INVERSE RELATIONSHIP BETWEEN AORTIC ROOT DIAMETER AND RENAL FUNCTION IN HYPERTENSIVE SUBJECTS

Recent studies suggest that enlarged aortic root diameter (ARD) may predict cardiovascular events in absence of aneurysmatic alterations. Little is known about the influence of renal function on ARD. Our study was aimed to assess the relationships between glomerular filtration rate (GFR) and ARD in hypertensive subjects

[OP.7B.08] INFLUENCE OF GENDER ON THE RELATIONSHIPS BETWEEN NEW INDICES OF ADIPOSITY AND LEFT VENTRICULAR MASS AND HYPERTROPHY IN HYPERTENSIVE PATIENTS

OBJECTIVE: The unfavourable effects of the association of obesity with hypertension on cardiac structure and function have been extensively studied. However, controversy still exists about the influence of gender on the relationship between obesity and left ventricular mass (LVM) and hypertrophy (LVH). Even if body mass index (BMI) and waist circumference (WC) are widely used as anthropometric predictors for cardiovascular diseases (CVD), their validity has been questioned. Recently, Body Shape Index (ABSI) and Body Roundness Index (BRI) were proposed as alternative measures of adiposity that may better reflect health status (1-2).Our study was aimed to assess the ability of ABSI and BRI in identifying LVH and to determine whether they are superior to BMI and WC. Moreover, the influence of gender on the relationships between all these indices of adiposity and LVM was also evaluated. DESIGN AND METHOD: We enrolled 724 subjects with EH (mean age 45 ± 12 years, 63 % men) without cardiovascular complications.In all subjects the anthropometric indices (weight, height and waist circumference) and the routine biochemical parameters were determined. BMI, ABSI and BRI were calculated. Furthermore, all patients underwent a 24-h blood pressure monitoring and an echocardiogram. LVM was indexed for body surface area (LVMI) and for height2.7 (LVMH2.7). RESULTS: The univariate correlations of LVMI and LVMH2.7 with the measures of adiposity evaluated are shown in the table 1.ROC curves analysis revealed that in overall population (table 2) and in men BRI has a greater ability to identify LVH defined as LVMH2.7 > 51 g/m2.7.(Figure is included in full-text article.) CONCLUSIONS: : Our results seems to suggest that in men, but not in women, the BRI has a greater sensitivity to detect LVH than ABSI and the traditional measures of adiposity

Outcome of 421 adult patients with Philadelphia-negative acute lymphoblastic leukemia treated under an intensive program inspired by the GIMEMA LAL1913 clinical trial: a Campus ALL study

The introduction of pediatric-inspired regimens in adult Philadelphia-negative acute lymphoblastic leukemia (Ph-ALL) has significantly improved patients’ prognosis. Within the Campus ALL network we analyzed the outcome of adult Ph-ALL patients treated according to the GIMEMA LAL1913 protocol outside the clinical trial, to compare the real-life data with the study results. We included 421 consecutive patients, with a median age of 42 years. The complete remission (CR) rate after the first course of chemotherapy was 94% and a measurable residual disease (MRD) negativity after the third course was achieved in 72% of patients. The 3-year overall survival (OS) and disease-free survival (DFS) were 67% and 57%, respectively. In a multivariate analysis, MRD positivity negatively influenced DFS. In a time-dependent analysis including only very high risk (VHR) and MRD positive cases, transplanted (HSCT) patients had a significantly better DFS than non-HSCT ones (P=0.0017). During induction, grade ≥2 pegaspargase-related hepato-toxicity was observed in 25% of patients (vs 12% in the GIMEMA LAL1913 trial, P=0.0003). In this large real-life cohort of Ph-ALL, we confirmed the very high CR rate and a superimposable OS and DFS compared to the GIMEMA LAL1913 clinical trial: CR rate after C1 94% vs 85%, P=0.0004; 3-year OS 67% vs 67%, P=0.94; 3-year DFS 57% vs 63%, P=0.17. HSCT confirms its important role in VHR and MRD-positive patients. The rate of pegaspargase-related toxicity was significantly higher in the real-life setting, emphasizing the importance of dose adjustment in the presence of risk factors to avoid excessive toxicity

