Μελέτη του ρόλου των ιδιαίτερα αυξημένων επιπέδων της HDL χοληστερόλης αλλά και της λειτουργικότητας των κλασμάτων της σε σχέση με την ακεραιότητα του ενδοθηλιακού γλυκοκάλυκα και την αρτηριακή σκληρία σε ασθενείς με ιδιοπαθή υπέρταση

Εισαγωγή: Το κάπνισμα και η HDL χοληστερόλη (HDL-C) αποτελούν μείζονες παράγοντες καρδιαγγειακού κινδύνου με αντίστροφη δράση. Οι καπνιστές παρουσιάζουν επηρεασμένη ενδοθηλιακή λειτουργία (η οποία εκφράζεται από διαταραχή της ακεραιότητας του ενδοθηλιακού γλυκοκάλυκα-ΕΓ) και αυξημένη αορτική σκληρία, στοιχεία που υποδηλώνουν υποκλινική βλάβη οργάνων-στόχων, σε υπερτασικούς ασθενείς. Τα αυξημένα επίπεδα HDL-C διαδραματίζουν προστατευτικό ρόλο ενάντια στην καρδιαγγειακή νόσο. Σε προηγούμενη μελέτη αναδείξαμε ότι σε μεσήλικες υπερτασικούς ασθενείς τα επίπεδα HDL-C μεταξύ 71 και 101mg/dl παρουσιάζουν ανάστροφη συσχέτιση με την περιοχή οριακής διάχυσης των υπογλώσσιων μικροαγγείων διαμέτρου 5 έως 9μm (PBR5-9) του ΕΓ, ασκώντας πιθανά προστατευτική δράση στο ενδοθήλιο. Στην παρούσα μελέτη διερευνήσαμε το ρόλο των αυξημένων επιπέδων HDL-C στην αορτική σκληρία και την ακεραιότητα του ΕΓ με βάση το φύλο και την καπνιστική συνήθεια σε μεσήλικες υπερτασικούς ασθενείς υπό αγωγή. Μέθοδοι: Μελετήσαμε 193 υπερτασικούς ασθενείς υπό αγωγή (μέση ηλικία = 61 ± 11 έτη, 58% γυναίκες, 28% καπνιστές), τους οποίους ταξινομήσαμε σε 4 ομάδες με βάση το φύλο και την καπνιστική συνήθεια. Αξιολογήσαμε την αρτηριακή πίεση ιατρείου, το λιπιδαιμικό προφίλ νηστείας {ολική χοληστερόλη, HDL-C, LDL χοληστερόλη (LDL-C) και τριγλυκερίδια}, την αορτική σκληρία, μέσω του υπολογισμού της καρωτιδο-μηριαίας ταχύτητας σφυγμικού κύματος (PWV) και την ενδοθηλιακή λειτουργία, μέσω του υπολογισμού της PBR5-9, ενός μη επεμβατικού δείκτη αξιολόγησης του πάχους του ΕΓ (υψηλές τιμές PBR αντιστοιχούν σε μειωμένο πάχος ΕΓ). Αποτελέσματα: Στο σύνολο του πληθυσμού, τα επίπεδα της HDL-C παρουσίασαν ανάστροφη συσχέτιση με τη PWV (r = −0.15, p = 0.03) και τη PBR5-9 (r = −0.15, p = 0.03). Επιπλέον, η HDL-C παρουσίασε ανάστροφη συσχέτιση με τη PBR5-9 στους άντρες (r = −0.29, p = 0.008), τόσο καπνιστές (r = −0.35, p < 0.05) όσο και μη καπνιστές (r = −0.27, p < 0.05) και τη PWV στις γυναίκες μη καπνίστριες (r = −0.28, p = 0.009). Από τη διενέργεια ανάλυσης πολλαπλής παλινδρόμησης, χρησιμοποιώντας την ηλικία, το βάρος, το κάπνισμα, τα επίπεδα της HDL-C και της LDL-C, ως ανεξάρτητες μεταβλητές, διαπιστώσαμε ότι η HDL-C σχετίζεται ανεξάρτητα με τη PWV (β = −0.14, p = 0.02) στο σύνολο του πληθυσμού και με τη PBR5-9 στους άντρες (β = −0.28, p = 0.01). Συμπεράσματα: Τα αυξημένα επίπεδα HDL-C σχετίζονται με μειωμένη αορτική σκληρία σε μεσήλικες