Assessment of the association between quality of life in patients with atrial fibrillation and cardiovascular outcomes during the one-year follow-up

Introduction: Research evidence indicates that atrial fibrillation (AF) could have a negative impact on the quality-of-life (QoL). AF symptom pattern and AF-related QoL have been associated with adverse cardiovascular outcomes. Aim: The aims of the present study are to evaluate AF-related impact on QoL using the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire, and to assess the association of QoL with adverse cardiovascular outcomes during the 1-year follow-up. Material and methods: An observational, cohort study that included AF patients treated at the Cardiology Clinic, Clinical Center of Serbia, willing to fill-in AFEQT questionnaire to assess the overall QoL (AFEQT score, 0 to 100) and QoL components: symptoms, daily activities, treatment concerns and treatment satisfaction. During the prospective 1-year follow-up, data on the following outcomes were collected: 1) major adverse cardiovascular outcomes - a combined endpoint, including: stroke/transient ischemic attack, myocardial infarction, percutaneous/surgical coronary revascularization, or cardiovascular death; 2) hospitalization for heart failure. Results: We included 202 AF patients (mean age: 64.5±12.4 years; 62.9% men; 24.3% asymptomatic AF). The mean AFEQT score was 64.3± 8.8. There was a negative correlation between objective estimate of AF-related symptoms and AFEQT score (Spearman rho = -0.489, P<0.001). During 1-year follow-up, major adverse cardiovascular outcomes occurred in 8.4% of patients and 3.5% were hospitalized for heart failure. In a multivariate logistic regression model, controlling for clinical variables, treatment satisfaction score was significantly associated with major adverse cardiovascular outcomes (OR, 0.97; 95%CI, 0.94-0.99, P=0.022), while the overall AFEQT score was associated with heart failure hospitalizations (OR, 0.98; 95%CI, 0.95-0.99; P=0.014). Conclusion: Our results indicate that AF has a negative impact on QoL. Better QoL as assessed by AFEQT score and higher treatment satisfaction are associated with reduced odds for adverse outcomes, which is relevant for clinical risk-stratification and appropriate treatment of AF patients

Relationship between the type of atrial fibrillation and thromboembolic events

Background/Aim. Atrial fibrillation (AF) increases the risk for ischemic stroke and other thromboembolic (TE) events. Aim of the study was to examine the relationship between clinical types of atrial fibrillation (AF) and (TE) events. Methods. This longitudinal, observational study included patients with nonvalvular AF as main indication for in-hospital and/or outpatient treatment in the Cardiology Clinic, Clinical Center of Serbia during a period 1992-2007. The treatment of AF was based on the International Guidelines for diagnosis and treatment of AF, correspondent to given study period. Clinical types of AF were defined according to the latest ACC/AHA/ESC Guidelines for AF, from 2006. Diagnosis of central and systemic TE events during a follow-up was made exclusively by the neurologist and vascular surgeon. Results. During a follow-up of 9.9 ± 6 years, TE events were documented in 88/1 100 patients (8%). In the time of TE event 46/88 patients (52.3%) had permanent AF. The patients with permanent AF were at baseline significantly older and more frequently had underlying heart disease and diabetes mellitus. Cumulative TE risk during follow-up was similar for patients with paroxysmal and permanent AF, and significantly higher as compared to TE risk in patients with persistent AF. However, multivariate Cox proportional hazard regression analysis with independent variables clinical types of AF at baseline and in the time of TE event, clinical and echocardiographic characteristics and therapy for prevention of TE complications at baseline and at the time of TE event, did not reveal independent predictive value of clinical type of AF for the occurrence of TE events during a follow-up. Conclusion. TE risk in patients with AF does not depend on clinical type of AF. Treatment for prevention of TE events should be based on the presence of well recognized risk factors, and not on the clinical type of AF

Clinical Study Relation of Biomarkers of Inflammation and Oxidative Stress with Hypertension Occurrence in Lone Atrial Fibrillation