[OP.3B.03] INFLUENCE OF SUBCLINICAL RENAL DAMAGE ON EARLY VASCULAR AGING IN PATIENT WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Objective: It is well known that kidney is frequently involved in patients with Systemic Lupus Erythematosus (SLE) However, conflicting data exist about the impact of renal involvement on vascular damage in this group of patients. The aim of this study was to evaluate the influence of renal damage on assessed by aortic pulse wave velocity (aPWV), evaluated a by intima-media thickness (IMT) measurement and assessed by renal resistive index (RRI) measurement, in patients with SLE. Design and method: We enrolled 52 SLE subjects (mean age 39 +/- 12 years), divided in two subgroups according to ACR/SLICC classification: patients with lupus nephritis, (LNG), and individuals presenting other features of SLE (Non Lupus Nephritis group, NLNG), compared to 20 age and sex matched healthy subjects. Each patient performed routine blood chemistry, ultrasonographic renal RI, ambulatory blood pressure measurement (ABPM), aPWV through an oscillometric device and ultrasound evaluation of carotid IMT. Results: These groups did not differ regarding clinical and demographic characteristics and 24-hour blood pressures Despite this, lupus patients showed higher values of IMT (ANOVA p = 0.0001), of aPWV (p < 0.01) and of RRI (p = 0.02) when compared to those of CG. NLNG showed similar values of IMT, aPWV, RRI and a lower percentage of patient treated with immunosuppressive drugs when compared to LNG (p = 0.0001). When the SLE patients were re-classified according to KDIGO classification, in 1) patients without Cronich Kidney Disease: NCKD), 2) patients with preclinical renal damage (PCKD) and 3) patients with clinical renal damage we observed that PCKD group showed higher values of IMT and aPWV in comparison to those of CCKD (both p = 0.001) and of NCKD groups (both p = 0.001), but similar RRI (p = ns). The percentage of patients treated with immunosopressive drugs was similar in PCKD group when compared to that of NCKD group, but lower than CCKD group (p = 0.05). Conclusions: Our results suggest that a good treatment in lupus nephritis leads to a reduced vascular involvement, and overall, being subclinical renal damage a powerful predictor of cardiovascular events, SLICC criteria should be reconsidered in order to avoid an under diagnosis and treatment of renal involvement in SLE patients

ASSOCIATION OF RENAL RESISTIVE INDEX WITH MARKERS OF EXTRARENAL VASCULAR CHANGES IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Introduction: Recent data suggest that renal hemodynamic parameters obtained by duplex Doppler sonography, especially the intrarenal resistive index (RRI), may be associated with systemic vascular changes. However, limited and conflicting data exist about the relationship between aortic stiffness and RI in autoimmune diseases, like systemic lupus erythematosus (SLE). Aim: To evaluate the relationship between RRI and arterial stiffness, assessed by aortic pulse wave velocity (aPWV), and between RRI and carotid atherosclerosis, evaluated by intima-media thickness (IMT) measurement in patients with SLE. Methods: In this cross-sectional study, we enrolled 39 SLE subjects (mean age 39 years) that were compared with a control group of healthy individuals, matched for age and sex. In all subjects routine blood chemistry and standard urinalysis were obtained. Each patient performed ultrasonographic renal RI, 24-h ambulatory blood pressure measurement (ABPM), aPWV through an oscillometric device and ultrasound evaluation of carotid IMTResults: RI correlated significantly with aortic PWV (r: 0.44; p = 0.006), and with carotid IMT (r: 0.46; p = 0.003) in the study population (Figure). Both correlations held (p = 0.01) even after correction for age, mean arterial pressure, and glomerular filtration rate. Conclusions: Our results seems to suggest that, as previously demonstrated in other clinical settings, the RRI may be considered a marker of systemic vascular changes and probably a predictor of cardiovascular risk also in SLE patients

Early Vascular Aging in Normotensive Patients With Systemic Lupus Erythematosus: Comparison With Young Patients Having Hypertension.

Connective tissue diseases, like systemic lupus erythematosus (SLE), are associated with early and accelerated atherosclerosis. Recently, the concept of "early vascular aging" (EVA) has been more widely accepted. Aortic stiffness is one of the important markers of EVA. We evaluated EVA and subclinical atherosclerosis, by measuring aortic pulse wave velocity (aPWV) and carotid intima-media thickness (cIMT), in 50 normotensive patients with SLE (mean age: 39 ± 12 years). We compared these participants with 50 age- and sex-matched patients with essential hypertension (EH) and 20 healthy controls. Each participant underwent 24-hour ambulatory blood pressure monitoring (ABPM), aPWV, and cIMT measurements. Clinic and 24-hour ABPM values were significantly lower in patients with SLE and controls when compared with the participants having EH (all P < .0001), but aPWV and cIMT were significantly lower in the control group when compared with patients having SLE and EH (all P < .001). Overall, patients with SLE and EH had similar cIMT and aPWV values (P = .31 and P = .47, respectively). Our results suggest that SLE has a similar deleterious impact on EVA as EH

The renal resistive index: is it a misnomer?