υπερτασικούς ασθενείς, τόσο σε άντρες όσο και γυναίκες. Παράλληλα, φαίνεται ότι ασκούν προστατευτική δράση στη δομή του ΕΓ μόνο σε άντρες υπερτασικούς ασθενείς (τόσο σε καπνιστές όσο και μη-καπνιστές) και όχι σε γυναίκες (οι οποίες παρουσιάζουν συνήθως υψηλότερες τιμές HDL-C), γεγονός που πιθανά υποδηλώνει τη μεγαλύτερη σημασία τους για την προστασία του ενδοθηλίου στους άντρες.Introduction: Smoking and HDL cholesterol (HDL-C) are both considered major cardiovascular (CV) risk factors. Smokers display impaired endothelial function (due to endothelial glycocalyx-EG- loss of integrity) and increased aortic stiffness, which denote subclinical organ damage in hypertensive patients. Increased HDL-C levels exert protective role against CV disease. In a previous study, we showed that HDL-C levels between 71 and 101mg/dl were inversely related to perfused boundary region of sublingual microvessels, ranged from 5 to 9μm (PBR5-9) in middle-aged treated hypertensive patients. In the present study, we investigated the role of increased HDL-C levels in aortic stiffness and EG integrity, regarding sex and smoking habit in middle-aged treated hypertensive patients. Methods: We studied 193 treated hypertensive patients (mean age = 61 ± 11 years, 58% women, 28% smokers) divided in 4 groups regarding sex and smoking habit. We evaluated office blood pressure, fasting lipid profile {total cholesterol, HDL-C, LDL cholesterol (LDL-C) and triglycerides}, aortic stiffness by measuring carotid-to-femoral pulse wave velocity (PWV), and endothelial function by calculating PBR5-9, a non-invasive index of EG evaluation (high PBR values imply reduced EG thickness). Results: We found that, in total population, HDL-C levels were inversely associated with PWV (r = −0.15, p = 0.03) and PBR5-9 (r = −0.15, p = 0.03). Moreover, HDL-C levels were negatively related to PBR5-9 in men (r = −0.29, p = 0.008), either smokers (r = −0.35, p < 0.05) or non-smokers (r = −0.27, p < 0.05) and PWV in women non-smokers (r = −0.28, p = 0.009). In a multiple linear regression analysis, using age, weight, smoking habit, HDL-C and LDL-C levels as independent variables, we found that HDL-C independently predicts PWV (β = −0.14, p = 0.02) in the total population and PBR5-9 (β = −0.28, p = 0.01) only in men. Conclusions: Increased HDL-C levels are related to reduced aortic stiffness in middle-aged treated hypertensive patients, both men and women. They also seem to exert a protective role in EG only in men hypertensive patients and not in women (who usually show higher values of HDL-C), which possibly denotes their greater importance regarding endothelial protection in men