We compared plasma levels of biomarkers of inflammation (CRP) and oxidation (oxLDL), determined at study inclusion in lone atrial fibrillation (LAF) patients (48.6 ± 11.5 years; 74.0% men) and sinus rhythm controls (49.7 ± 9.3 years; 72.7% men, &gt; 0.05), and investigated the association of baseline CRP and oxLDL levels with the risk for vascular disease (VD) development (hypertension, cerebrovascular disease, coronary/peripheral artery disease, and pulmonary embolism) during prospective followup. Baseline CRP (1.2 [0.7-1.9] mg/L versus 1.1 [0.7-1.6] mg/L) and oxLDL levels (66.3 ± 21.2 U/L versus 57.1 ± 14.6 U/L) were higher in LAF patients (both &lt; 0.05). Following a median of 36 months, incident VD occurred in 14 (28.0%) LAF patients, all of whom developed arterial hypertension, and in 5 (11.4%) controls (hypertension, = 4; coronary artery disease, = 1), &lt; 0.05. LAF patients developed VD more frequently and at a younger age. Both CRP (HR, 2.54; 95% CI, 1.26-5.12; = 0.009) and oxLDL (HR, 2.24; 95% CI, 1.14-4.40; = 0.019) were multivariate predictors of incident hypertension in LAF patients, but not in the controls. Further research should clarify clinical relevance of investigated biomarkers for risk stratification and treatment of LAF patients

The Association of CHA2DS2-VASc Score and Blood Biomarkers with Ischemic Stroke Outcomes: The Belgrade Stroke Study

-VASc score with unfavourable functional outcome (defined as a 30-day modified Rankin Scale [mRS] ≥3) in patients presenting with acute ischemic stroke (AIS), and examined whether the addition of blood biomarkers (troponin I [TnI], fibrinogen, C-reactive protein [CRP]) affects the model discriminatory ability.We conducted an observational single-centre study of consecutive patients with AIS. All patients were admitted to hospital within 24 hours from the neurological symptoms onset.-VASc and TnI or TnI, fibrinogen and CRP (z statistic 0.369, p = 0.7119; integrated discrimination index 0.00801 and 0.00172, respectively, both p>0.05).-VASc score did not significantly increase the predictive ability of the model

PERINATAL DISORDERS AND FURTHER DEVELOPMENT OF THE HIGH-RISK NEWBORN INFANTS

Autori u radu ispituju razvoj djece s faktorima rizika a sa svrhom pravovremene detekcije neurorazvojnih smetnji, kako bi se na vrijeme mogao provesti odgovarajući tretman. U timskoj, interdisciplinarnoj obradi u kojoj su učestvovali neonatolog, fizijatar, pedopsiholog, defektolog logoped i defektolog pedagog obrađeno je 325 djece, 76 uredno rađenih koji predstavljaju kontrolnu skupinu i 249 rođenih uz faktore rizika (vakuum ekstraktor, prenošeni, prijevremeno rođeni, djeca od majki s EPH gestozom). Po otpustu iz rodilišta djeca su pismeno pazivana na kontrolu na koju su se javila u prosječnoj dobi od 4-5 godina. Rezultati su detaljno prikazani u tablicama. U novorođenačkoj dobi acidoza je najviše zastupljena u djece iz EPH gestoza {36Y/o) dok je novorođenačka žutica bila najčešća u djece rođene uz vakuum ekstraktor. Uredan novorođenački tok imalo je 85% djece rođene bez faktora rizika. U testu inteligencije najbolje su rezultate pokazala djeca iz EPH gestoze, oni imaju i najmanje izraženu hiperaktivnost. Smetnje ponašanja (48°/o) najviše su bile izražene u skupini djece rođene uz vakuum ekstraktor. Uredan nalaz lokomotorike pokazalo je 30,3"/o djece, pretežno iz kontrolne skupine, dok je 67,1U/~ djece imalo naznačene smetnje lokomocije. Sve aberacije razvoja djece dijagnosticirane su tijekom praćenja ove djece, dok ih okolina nije zamj ećivala , pa stoga autori ukazuju na potrebu stalnog praćenja sve djece, a rizične posebno tijekom cijelog djetinjstva.In this paper the authors deal with development of the infants with risk factors in order to detect on time a neurological development of their disorders, and to apply an adequate treatment. The interdisicplinary team-work included a neonatologist, a physiatrist, a pedopsychologist, a defectologist engaged in treatment of speech defects and a defectologist-pedagogue. In this study 325 children were elaborated, of whom 76 were normally born representing a ocntrol group, and 249 children were born with risk factors (vacuum extractor, postmaturity, prematurity, children born of mothers with EPH gestosis). The children were later invited to come for a followup, and this control took place when the children were at their mean age of 4,5 years. The results were shown in tables in detail. At the newborn age acidosis was mostly present in the infants bor of mothers with EPH gestosis (36,3~/o), while the newborn icterus was not frequently found in infants delivered by vacuum extractor. The normal newborn course had 85°/o infants without a risk factor. In IQ test the best results were demonstrated in children born of mothers with EPH gestosis. They had least expressed hyper· activity. The behavioural disorders (48,03/o) were mostly expressed in the group of children delivered by vacuum extractor. The normal locomotor finding was evident in 30,3% children, and it was mostly found in the control group, while 67,1% children had slight locomotor disorders. All developmental aberations of cheldren were diagnosed during their follow-up, while these were not noticed by their family. Therefore, the authors stress the need of permanent follow-up of all children, especially those with risk during the whole childhood

