Evaluation of nocturnal blood pressure by the Multi-P Analysis of 24-hour ambulatory monitoring

Ambulatory blood pressure monitoring (ABPM) is utilized to identify "dippers" and "non dippers" among hypertensives. Such a classification has either prognostic or therapeutical implications. Rigid definitions of nocturnal time period (e.g., from 10 p.m. to 7 a.m.) may not correspond to actual sleep patterns, and thus may lead to faulty interpretations. In our study, we analyzed 32 ABPM; diurnal and nocturnal blood pressure (BP) were assessed by three different ways: the patients' diary method; fixed intervals utilized by Spacelabs software; Multi-P Analysis (MPA) of the data. MPA method proved to be effective to evaluate nocturnal BP values. In comparison with Spacelabs program, it seems to define more precisely nocturnal BP, which differs less from the real sleep-time values. This modifies the percentage of dippers, which is greater than that obtained by Spacelabs program and equal to that calculated by the patients reported nocturnal sleep intervals. These results suggest that MPA method may be a contribution to a better definition of nocturnal B

Comparative effects of lisinopril and losartan on insulin sensitivity in the treatment of non diabetic hypertensive patients

AIMS: The aim of this study was to compare the effects of the ACE-inhibitor lisinopril and the angiotensin II receptor antagonist losartan on insulin sensitivity in the treatment of non diabetic hypertensives. METHODS: Twenty-five non diabetic subjects with mild to moderate hypertension, 11 females and 14 males, aged 44-63 years, after a 4-week wash-out period on placebo, were randomized to receive lisinopril 20 mg once daily or losartan 50 mg once daily for 6 weeks. Following another 4-week wash-out period, patients were crossed to the alternative regimen for further 6 weeks. At the end of the placebo and of the active treatment periods, blood pressure (BP) was measured (by standard mercury sphygmomanometer, Korotkoff I and V) and insulin sensitivity was assessed by the euglycaemic hyperinsulinaemic clamp technique. Glucose infusion rate (GIR) during the last 30 min of clamp and total glucose requirement (TGR) were evaluated. RESULTS: Both lisinopril and losartan significantly reduced SBP (by a mean of 20.2 and 17.2 mmHg, respectively) and DBP (by a mean of 15.2 and 12.3 mmHg, respectively), with no difference between the two treatments. GIR, used as an indicator of insulin sensitivity, was significantly increased by lisinopril (+1.5 mg min(-1) kg(-1), P<0.05 vs baseline) but not by losartan (+0.42 mg min(-1) kig(-1), NS), the difference between the two drugs being statistically significant (P<0.05). TGR was increased by lisinopril (+7.3 g, P<0.05 vs baseline), whereas losartan did not significantly modify it (+1.9 g, NS). CONCLUSIONS: In conclusion, with all cautions due to an absence in this study of a randomized placebo phase, our findings suggest that lisinopril improved insulin sensitivity whereas losartan did not affect i

ECG-based score estimates the probability to detect Fabry Disease cardiac involvement

Objectives: To elaborate an ECG-based nomogram estimating the probability to detect cardiac involvement by cardiac magnetic resonance (CMR) in Fabry Disease (FD). Methods: 119 FD patients and 26 healthy controls underwent ECG and CMR. Test (n = 88, 60%) and validation cohorts (n = 57, 40%) were randomly derived. Cardiac involvement was defined as the presence of low myocardial T1 value, a CMR-surrogate of myocardial glycosphingolipid storage. ECG changes associated with low T1 value were identified in the test cohort, included in the nomogram and then tested in the validation cohort. Results: Sokolow-Lyon index (AUC = 0.769), ratio between P-wave and PR-segment durations (Pwave/PRsegment) (AUC = 0.778), QRS duration (AUC = 0.703), QT (AUC = 0.769) duration were independently associated with the presence of low T1 on CMR at multivariate analysis. An ECG-based nomogram including these four parameters was accurate in identifying patients with CMR evidence of glycosphingolipid storage (c-index of the derived-nomogram = 0.90 in the test group; 0.81 in the validation group). Conclusion: We propose a practical ECG-based nomogram accurately estimating the probability to detect low T1 values by CMR in FD patients. The application of this tool in clinical practice could improve early detection of FD cardiac involvement.</p

Trabecular complexity as an early marker of cardiac involvement in Fabry disease

Aims Fabry cardiomyopathy is characterized by glycosphingolipid storage and increased myocardial trabeculation has also been demonstrated. This study aimed to explore by cardiac magnetic resonance whether myocardial trabecular complexity, quantified by endocardial border fractal analysis, tracks phenotype evolution in Fabry cardiomyopathy. Methods and results Study population included 20 healthy controls (12 males, age 32 +/- 9) and 45 Fabry patients divided into three groups: 15 left ventricular hypertrophy (LVH)-negative patients with normal T1 (5 males, age 28 +/- 13; Group 1); 15 LVH-negative patients with low T1 (9 males, age 33 +/- 9.6; Group 2); 15 LVH-positive patients (11 males, age 53.5 +/- 9.6; Group 3). Trabecular fractal dimensions (Dfs) (total, basal, mid-ventricular, and apical) were evaluated on cine images. Total Df was higher in all Fabry groups compared to controls, gradually increasing from controls to Group 3 (1.27 +/- 0.02 controls vs. 1.29 +/- 0.02 Group 1 vs. 1.30 +/- 0.02 Group 2 vs. 1.34 +/- 0.02 Group 3; P&lt;0.001). Group 3 showed significantly higher values of all Dfs compared to the other Groups. Both basal and total Dfs were significantly higher in Group 1 compared with controls (basal: 1.30 +/- 0.03 vs. 1.26 +/- 0.04, P =0.010; total: 1.29 +/- 0.02 vs. 1.27 +/- 0.02, P=0.044). Total Df showed significant correlations with: (i) T1 value (r=-0.569; P&lt;0.001); (ii) LV mass (r=0.664, P&lt;0.001); (iii) trabecular mass (r=0.676; P &lt;0.001); (iv) Mainz Severity Score Index (r=0.638; P&lt;0.001). Conclusion Fabry cardiomyopathy is characterized by a progressive increase in Df of endocardial trabeculae together with shortening of T1 values. Myocardial trabeculation is increased before the presence of detectable sphingolipid storage, thus representing an early sign of cardiac involvement

Atrial Dysfunction Assessed by Cardiac Magnetic Resonance as an Early Marker of Fabry Cardiomyopathy

In this retrospective, observational study, 45 patients with Anderson-Fabry disease (AFD) underwent CMR with T1 mapping using shortened modified Look-Locker inversion recovery sequences, 2-dimensional echocardiography and quantification of Mainz Severity Score Index (MSSI). LA total strain showed very good correlation with native septal T1, LV maximum wall thickness, atrial volumes, and global or cardiovascular MSSI. A good correlation was found with native T1 values, which in pre-hypertrophic patients with AFD had been shown to provide prognostic information. This study contributes to the characterization of the pre-hypertrophic phenotype of AFD, introducing LA total strain as a potential novel indicator of early cardiac involvement and a possible tool to personalize management decisions in Fabry disease patients