Research of the role of extremely high levels of HDL cholesterol and the functionality of HDL subclasses regarding endothelial glycocalyx integrity and arterial stiffness in patients with essential hypertension

Introduction: Smoking and HDL cholesterol (HDL-C) are both considered major cardiovascular (CV) risk factors. Smokers display impaired endothelial function (due to endothelial glycocalyx-EG- loss of integrity) and increased aortic stiffness, which denote subclinical organ damage in hypertensive patients. Increased HDL-C levels exert protective role against CVdisease. In a previous study, we showed that HDL-C levels between 71 and 101mg/dl were inversely related to perfused boundary region of sublingual microvessels, ranged from 5 to 9μm (PBR5-9) in middle-aged treated hypertensive patients. In the present study, we investigated the role of increased HDL-C levels in aortic stiffness and EG integrity, regarding sex and smoking habit in middle-aged treated hypertensive patients.Methods: We studied 193 treated hypertensive patients (mean age = 61 ± 11 years, 58% women, 28% smokers) divided in 4 groups regarding sex and smoking habit. We evaluated office blood pressure, fasting lipid profile{total cholesterol, HDL-C, LDL cholesterol (LDL-C) and triglycerides}, aortic stiffness by measuring carotid-to-femoral pulse wave velocity (PWV), and endothelial function by calculating PBR5-9, a non-invasive index of EG evaluation (high PBR values imply reduced EG thickness).Results: We found that, in total population, HDL-C levels were inversely associated with PWV (r = −0.15, p = 0.03) and PBR5-9 (r = −0.15, p = 0.03). Moreover, HDL-C levels were negatively related to PBR5-9 in men (r = −0.29,p = 0.008), either smokers (r = −0.35, p < 0.05) or non-smokers (r = −0.27, p < 0.05) and PWV in women non-smokers (r = −0.28, p = 0.009). In a multiple linear regression analysis, using age, weight, smoking habit, HDL-C and LDL-C levels as independent variables, we found that HDL-C independently predicts PWV (β = −0.14, p = 0.02) in the total population and PBR5-9 (β = −0.28, p = 0.01) only in men.Conclusions: Increased HDL-C levels are related to reduced aortic stiffness in middle-aged treated hypertensive patients, both men and women. They also seem to exert a protective role in EG only in men hypertensive patients and not in women (who usually show higher values of HDL-C), which 133 possibly denotes their greater importance regarding endothelial protection in men.Εισαγωγή: Το κάπνισμα και η HDL χοληστερόλη (HDL-C) αποτελούν μείζονες παράγοντες καρδιαγγειακού κινδύνου με αντίστροφη δράση. Οι καπνιστές παρουσιάζουν επηρεασμένη ενδοθηλιακή λειτουργία (η οποία εκφράζεται από διαταραχή της ακεραιότητας του ενδοθηλιακού γλυκοκάλυκα-ΕΓ) και αυξημένη αορτική σκληρία, στοιχεία που υποδηλώνουνυποκλινική βλάβη οργάνων-στόχων, σε υπερτασικούς ασθενείς. Τα αυξημένα επίπεδα HDL-C διαδραματίζουν προστατευτικό ρόλο ενάντια στην καρδιαγγειακή νόσο. Σε προηγούμενη μελέτη αναδείξαμε ότι σε μεσήλικεςυπερτασικούς ασθενείς τα επίπεδα HDL-C μεταξύ 71 και 101mg/dl παρουσιάζουν ανάστροφη συσχέτιση με την περιοχή οριακής διάχυσης των υπογλώσσιων μικροαγγείων διαμέτρου 5 έως 9μm (PBR5-9) του ΕΓ, ασκώνταςπιθανά προστατευτική δράση στο ενδοθήλιο. Στην παρούσα μελέτη διερευνήσαμε το ρόλο των αυξημένων επιπέδων HDL-C στην αορτική σκληρία και την ακεραιότητα του ΕΓ με βάση το φύλο και την καπνιστική συνήθεια σε μεσήλικες υπερτασικούς ασθενείς υπό αγωγή.Μέθοδοι: Μελετήσαμε 193 υπερτασικούς ασθενείς υπό αγωγή (μέση ηλικία = 61 ± 11 έτη, 58% γυναίκες, 28% καπνιστές), τους οποίους ταξινομήσαμε σε 4 ομάδες με βάση το φύλο και την καπνιστική συνήθεια. Αξιολογήσαμε την αρτηριακή πίεση ιατρείου, το λιπιδαιμικό προφίλ νηστείας {ολική χοληστερόλη, HDL-C, LDL χοληστερόλη (LDL-C) και τριγλυκερίδια}, τηναορτική σκληρία, μέσω του υπολογισμού της καρωτιδο-μηριαίας ταχύτητας σφυγμικού κύματος (PWV) και την ενδοθηλιακή λειτουργία, μέσω του υπολογισμού της PBR5-9, ενός μη επεμβατικού δείκτη αξιολόγησης του πάχους του ΕΓ (υψηλές τιμές PBR αντιστοιχούν σε μειωμένο πάχος ΕΓ).Αποτελέσματα: Στο σύνολο του πληθυσμού, τα επίπεδα της HDL-C παρουσίασαν ανάστροφη συσχέτιση με τη PWV (r = −0.15, p = 0.03) και τη PBR5-9 (r = −0.15, p = 0.03). Επιπλέον, η HDL-C παρουσίασε ανάστροφη συσχέτιση με τη PBR5-9 στους άντρες (r = −0.29, p = 0.008), τόσο καπνιστές (r = −0.35, p < 0.05) όσο και μη καπνιστές (r = −0.27, p < 0.05) και τη PWV στις γυναίκες μη καπνίστριες (r = −0.28, p = 0.009). Από τη διενέργεια ανάλυσης πολλαπλής παλινδρόμησης, χρησιμοποιώντας την ηλικία, το βάρος, το 131 κάπνισμα, τα επίπεδα της HDL-C και της LDL-C, ως ανεξάρτητες μεταβλητές,διαπιστώσαμε ότι η HDL-C σχετίζεται ανεξάρτητα με τη PWV (β = −0.14, p = 0.02) στο σύνολο του πληθυσμού και με τη PBR5-9 στους άντρες (β = −0.28, p = 0.01).Συμπεράσματα: Τα αυξημένα επίπεδα HDL-C σχετίζονται με μειωμένη αορτική σκληρία σε μεσήλικες υπερτασικούς ασθενείς, τόσο σε άντρες όσο και γυναίκες. Παράλληλα, φαίνεται ότι ασκούν προστατευτική δράση στη δομή του ΕΓ μόνο σε άντρες υπερτασικούς ασθενείς (τόσο σε καπνιστές όσο και μη-καπνιστές) και όχι σε γυναίκες (οι οποίες παρουσιάζουν συνήθως υψηλότερες τιμές HDL-C), γεγονός που πιθανά υποδηλώνει τη μεγαλύτερη σημασία τους για την προστασία του ενδοθηλίου στους άντρες