Management of patients with adrenal incidentaloma – 2019 update

Zadnjih desetak godina došlo je do značajnih promjena u zdravstvenom zbrinjavanju bolesnika s incidentalomima nadbubrežne žlijezde koje su rezultirale novim preporukama za dijagnostiku i liječenje ovih bolesnika napravljenim u suradnji Europskoga endokrinološkog društva i Europske mreže za istraživanje tumora nadbubrežne žlijezde. Na temelju navedenih preporuka i višegodišnjega vlastitog iskustva Referentni centar Ministarstva zdravstva Republike Hrvatske za bolesti nadbubrežne žlijezde predlaže izmjene i dopune preporuka za dijagnostiku i liječenje ovih bolesnika objavljenih u Liječničkom vjesniku 2010. godine.In the last decade, the clinical care of patients with adrenal incidentaloma has been significantly changed which prompted the European Society of Endocrinology and European Network for the Study of Adrenal Tumors to develop an updated clinical practice guideline for the management of these patients. In accordance with the aforementioned recommendations and based on its own experience, the Croatian Referral Center for adrenal gland disorders provides an update of the previous guideline for the clinical management of patients with adrenal incidentaloma published in Liječnički vjesnik in 2010

Assessment and prognostic implications of endothelial function in patients with atrial fibrillation.

