfarkt pasienter i alderen mellom 15-60 år, og deres foreldre, partnere og voksne barn mellom 2010-2015 for å få kunnskap om risikofaktorer, aterosklerose og om kardiovaskulære hendelser i familier. Denne avhandlingen redegjør for deltakelsesratene til tre generasjoner, forekomst av hjerneinfarkt og utbredelsen av aterosklerose hos unge mennesker som ligger under ansvarsområde for Haukeland universitetssykehus i Bergen, Norge. Våre resultater av unge hjerneinfarkt pasienter ble sammenlignet med deres partnere som kontroller, og relatert til risikofaktorer og til 5-års utkom. Alle resultatene ble justert for alder og kjønn. Artikkel I beskrev aktiv deltakelse for 385 pasienter (96.5%), 260 kontroller (80.0%) og 414 (74.6%) voksne barn. Lavere deltakelsesrate var hos pasientforeldrene (55.2% fedre og 57.3% mødre), og enda lavere hos partnerforeldre (38.4% fedre og 40.2% mødre). Forekomst av hjerneinfarkt hos pasienter ≤49 år var 15.0 per 100.000 per år. Artikkel II presenterte utbredelse av aterosklerose i syv vaskulære områder, og relaterte det til 5-års utkom. Vi definerte ung alder ≤49 år og middelalder ≥50 år. Ca 50.0% av unge mannlige og 33.0% av unge kvinnelige pasienter hadde aterosklerose. Den totale utbredelsen av aterosklerose var kun høyere blant unge kvinnelige pasienter sammenlignet med unge kvinnelige kontroller. I løpet av en 5-års periode, fikk 13.7% pasienter og 4.1% kontroller nye vaskulære hendelser, med signifikante flere hendelser blant unge kvinnelige pasienter i forhold til unge kvinnelige kontroller. Ingen signifikant forskjell ble funnet i mortalitetsraten blant pasienter og kontroller (henholdvis på 5.5% og 3.5%). Justert for alder og kjønn, nye vaskulære hendelser var assosiert med iskjemisk elektrokardiogram (EKG), patologisk ankel-arm index, femoral intima-media tykkelse (fIMT) og antall vaskulære områder med aterosklerose (NAA) blant pasienter, og med abdominal aorta plakk, karotis intima-media tykkelse (cIMT), fIMT og NAA blant kontroller. Mortalitet var assosiert med økende alder, iskjemisk EKG og NAA blant pasienter, og med cIMT blant kontroller. Artikkel III beskrev total risikofaktorbyrde og relaterte det til aterosklerose. Risikofaktor var tilstede hos 96.4% unge mannlige pasienter og hos 94.3% unge kvinnelige pasienter. Risikofaktorbyrden var kun høyere blant unge kvinnelige pasienter sammenlignet med unge kvinnelige kontroller. Aterosklerosen var assosiert med høy alder, hypertensjon, diabetes mellitus og kroppsmasseindex i en kombinert analyse for pasienter og kontroller, justert for alder, kjønn og alle risikofaktorer.From 2010 to 2015, the three-generations Norwegian Stroke in the Young Study (NOR-SYS) included ischaemic stroke patients aged 15-60 years, and their parents, partners and adult offspring to gain more knowledge about vascular risk factors, atherosclerosis and cardiovascular events in families. This thesis explores the inclusion rates of three generations, incidence of ischaemic stroke and the prevalence of atherosclerotic disease at a young age in the well-defined patient population referred to Haukeland University Hospital, Norway. Our results were compared to the patients’ partners, serving as controls, and related to vascular risk factors and 5-year outcome after stroke. All results were age- and sex-adjusted. Paper I described active participation of 385 patients (96.5%), 260 controls (80.0%) and 414 (74.6%) adult offspring. The active participation rate for patients’ parents was low (55.2% fathers and 57.3% mothers), and the active participation rate for partners’ parents was even lower (38.4% fathers and 40.2% mothers). The mean annual incidence rate of young stroke patients ≤49 years was 15.0 per 100.000. Paper II presented the prevalence of atherosclerosis in seven vascular areas related to 5-year outcome. Young age was defined as ≤49 years and middle-aged was defined as ≥50 years. About 50% of young male patients, and about 33% of young female patients had prevalent atherosclerosis. Compared to controls, atherosclerosis was more prevalent only in young female patients. At 5-year follow up, 13.7% patients and 4.1% controls had experienced new cardiovascular events, and the occurrence rate was higher in young female patients than in young female controls. The mortality rate was low and did not differ between patients and controls (5.5% vs 3.5%). Adjusted for age and sex, the occurrence of new cardiovascular events were associated with ischaemic electrocardiogram (ECG), pathological ankle-arm index, femoral intima-media thickness (fIMT) and increased number of vascular areas with atherosclerosis (NAA) among patients, and with abdominal aorta plaques (AAP), carotid intima-media thickness (cIMT), fIMT and NAA among controls. Mortality was associated with higher age, ischaemic ECG and NAA with among patients, and with cIMT among controls. Paper III presented the total risk factor burden related to prevalence of atherosclerosis. In total, risk factors were present among 96.4% of young male patients and 94.3% of young female patients. Compared to controls, only young female stroke patients had a higher risk factor burden. Prevalent atherosclerosis was associated with age, hypertension, diabetes mellitus, smoking and body-mass index in a combined analysis for patients and controls, adjusted for age, sex, and all risk factors.Doktorgradsavhandlin

Pediatric Stroke: Clinical Findings and Radiological Approach

This paper focuses on radiological approach in pediatric stroke including both ischemic stroke (Arterial Ischemic Stroke and Cerebral Sinovenous Thrombosis) and hemorrhagic stroke. Etiopathology and main clinical findings are examined as well. Magnetic Resonance Imaging could be considered as the first-choice diagnostic exam, offering a complete diagnostic set of information both in the discrimination between ischemic/hemorrhagic stroke and in the identification of underlying causes. In addition, Magnetic Resonance vascular techniques supply further information about cerebral arterial and venous circulation. Computed Tomography, for its limits and radiation exposure, should be used only when Magnetic Resonance is not available and on unstable patients

Alteration of cerebrovascular haemodynamic patterns due to atrial fibrillation: an in silico investigation

There has recently been growing evidence that atrial fibrillation (AF), the most common cardiac arrhythmia, is independently associated with the risk of dementia. This represents a very recent frontier with high social impact for the number of individuals involved and for the expected increase in AF incidence in the next 40 years. Although a number of potential haemodynamic processes, such as microembolisms, altered cerebral blood flow, hypoperfusion and microbleeds, arise as connecting links between the two pathologies, the causal mechanisms are far from clear. An in silico approach is proposed that combines in sequence two lumped-parameter schemes, for the cardiovascular system and the cerebral circulation. The systemic arterial pressure is obtained from the cardiovascular system and used as the input for the cerebral circulation, with the aim of studying the role of AF on the cerebral haemodynamics with respect to normal sinus rhythm (NSR), over a 5000 beat recording. In particular, the alteration of the haemodynamic (pressure and flowrate) patterns in the microcirculation during AF is analysed by means of different statistical tools, from correlation coefficients to autocorrelation functions, crossing times, extreme values analysis and multivariate linear regression models. A remarkable signal alteration, such as a reduction in signal correlation (NSR, about 3 s; AF, less than 1 s) and increased probability (up to three to four times higher in AF than in NSR) of extreme value events, emerges for the peripheral brain circulation. The described scenario offers a number of plausible cause-effect mechanisms that might explain the occurrence of critical events and the haemodynamic links relating to AF and dementia.Comment: 13 pages, 9 Figures, 3 Table