Hypertension‐mediated organ damage regression associates with blood pressure variability improvement three years after successful treatment initiation in essential hypertension

Blood pressure variability (BPV) has been associated with the development, progression, and severity of cardiovascular (CV) organ damage and an increased risk of CV morbidity and mortality. We aimed to explore any association between short‐term BPV reduction and hypertension‐mediated organ damage (HMOD) regression in hypertensive patients 3‐year post‐treatment initiation regarding BP control. 24‐h ambulatory blood pressure monitoring (24 h ABPM) was performed at baseline in 180 newly diagnosed and never‐treated hypertensive patients. We measured 24 h average systolic (24 h SBP) and diastolic BP (24 h DBP) as well as 24 h systolic (sBPV) and diastolic BPV (dBPV). Patients were initially evaluated and 3 years later regarding arterial stiffness (PWV), left ventricular hypertrophy (LVMI), carotid intima‐media thickness (cIMT), 24 h microalbumin levels (MAU), and coronary flow reserve (CFR). Successful BP treatment was defined as 24 h SBP/DBP < 130/80 mm Hg based on 2nd ABPM and subsequently, patients were characterized as controlled (n = 119, age = 53 ± 11 years) or non‐controlled (n = 61, age = 47 ± 11 years) regarding their BP levels. In the whole population and the controlled group, 24 h SBP/DBP, sBPV/dBPV, LVMI, and IMT were decreased. Additionally, LVMI improvement was related with both sBPV (p < .001) and dBPV reduction (r = .18, p = .02 and r = .20, p = .03, respectively). In non‐controlled hypertensives, PWV was increased. In multiple linear regression analysis, sBPV and dBPV reduction predicted LVMI improvement in total population and controlled group independently of initial office SBP, mean BP, and 24 h‐SBP levels. In middle‐aged hypertensive patients, a 3‐year antihypertensive treatment within normal BP limits, confirmed by 24‐h ABPM, leads to CV risk reduction associated with sBPV and dBPV improvement