UVOD: u atrijalnoj fibrilaciji (AF) povišen je rizik od tromboembolijskih (TE) komplikacija praćenih visokim mortalitetom ili trajnim invaliditetom. Poslednjih godina je pokazano da povišenom TE riziku, pored staze krvi u levoj pretkomori (LP), doprinose strukturne i funkcionalne promene endotela LP, kao i povišeni nivoi cirkulišućih medijatora koji odražavaju proinflamatorno (npr. C-reaktivni protein, CRP, fibrinogen), prokoagulantno (npr. D-dimer), prooksidativno stanje (npr. oksidisani lipoproteini male gustine, oxLDL) i neurohormonalnu aktivaciju (npr. B-tip natriuretskog peptida, BNP). Endotelno oštećenje je najčeće povezano sa povišenom koncetracijom von Willebrandovog faktora (vWF) u krvi, za koji se smatra da potiče iz oštećenog endokarda LP. Kod jednog broja obolelih, dokumentovani su i znaci disfunkcije endotela arterijskih krvnih sudova (snižena endotel-zavisna dilatacija, flow-mediated dilation, FMD), a pokazana je i povezanost endotelnog oštećenja, prokoagulantnih medijatora i remodelovanja LP. Međutim, ostalo je nerazjašnjeno da li je endotelna disfunkcija prisutna kod svih obolelih od AF (nezavisno od kliničkog tipa aritmije ili pridruženog kardiovaskularnog oboljenja), da li je endotelna disfunkcja ograničena na LP ili obuhvata i disfunkciju vaskularnog endotela i da li doprinosi prokoagulantnom, proinflamatornom i prooksidativnom stanju. Takođe, prognostički značaj endotelne (dis)funkcije u pogledu uticaja na morbiditet i mortalitet obolelih od AF nedovoljno je ispitan. CILJEVI ISTRAŽIVANJA: (I) Procena vaskularne endotelne funkcije ultrazvučnom metodom endotel-zavisne vazodilatcije brahijalne arterije (FMD) kod obolelih od AF sa i bez strukturnog srčanog oboljenja i kardiovaskularnih (KV) faktora rizika. (II) Poređenje pokazatelja endotelne funkcije obolelih od AF i zdravih osoba. (III) Procena povezanosti pokazatelja endotelne funkcije određenih pomoću FMD metode i laboratorijskih pokazatelja endotelnog oštećenja (vWF), inflamacije (CRP, fibrinogen), tromboze (D-dimer), neurohormonalne aktivacije (BNP) i oksidativnog stresa (oxLDL). (IV) Ispitivanje povezanosti endotelne funkcije (FMD i vWF) i remodelovanja LP, izraženog ehokardiografskom procenom volumena LP. (V) Ispitivanje značaja endotelne funkcije za prognozu različitih oblika AF (paroksizmalne, perzistentne, permanentne) kod osoba sa i bez strukturnog srčanog oboljenja...INTRODUCTION: atrial fibrillation (AF) confers an increased risk of thromboembolic (TE) complications, associated with high mortality and disability rates. Besides blood stasis in the left atrium (LA), recent evidence attributed increased TE risk in AF to the structural and functional changes of the atrial endocardium and to the raised blood levels of pro-inflammatory (i.e C-reactive protein, CRP, fibrinogen), pro-thrombotic (i.e D-dimer), and pro-oxidative (oxidized low density lipoprotein, oxLDL) mediators and increased neurohormonal activity (i.e. B-type natriuretic peptide, BNP). Endothelial dysfunction in AF was associated with increased plasma levels of von Willebrand factor (vWF), considered a marker of endocardial damage. In some instances, decreasedendothelium dependent vasodilation (FMD) was documented in the peripheral blood vessels of AF patients, accompanied by increased levels of procoagulant factors and evidence of LA remodeling. However, whether endothelial dysfunction is present in all AF subjects (regardless of AF type or associated comorbidities) and whether endothelial dysfunction is systemic or confined to the LA endocardium remains unclear. The association of endothelial dysfunction with markers of inflammation, oxidative and prothrombotic state and neurohormonal activation is also unclear. The prognostic significance of endothelial dysfunction in AF remained largely un-investigated. AIMS: (I) Assessment of brachial artery FMD by vascular ultrasound in AF patients with and without associated cardiovascular (CV) disease. (II) Comparison of FMD in AF patients with healthy controls in sinus rhythm. (III) Assessment of the association between markers of endothelial (dys)function (FMD, vWF) and biomarkers of inflammation (CRP, fibrinogen), thrombosis (D-dimer), oxidative stress (oxLDL) and neurohormonal activity (BNP). (IV) Assessment of the association of markers of endothelial (dys)function (FMD, vWF) with LA remodeling as evidenced by echocardiographic determination of the LA volume. (V) Evaluation of the prognostic significance of endothelial (dys)function for adverse vascular events in AF patients with and without CV disease..

Assessment and prognostic implications of endothelial function in patients with atrial fibrillation.

