Frequency of left ventricular hypertrophy in non-valvular atrial fibrillation

Left ventricular hypertrophy (LVH) is significantly related to adverse clinical outcomes in patients at high risk of cardiovascular events. In patients with atrial fibrillation (AF), data on LVH, that is, prevalence and determinants, are inconsistent mainly because of different definitions and heterogeneity of study populations. We determined echocardiographic-based LVH prevalence and clinical factors independently associated with its development in a prospective cohort of patients with non-valvular (NV) AF. From the "Atrial Fibrillation Registry for Ankle-brachial Index Prevalence Assessment: Collaborative Italian Study" (ARAPACIS) population, 1,184 patients with NVAF (mean age 72 \ub1 11 years; 56% men) with complete data to define LVH were selected. ARAPACIS is a multicenter, observational, prospective, longitudinal on-going study designed to estimate prevalence of peripheral artery disease in patients with NVAF. We found a high prevalence of LVH (52%) in patients with NVAF. Compared to those without LVH, patients with AF with LVH were older and had a higher prevalence of hypertension, diabetes, and previous myocardial infarction (MI). A higher prevalence of ankle-brachial index 640.90 was seen in patients with LVH (22 vs 17%, p = 0.0392). Patients with LVH were at significantly higher thromboembolic risk, with CHA2DS2-VASc 652 seen in 93% of LVH and in 73% of patients without LVH (p <0.05). Women with LVH had a higher prevalence of concentric hypertrophy than men (46% vs 29%, p = 0.0003). Logistic regression analysis demonstrated that female gender (odds ratio [OR] 2.80, p <0.0001), age (OR 1.03 per year, p <0.001), hypertension (OR 2.30, p <0.001), diabetes (OR 1.62, p = 0.004), and previous MI (OR 1.96, p = 0.001) were independently associated with LVH. In conclusion, patients with NVAF have a high prevalence of LVH, which is related to female gender, older age, hypertension, and previous MI. These patients are at high thromboembolic risk and deserve a holistic approach to cardiovascular prevention

Assessment of renal resistance index after captopril test by Doppler in essential and renovascular hypertension.

Assessment of renal resistance index after captopril test by Doppler in essential and renovascular hypertension. Ultrasonic duplex scanning has been validated as a noninvasive method to evaluate the kidney arteries and hemodynamic characteristics of renal blood flow in patients with renal artery stenosis. The purpose of our study was to assess the changes in renal vascular impedance in 22 patients with renovascular hypertension, as compared with 45 essential hypertensives and 15 normotensives, by using the Doppler parameter resistance index (RI) before and after a captopril oral test. After the captopril test the ΔRI decreased significantly in the stenotic artery (P < 0.05). Univariate analysis showed that PRA values after captopril correlated inversely with the changes of RI only in the stenotic artery (P < 0.05). Thus, our findings suggest that the application of the captopril test to renal echo-Doppler may represent a feasible, noninvasive, and inexpensively useful tool in the screening studies aimed at diagnosing renovascular hypertension