Pulse wave analysis using the Mobil-O-Graph, Arteriograph and Complior device: a comparative study

Purpose: Pulse wave velocity (PWV) is a marker of arterial stiffness with major prognostic value. We compared Arteriograph and Complior devices with the Mobil-O-Graph for assessment of PWV and central systolic blood pressure (cSBP). Materials and Methods: We studied 316 consecutive subjects (age: 55 ± 14 years). For each individual, we measured PWV and cSBP with Arteriograph, Complior and Mobil-O-Graph and compared the readings. Differences in values among three devices were calculated for each measurement. We used Bland-Altman analysis, intraclass correlation coefficient (ICC) and coefficient of variation (CV). Results: Bland-Altman analysis indicated a mean difference for PWV: i.0.5 m/s (limits of agreement -1.4–2.4) between Complior and Mobil-O-Graph, ii.0.6 m/s (limits of agreement -1.4–2.6) between Arteriograph and Mobil-O-Graph. cSBP mean difference was 3.8 mmHg between Complior and Mobil-O-Graph (limits of agreement -12.5–20.1) and 9.2 mmHg between Arteriograph and Mobil-O-Graph (limits of agreement -7.6–26). ICC for PWV was 0.86 between Arteriograph and Mobil-O-Graph, 0.87 between Complior and Mobil-O-Graph and for cSBP 0.92 and 0.91 respectively. CV for PWV was 9.5% between Arteriograph and Mobil-O-Graph, 8.8% between Complior and Mobil-O-Graph. Respective values for cSBP were 6.8% and 5.1%. Conclusion: Our study shows acceptable agreement among the three devices regarding pulse wave analysis markers though Mobil-O-Graph appears to underestimate the values of these markers. Further studies are needed to explore the agreement between the 3 devices in various clinical settings and patient populations

Giant Pulmonary Artery Thrombotic Material, Due to Chronic Thromboembolic Pulmonary Hypertension, Mimics Pulmonary Artery Sarcoma

In this article, we present the case of a 38-year-old female who suffered from serious respiratory distress. After an extensive pulmonary artery imaging diagnostic work-up (CTPA, MRA and PET), we were unable to differentiate between chronic thromboembolic pulmonary hypertension (CTEPH) vs. pulmonary artery sarcoma (PAS) due to extensive filling defects and extraluminal findings. Although surgery was postponed for nine months due to the COVID-19 pandemic, CTEPH diagnosis, due to a high-thrombus burden, was finally confirmed after pulmonary endarterectomy (PEA). Conclusively, imaging findings of rare cases of CTEPH might mimic PAS and the surgical removal of the lesion are both needed for a final diagnosis. What is Already Known about This Topic? Pulmonary artery sarcoma (PAS) is a rare but aggressive malignancy, which originates from the intimal layer of the pulmonary artery (PA); Chronic thromboembolic pulmonary hypertension (CTEPH) is based on chronic, organized flow-limiting thrombi inside PA circulation and subsequent pulmonary hypertension. What Does This Study Contribute? Since radiological findings of CTEPH cases might rarely mimic PAS, pulmonary artery endarterectomy and subsequent histopathologic study are needed for a final diagnosis