UVOD: u atrijalnoj fibrilaciji (AF) povišen je rizik od tromboembolijskih (TE) komplikacija praćenih visokim mortalitetom ili trajnim invaliditetom. Poslednjih godina je pokazano da povišenom TE riziku, pored staze krvi u levoj pretkomori (LP), doprinose strukturne i funkcionalne promene endotela LP, kao i povišeni nivoi cirkulišućih medijatora koji odražavaju proinflamatorno (npr. C-reaktivni protein, CRP, fibrinogen), prokoagulantno (npr. D-dimer), prooksidativno stanje (npr. oksidisani lipoproteini male gustine, oxLDL) i neurohormonalnu aktivaciju (npr. B-tip natriuretskog peptida, BNP). Endotelno oštećenje je najčeće povezano sa povišenom koncetracijom von Willebrandovog faktora (vWF) u krvi, za koji se smatra da potiče iz oštećenog endokarda LP. Kod jednog broja obolelih, dokumentovani su i znaci disfunkcije endotela arterijskih krvnih sudova (snižena endotel-zavisna dilatacija, flow-mediated dilation, FMD), a pokazana je i povezanost endotelnog oštećenja, prokoagulantnih medijatora i remodelovanja LP. Međutim, ostalo je nerazjašnjeno da li je endotelna disfunkcija prisutna kod svih obolelih od AF (nezavisno od kliničkog tipa aritmije ili pridruženog kardiovaskularnog oboljenja), da li je endotelna disfunkcja ograničena na LP ili obuhvata i disfunkciju vaskularnog endotela i da li doprinosi prokoagulantnom, proinflamatornom i prooksidativnom stanju. Takođe, prognostički značaj endotelne (dis)funkcije u pogledu uticaja na morbiditet i mortalitet obolelih od AF nedovoljno je ispitan. CILJEVI ISTRAŽIVANJA: (I) Procena vaskularne endotelne funkcije ultrazvučnom metodom endotel-zavisne vazodilatcije brahijalne arterije (FMD) kod obolelih od AF sa i bez strukturnog srčanog oboljenja i kardiovaskularnih (KV) faktora rizika. (II) Poređenje pokazatelja endotelne funkcije obolelih od AF i zdravih osoba. (III) Procena povezanosti pokazatelja endotelne funkcije određenih pomoću FMD metode i laboratorijskih pokazatelja endotelnog oštećenja (vWF), inflamacije (CRP, fibrinogen), tromboze (D-dimer), neurohormonalne aktivacije (BNP) i oksidativnog stresa (oxLDL). (IV) Ispitivanje povezanosti endotelne funkcije (FMD i vWF) i remodelovanja LP, izraženog ehokardiografskom procenom volumena LP. (V) Ispitivanje značaja endotelne funkcije za prognozu različitih oblika AF (paroksizmalne, perzistentne, permanentne) kod osoba sa i bez strukturnog srčanog oboljenja...INTRODUCTION: atrial fibrillation (AF) confers an increased risk of thromboembolic (TE) complications, associated with high mortality and disability rates. Besides blood stasis in the left atrium (LA), recent evidence attributed increased TE risk in AF to the structural and functional changes of the atrial endocardium and to the raised blood levels of pro-inflammatory (i.e C-reactive protein, CRP, fibrinogen), pro-thrombotic (i.e D-dimer), and pro-oxidative (oxidized low density lipoprotein, oxLDL) mediators and increased neurohormonal activity (i.e. B-type natriuretic peptide, BNP). Endothelial dysfunction in AF was associated with increased plasma levels of von Willebrand factor (vWF), considered a marker of endocardial damage. In some instances, decreasedendothelium dependent vasodilation (FMD) was documented in the peripheral blood vessels of AF patients, accompanied by increased levels of procoagulant factors and evidence of LA remodeling. However, whether endothelial dysfunction is present in all AF subjects (regardless of AF type or associated comorbidities) and whether endothelial dysfunction is systemic or confined to the LA endocardium remains unclear. The association of endothelial dysfunction with markers of inflammation, oxidative and prothrombotic state and neurohormonal activation is also unclear. The prognostic significance of endothelial dysfunction in AF remained largely un-investigated. AIMS: (I) Assessment of brachial artery FMD by vascular ultrasound in AF patients with and without associated cardiovascular (CV) disease. (II) Comparison of FMD in AF patients with healthy controls in sinus rhythm. (III) Assessment of the association between markers of endothelial (dys)function (FMD, vWF) and biomarkers of inflammation (CRP, fibrinogen), thrombosis (D-dimer), oxidative stress (oxLDL) and neurohormonal activity (BNP). (IV) Assessment of the association of markers of endothelial (dys)function (FMD, vWF) with LA remodeling as evidenced by echocardiographic determination of the LA volume. (V) Evaluation of the prognostic significance of endothelial (dys)function for adverse vascular events in AF patients with and without CV disease..

