Uric acid and high sensitive C-reactive protein are associated with subclinical thoracic aortic atherosclerosis

AbstractBackground and purposeThe detection of atherosclerotic lesions in the aorta by transesophageal echocardiography (TEE) is a marker of diffuse atherosclerotic disease. Hyperuricemia is a well-recognized risk factor for cardiovascular diseases. However, no data are available concerning the relationship between serum uric acid (UA) and subclinical thoracic aortic atherosclerosis. We aimed to investigate the association between thoracic aortic atherosclerosis and serum UA level.MethodsWe studied 181 patients (mean age 46.3±8 years) who underwent TEE for various indications. Four different grades were determined according to intima–media thickness (IMT) of thoracic aorta. UA and other biochemical markers were measured with an automated chemistry analyzer.ResultsTEE evaluation characterized thoracic aortic intimal morphology as Grade 1 in 69 patients, Grade 2 in 52 patients, Grade 3 in 31 patients, and Grade 4 in 29 patients. The highest UA level was observed in patients with Grade 4 IMT when compared with Grade 1 and 2 IMT groups (p<0.001 and p=0.014, respectively). UA levels in patients with Grade 3 and Grade 2 IMT were also higher than patients with Grade 1 IMT group (p<0.001, for all). In multiple linear regression analysis, IMT was independently associated with UA level (β=0.350, p<0.001), age (β=0.219, p=0.001), total cholesterol (β=−0.212, p=0.031), low-density lipoprotein cholesterol (β=0.350, p=0.001), and high sensitivity C-reactive protein (hsCRP) levels (β=0.148, p=0.014).ConclusionUric acid and hsCRP levels are independently and positively associated with subclinical thoracic atherosclerosis

Morning blood pressure surge and arterial stiffness in newly diagnosed hypertensive patients

Objective: We aimed to investigate the relationship between the morning blood pressure (BP) surge and arterial stiffness in patients with newly diagnosed hypertension. Subjects and methods: Three hundred and twenty four (mean age 51.7 ± 11.4 years) patients who had newly diagnosed hypertension with 24 h ambulatory BP monitoring were enrolled. Parameters of arterial stiffness, pulse wave velocity and augmentation index (Aix) were measured by applanation tonometry and aortic distensibility was calculated by echocardiography. Results: Compared with the other groups, pulse wave velocity, day–night systolic BP (SBP) difference (p < 0.001, for all) and hs-CRP (p = 0.005) were higher in morning BP surge high group. Aortic distensibility values were significantly lower in morning BP surge high group compared to the other groups (p < 0.05, for all). Morning BP surge was found to be independently associated with pulse wave velocity (β = 0.286, p < 0.001), aortic distensibility (β= −0.384, p < 0.001) and day–night SBP difference (β = 0.229, p < 0.001) in multivariate linear regression analysis. Conclusions: We found independent relationship between morning BP surge and arterial stiffness which is a surrogate endpoint for cardiovascular diseases. The inverse relationship between morning BP surge and aortic distensibility and direct relation found in our study is new to the literature

Zautomatyzowane obrazowanie czynnościowe w optymalizacji opóźnienia przedsionkowo- -komorowego u chorych ze stymulatorem dwujamowym

Background: Optimisation of atrioventricular (AV) delay time has positive effects on left ventricular (LV) functions in patients with a DDD pacemaker. However, the method used for optimisation is still debated.Aim: To evaluate the effect of different AV delay times on various LV systolic performances by using automated functional imaging (AFI) in patients with a DDD pacemaker and preserved LV systolic function.Methods: The study population consisted of 40 patients with a DDD pacemaker implanted for third degree AV block and preserved LV systolic function (19 men; mean age 64.3 ± 10.9 years). During each pacing period, blood samples were taken for the measurement of B-type natriuretic peptide (BNP) levels, and telemetric and echocardiographic evaluations were performed to all patients. Also peak systolic global longitudinal strain (PSGLS) was calculated using the AFI method.Results: No significant differences except for LV outflow tract-velocity time integral (LVOT–VTI) were observed in pulse wave Doppler parameters with different AV delay times. PSGLS were better at 150 and 200 ms AV delay times compared to 100 ms (p &lt; 0.001 for 100–150 ms and 100–200 ms). Similarly, LVOT–VTI values were significantly higher at 150 and 200 ms AV delay times compared to 100 ms (for 100–150 ms, p = 0.017 and for 100–200 ms, p = 0.013). Also there was a significant reduction in BNP levels at 150 ms and 200 ms compared to 100 ms AV delay time (for 100–150 ms, p = 0.001, and for 100–200 ms, p &lt; 0.001).Conclusions: In patients with an implanted DDD pacemaker and preserved LV systolic function, increasing AV delay time has beneficial effects on LV systolic performance in the acute phase, as shown by the AFI method in our study. Wstęp: Optymalizacja opóźnienia przedsionkowo-komorowego (AV) ma korzystny wpływ na czynność lewej komory (LV) u pacjentów ze stymulatorem typu DDD. Jednak wybór stosowanej w tym celu metody nadal budzi wątpliwości.Cel: Celem niniejszego badania była ocena wpływu opóźnienia AV na czynność skurczową LV przy użyciu zautomatyzowanego obrazowania czynnościowego (AFI) u pacjentów ze stymulatorem typu DDD i zachowaną czynnością skurczową LV.Metody: Grupa badana składała się z 40 chorych ze stymulatorem typu DDD wszczepionym z powodu bloku AV III stopnia i z zachowaną czynnością skurczową LV (19 mężczyzn; średnia wieku 64,3 ± 10,9 roku). W czasie każdego okresu stymulacji pobierano próbki krwi w celu oznaczenia stężeń peptydu natriuretycznego typu B (BNP). U wszystkich chorych przeprowadzono ocenę telemetryczną i echokardiograficzną. Ponadto obliczono globalne maksymalne skurczowe odkształcenie podłużne (PSGLS), stosując metodę AFI.Wyniki: Nie stwierdzono istotnych różnic w parametrach uzyskanych w badaniu doplerem fali pulsacyjnej w zależności od zmian opóźnienia AV, z wyjątkiem całki prędkości przepływu w czasie dla drogi odpływu LV (LVOT–VTI). Wartości PSGLS były większe w przypadku opóźnienia AV wynoszącego 150 ms i 200 ms niż wtedy, gdy wynosiło ono 100 ms (p &lt; 0,001 dla 100–150 ms i 100–200 ms). Również wartości LVOT–VTI były istotnie większe, gdy opóźnienie AV wynosiło 150 ms i 200 ms niż wtedy, gdy wynosiło ono 100 ms (p = 0,017 dla 100–150 ms i p = 0,013 dla 100–200 ms). Ponadto stwierdzono istotne zmniejszenie stężenia BNP przy opóźnieniu AV wynoszącym 150 ms i 200 ms w stosunku do wartości występujących przy100 ms (p = 0,001 dla 100–150 ms i p &lt; 0,001 dla 100–200 ms).Wnioski: U chorych z wszczepionym stymulatorem typu DDD i zachowaną czynnością skurczową LV wydłużenie opóźnienia AV miało korzystny wpływ na czynność skurczową LV, co wykazano w niniejszym badaniu, stosując metodę AFI.