Giant Pulmonary Artery Thrombotic Material, Due to Chronic Thromboembolic Pulmonary Hypertension, Mimics Pulmonary Artery Sarcoma

In this article, we present the case of a 38-year-old female who suffered from serious respiratory distress. After an extensive pulmonary artery imaging diagnostic work-up (CTPA, MRA and PET), we were unable to differentiate between chronic thromboembolic pulmonary hypertension (CTEPH) vs. pulmonary artery sarcoma (PAS) due to extensive filling defects and extraluminal findings. Although surgery was postponed for nine months due to the COVID-19 pandemic, CTEPH diagnosis, due to a high-thrombus burden, was finally confirmed after pulmonary endarterectomy (PEA). Conclusively, imaging findings of rare cases of CTEPH might mimic PAS and the surgical removal of the lesion are both needed for a final diagnosis. What is Already Known about This Topic? Pulmonary artery sarcoma (PAS) is a rare but aggressive malignancy, which originates from the intimal layer of the pulmonary artery (PA); Chronic thromboembolic pulmonary hypertension (CTEPH) is based on chronic, organized flow-limiting thrombi inside PA circulation and subsequent pulmonary hypertension. What Does This Study Contribute? Since radiological findings of CTEPH cases might rarely mimic PAS, pulmonary artery endarterectomy and subsequent histopathologic study are needed for a final diagnosis

Peak exercise myocardial deformation indices during cardiopulmonary exercise testing are associated with exercise capacity and ventilatory efficiency in patients with dilated cardiomyopathy

Objective: Little is known about the exercise-induced changes in the multidimensional mechanical properties of the heart. We aimed to evaluate the myocardial deformation indices (MDI) at rest and their response at peak exercise during the same cardiopulmonary exercise testing (CPET) session, investigating their relationship to exercise capacity and ventilatory sufficiency in dilated cardiomyopathy (DCM) patients. Methods: We evaluated left ventricular (LV) function using speckle tracking imaging (STI) at rest and peak exercise during the same CPET session in 57 idiopathic DCM patients in New York Heart Association (NYHA) I–II class [54 ± 12 years, 42 males, ejection fraction (EF) 33 ± 9%]. We measured global longitudinal strain (GLS), longitudinal strain rate at systole (LSRS) and diastole (LSRD), and circumferential strain rate (CircS). Results: Resting GLS, LSRS, and LSRD were impaired compared with the predicted values but were improved at peak exercise (p −1.10 sec−1 (AUC = 0.80, p −13% (AUC = 0.81, p = 0.002) predicted impaired exercise capacity (peak VO2 34). In multiple regression analysis, peak exercise LSRS and GLS were independently related to the peak VO2 (Beta = −0.39, p = 0.003) and VE/VCO2 slope (Beta = 0.35, p = 0.02), respectively. Conclusions: Peak exercise LSRS and GLS in NYHA I–II DCM patients subjected to CPET were associated with aerobic exercise capacity and ventilatory efficiency. Consequently, LSRS and GLS at peak exercise, through their association with CPET-derived CV risk indices, may underline the severity of heart failure and predict future CV events in this DCM population

May We Use Non-Invasive Indices of Aortic Stiffness and Endothelial Glycocalyx as Biomarkers for Idiopathic Pulmonary Artery Hypertension Follow-Up?

Idiopathic pulmonary arterial hypertension (IPAH) initial evaluation and follow-up, a rare and incurable disease if left untreated, is based on a multiparametric approach (functional status of the patient, biomarkers, hemodynamic parameters and imaging evaluation of right heart impairment). Arterial stiffness (AS) and endothelial glycocalyx are indices of systemic circulation. We present the 3-years follow-up of a female IPAH patient. We propose aortic stiffness and endothelial glycocalyx indices as non-invasive markers of either improvement or deterioration of IPAH disease