Assessment and prognostic implications of endothelial function in patients with atrial fibrillation.

UVOD: u atrijalnoj fibrilaciji (AF) povišen je rizik od tromboembolijskih (TE) komplikacija praćenih visokim mortalitetom ili trajnim invaliditetom. Poslednjih godina je pokazano da povišenom TE riziku, pored staze krvi u levoj pretkomori (LP), doprinose strukturne i funkcionalne promene endotela LP, kao i povišeni nivoi cirkulišućih medijatora koji odražavaju proinflamatorno (npr. C-reaktivni protein, CRP, fibrinogen), prokoagulantno (npr. D-dimer), prooksidativno stanje (npr. oksidisani lipoproteini male gustine, oxLDL) i neurohormonalnu aktivaciju (npr. B-tip natriuretskog peptida, BNP). Endotelno oštećenje je najčeće povezano sa povišenom koncetracijom von Willebrandovog faktora (vWF) u krvi, za koji se smatra da potiče iz oštećenog endokarda LP. Kod jednog broja obolelih, dokumentovani su i znaci disfunkcije endotela arterijskih krvnih sudova (snižena endotel-zavisna dilatacija, flow-mediated dilation, FMD), a pokazana je i povezanost endotelnog oštećenja, prokoagulantnih medijatora i remodelovanja LP. Međutim, ostalo je nerazjašnjeno da li je endotelna disfunkcija prisutna kod svih obolelih od AF (nezavisno od kliničkog tipa aritmije ili pridruženog kardiovaskularnog oboljenja), da li je endotelna disfunkcja ograničena na LP ili obuhvata i disfunkciju vaskularnog endotela i da li doprinosi prokoagulantnom, proinflamatornom i prooksidativnom stanju. Takođe, prognostički značaj endotelne (dis)funkcije u pogledu uticaja na morbiditet i mortalitet obolelih od AF nedovoljno je ispitan. CILJEVI ISTRAŽIVANJA: (I) Procena vaskularne endotelne funkcije ultrazvučnom metodom endotel-zavisne vazodilatcije brahijalne arterije (FMD) kod obolelih od AF sa i bez strukturnog srčanog oboljenja i kardiovaskularnih (KV) faktora rizika. (II) Poređenje pokazatelja endotelne funkcije obolelih od AF i zdravih osoba. (III) Procena povezanosti pokazatelja endotelne funkcije određenih pomoću FMD metode i laboratorijskih pokazatelja endotelnog oštećenja (vWF), inflamacije (CRP, fibrinogen), tromboze (D-dimer), neurohormonalne aktivacije (BNP) i oksidativnog stresa (oxLDL). (IV) Ispitivanje povezanosti endotelne funkcije (FMD i vWF) i remodelovanja LP, izraženog ehokardiografskom procenom volumena LP. (V) Ispitivanje značaja endotelne funkcije za prognozu različitih oblika AF (paroksizmalne, perzistentne, permanentne) kod osoba sa i bez strukturnog srčanog oboljenja...INTRODUCTION: atrial fibrillation (AF) confers an increased risk of thromboembolic (TE) complications, associated with high mortality and disability rates. Besides blood stasis in the left atrium (LA), recent evidence attributed increased TE risk in AF to the structural and functional changes of the atrial endocardium and to the raised blood levels of pro-inflammatory (i.e C-reactive protein, CRP, fibrinogen), pro-thrombotic (i.e D-dimer), and pro-oxidative (oxidized low density lipoprotein, oxLDL) mediators and increased neurohormonal activity (i.e. B-type natriuretic peptide, BNP). Endothelial dysfunction in AF was associated with increased plasma levels of von Willebrand factor (vWF), considered a marker of endocardial damage. In some instances, decreasedendothelium dependent vasodilation (FMD) was documented in the peripheral blood vessels of AF patients, accompanied by increased levels of procoagulant factors and evidence of LA remodeling. However, whether endothelial dysfunction is present in all AF subjects (regardless of AF type or associated comorbidities) and whether endothelial dysfunction is systemic or confined to the LA endocardium remains unclear. The association of endothelial dysfunction with markers of inflammation, oxidative and prothrombotic state and neurohormonal activation is also unclear. The prognostic significance of endothelial dysfunction in AF remained largely un-investigated. AIMS: (I) Assessment of brachial artery FMD by vascular ultrasound in AF patients with and without associated cardiovascular (CV) disease. (II) Comparison of FMD in AF patients with healthy controls in sinus rhythm. (III) Assessment of the association between markers of endothelial (dys)function (FMD, vWF) and biomarkers of inflammation (CRP, fibrinogen), thrombosis (D-dimer), oxidative stress (oxLDL) and neurohormonal activity (BNP). (IV) Assessment of the association of markers of endothelial (dys)function (FMD, vWF) with LA remodeling as evidenced by echocardiographic determination of the LA volume. (V) Evaluation of the prognostic significance of endothelial (dys)function for adverse vascular events in AF patients with and without CV disease..