Progress in digital ultrasound technology and diffusion of Doppler ultrasound evaluation of the kidney enable a widespread non-invasive evaluation of renal haemodynamics. Initially most attention has been paid to the study of extraparenchymal renal arteries, mainly to detect renovascular disease. However, this approach has low reproducibility and accuracy. Therefore, interest has gradually moved towards the duplex evaluation of intrarenal anatomy, where the best and most reliable signals are obtained from the large segmental or interlobar arteries that run directly towards the transducer. Among the sonographic parameters used in the last decade, great emphasis has been placed on the intrarenal resistive index (RRI), which is defined as the dimensionless ratio of the difference between maximum and minimum (end-diastolic) flow velocity to maximum flow velocity. It has been used for a long time for the diagnostic and prognostic assessment of renovascular disease . One of the earliest prospective uses of the RRI was in the prediction of kidney function outcomes following intervention for renal artery stenosis. In the pioneering study of Radermacher et al., an RRI[0.80 is associated with poorer outcomes, when surgery or angioplasty is used to correct renal artery stenosis ..

Association of renal resistive index with aortic pulse wave velocity in hypertensive patients

Background: Recent data suggest that renal haemodynamic parameters obtained by duplex Doppler sonography, especially the intrarenal resistive index (RI), may be associated with systemic vascular changes. However, conflicting data exist about the independent relationship between aortic stiffness and RI. The aim of this study was to evaluate the relationship between RI and arterial stiffness, assessed by aortic pulse wave velocity (aPWV), in hypertensive patients. Design: Cross-sectional study. Methods: We enrolled 264 hypertensive subjects aged between 30 and 70 years. They were divided into two groups, either with normal renal function (n=140) or with chronic kidney disease (CKD) (n=124). Each patient underwent assessment of ultrasonographic renal RI and measurement of aPWV through oscillometric device. Results: Patients with renal RI&gt;0.7 showed higher values of aPWV, both in the overall population (p&lt;0.001) and in the subgroups with (p&lt;0.01) and without CKD (p&lt;0.01). Moreover, statistically significant correlations were observed between aPWV and RI in the whole population (r=0.38, p&lt;0.001) and in the subgroups with (r=0.35, p&lt;0.001) and without CKD (r=0.31, p&lt;0.001). These correlations held even after adjustment for several confounding factors in multivariate analyses. Conclusions: Our results seem to corroborate the concept that the RI may be considered as a marker of systemic vascular changes and therefore a predictor of cardiovascular risk

EARLY VASCULAR AGING IN NORMOTENSIVE SUBJECTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS. COMPARISON WITH YOUNG HYPERTENSIVE PATIENTS

Introduction: It is well known that connective tissue diseases, like Systemic Lupus Erythematosus, are associated with early and accelerated atherosclerosis. During the last year, it has well established the concept of ‘‘Early vascular aging’’ (EVA), whose the aortic stiffness represents one of the most important markers. Aim: To evaluate early vascular aging, assessed by measuring Aortic pulse wave velocity (aPWV), as an arterial stiffness index, in a group of normotensive patients with SLE and to compare these subjects with a group of young essential hypertensive (EH) individuals.Methods: In this cross-sectional study we have enrolled 50 normotensive SLE subjects (45 women and 5 men) with mean age of 39 ± 11.6 years matched for age and sex with a group of essential hypertensive patients (mean age 39 ± 10.8 years, 45 women and 5 men) and with a control group of health volunteers. Each patient has been underwent to 24-h ambulatory blood pressure measurement (ABPM) and to aPWV measurement through an oscillometric device (Arteriograph). Results: Clinic and 24-h systolic and diastolic blood pressure values were significantly lower in the SLE patients and in control group patients when compared to those of the hypertensive subjects (all p&lt; 0.005). Despite this difference regarding BP, aPWV and IMT were not different between the two studied groups, being respectively PWV: 8.8 ± 2 m/s; IMT: 0.81 ± 0.2 I n SLE subjects and PWV: 9.5 ± 2 m/s IMT 0.77 ± 0.2 in the group of young essential hypertensive patients; p[0.05. In both groups aPWV was greater than that of the normal population in the same age category (7.1 m/s). In addition to this, the number of patients with higher value of aPWV than 10 m/s (cut off that identifies who has more cardiovascular risk) it hasn’t been significant different between SLE patients (26 %) and hypertensive ones (38 %) Conclusions: Our results seem to suggest that SLE has the same deleterious impact on vascular aging as well as high blood pressure. It is very likely that this unfavourable effect of SLE is mediated by chronic inflammation