Significance of heterogenity in endothel-dependent vasodilatation occurrence in healthy individuals with or without coronary risk factors

Background/Aim. Brachial artery flow-mediated dilation (FMD) is extensively used for non-invasive assessment of endothelial function. Traditionally, FMD is calculated as a percent change of arterial diameter from the baseline value at an arbitrary time point after cuff deflation (usually 60 seconds). Considerable individual differences in brachial artery temporal response to hyperemic stimulus have been observed, potentially influenced by the presence of atherosclerotic risk factors (RF). The importance of such differences for the evaluation of endothelial function has not been well established. The aim of the stady was to determine the time course of maximal brachial artery endothelium- dependent dilation in healthy adults with and without RF, to explore the correlation of RF with brachial artery temporal response and to evaluate the importance of individual differences in temporal response for the assessment of endothelial function. Methods. A total of 115 healthy volunteers were included in the study. Out of them, 58 had no RF (26 men, mean age 44 ± 14 years) and 57 had at least one RF (29 men, mean age 45 ± 14 years). High-resolution color Doppler vascular ultrasound was used for brachial artery imaging. To determine maximal arterial diameter after cuff deflation and the time-point of maximal vasodilation off-line sequential measurements were performed every 10 seconds from 0 to 240 seconds after cuff release. True maximal FMD value was calculated as a percent change of the true maximal diameter from the baseline, and compared with FMD value calculated assuming that every participant reached maximal dilation at 60 seconds post cuff deflation (FMD60). Correlation of different RF with brachial artery temporal response was assessed. Results. A maximal brachial artery endothelium-dependent vasodilation occurred from 30-120 seconds after cuff release, and the mean time of endothelium-dependent dilation was 68 ± 20 seconds. Individuals without RF had faster endothelium-dependent dilation (mean time 62 ± 17 seconds), and a shorter timespan (30 to 100 seconds), than participants with RF (mean time 75 ± 21 seconds, time-span 40 to 120 seconds) (p &lt; 0.001). Time when the maximal endotheliumdependent dilation occurred was independently associated with age, serum lipid fractions (total cholesterol, LDL and HDL cholesterol), smoking, physical activity and C-reactive protein. True maximal FMD value in the whole group (6.7 ± 3.0%) was significantly higher (p &lt; 0.001) than FMD60 (5.2 ± 3.5%). The same results were demonstrated for individuals with RF (4.9 ± 1.7% vs 3.1 ± 2.3%, p &lt; 0.001) and without RF (8.4 ± 2.9% vs 7.2 ± 3.2%, p &lt; 0.05). Conclusion. The temporal response of endothelium- dependent dilation is influenced by the presence of coronary FR and individually heterogeneous. When calculated according to the commonly used approach, i.e. 60 seconds after cuff deflation, FMD is significantly lower than the true maximal FMD. The routinely used measurement time-points for FMD assessment may not be adequate for the detection of true peak vasodilation in individual persons. More precise evaluation of endothelial function can be achieved with sequential measurement of arterial diameter after hyperemic stimulus