Preferential vascular effects of amlodipine in reducing stiffness in muscular not elastic arteries in essential hypertension & the metabolic syndrome

Introduction: Arterial stiffness and wave reflection are independent prognosticators of cardiovascular morbidity and mortality. There are two types off arteries in the body; elastic and muscular. The elastic arteries receive the blood directly from the heart while the muscular arteries distribute the blood to various organs of the body. The elasticity of the major arteries decreases with age and therefore may play a key role in the development and control of hypertension and subsequently the choice of drug therapy. The aim of the study is to evaluate the effects of the amlodipine, on arterial stiffness in essential hypertension, compared to hydrochlorothiazide. Methodology: We randomised 24 hypertensive patients hypertension (clinic blood pressure (BP) > 140/90 mmHg and ambulatory >135/85 mmHg) to amlodipine 5 mg or hydrochlorothiazide 12.5 mgs in a single blind parallel group study for one month and measured aortic pulse wave velocity (PWV) and augmentation index (AIx) at baseline and one month after treatment. The patients were studied fasting, having abstained from smoking, caffeinated beverages and alcohol 12 h prior to the measurements. Brachial BP and heart rate (Omron), pulse wave velocity (PWV, Complior) and augmentation index (AIx, SphymoCor), a measure of wave reflection, were measured in the supine position after a rest of 15 min. Results were analysed with JMP (SAS for Windows) using Wilcoxon-Rank Sums test and ANOVA. Results are expressed as mean ± SEM, p < 0.05 considered significant. Results: Both drugs produced a similar reduction in brachial BP but there was a greater reduction in the aortic systolic BP (20 ± 3 vs 7 ± 2 mmHg, p < 0.01) and AIx (5 ± 2 vs 1 ± 1%, p < 0.05) with amlodipine. There was no change in PWV with either drug. Conclusion: This short-term study suggests that the effects of amlodipine on arterial stiffness are primarily on muscular rather than elastic arteries. This should be kept in mind when choosing the HTN treatment in elderly and those with diseases affecting the aorta

3. Clinical features and outcome of patients with recurrent myocarditis

Clinical research. Presentation Type: Oral presentation. Introduction: Myocarditis can be associated with short and long term major cardiac event. However, most episodes are self-limited and rarely recurrent. The aim of this analysis was to describe a series of six patients who had multiple episodes of recurrent myocarditis and characterize their clinical, laboratory, electrocardiographic (ECG) and imaging features. Methodology: The patients were identified from cardiac MRI (CMR) database during the period of 2007–2016. Patients records were reviewed for demographic data, laboratory results including serum troponin I, ECG findings, coronary angiography, imaging findings from echocardiography and CMR. The diagnosis of acute myocarditis was ascertained by a combined clinical and imaging findings. Patients with myocarditis related to connective tissue disease were excluded. Results: During the study period, a total of 37 patients presented with acute myocarditis of which 6 (16.2%) patients (mean age 31.7 ± 10.4 years, 100% males) had multiple recurrent episodes; twice in 4 patients and 4 episodes in 2 patients (Table 1). The mean interval period between the first and last attack was 3.3 years (range was 0.8–5.0). After a median follow-up of 4.4 years, there was evidence of new epicardial or mid-wall myocardial delayed enhancement (MDE) with every new episode and all patients had persistent MDE on the last CMR. However, no patient developed persistent heart failure symptoms or left ventricular ejection fraction <40%. Only one patient had transient heart failure symptoms which improved on angiotensin converting enzyme inhibitors and beta blockers. Table 1 demonstrates imaging findings from the last echocardiography and CMR examinations. Conclusion: Recurrent myocarditis in our population is probably under-reported. One in six patients with myocarditis had clinical and imaging proven recurrence. The use of CMR may help to ascertain the diagnosis in otherwise unexplained elevated cardiac markers. The long term management and outcome of recurrent myocarditis requires further study

Importance of Reference Muscle Selection in Quantitative Signal Intensity Analysis of T2-Weighted Images of Myocardial Edema Using a T2 Ratio Method

Objectives. The purpose of our study was to identify the suitability of various skeletal muscles as reference regions for calculating the T2 SI ratio for a semiautomated quantification of the extent of myocardial edema with T2-weighted images. Methods. Thirty-four patients with acute myocardial infarction (MI) were enrolled. The extent of myocardial edema was determined by T2 SI ratio map, using 4 different muscles as reference: major and minor pectoralis, serratus anterior, teres minor-infraspinatus, and subscapularis. The size of myocardial edema as visually quantified was used as the standard of truth. The control group consisted of 15 patients with chronic MI. Intra- and interobserver variability were assessed. Results. Due to poor image quality four patients were excluded from the analysis. In acute MI patients, serratus anterior muscle showed the strongest correlation with the visual analysis (; ) and low inter- and intraobserver variability, while the other muscles resulted in a significant interobserver variability. In contrast, the use of other muscles as a reference led to overestimating edema size. Conclusions. In acute MI patients, serratus anterior resulted to be the most reliable and reproducible muscle for measuring the extent of myocardial edema.Peer Reviewe

Importance of Reference Muscle Selection in Quantitative Signal Intensity Analysis of T2-Weighted Images of Myocardial Edema Using a T2 Ratio Method

Objectives. The purpose of our study was to identify the suitability of various skeletal muscles as reference regions for calculating the T2 SI ratio for a semiautomated quantification of the extent of myocardial edema with T2-weighted images. Methods. Thirty-four patients with acute myocardial infarction (MI) were enrolled. The extent of myocardial edema was determined by T2 SI ratio map, using 4 different muscles as reference: major and minor pectoralis, serratus anterior, teres minor-infraspinatus, and subscapularis. The size of myocardial edema as visually quantified was used as the standard of truth. The control group consisted of 15 patients with chronic MI. Intra- and interobserver variability were assessed. Results. Due to poor image quality four patients were excluded from the analysis. In acute MI patients, serratus anterior muscle showed the strongest correlation with the visual analysis (r=0.799; P<0.001) and low inter- and intraobserver variability, while the other muscles resulted in a significant interobserver variability. In contrast, the use of other muscles as a reference led to overestimating edema size. Conclusions. In acute MI patients, serratus anterior resulted to be the most reliable and reproducible muscle for measuring the extent of myocardial edema

Prevalence of the frailty among Saudi patients referred for myocardial perfusion imaging: A cross sectional study

Clinical Research. Presentation type: Oral Presentation. Introduction: Frailty is a state of vulnerability and decreased physiological response to stressors. Saudi vision 2030 stated a goal to increase Saudi life expectancy by 5 years. As the population ages, the prevalence of frailty is expected to increase. Thus, identifying tools and resources that efficiently reduces frailty among elderly patients is important. We aim to describe the prevalence and predictors of frailty among Saudi patients referred for stress testing with nuclear imaging. Methodology: We included 876 patients (mean age 60.28 ± 11, females 48.29%) who underwent clinically indicated nuclear myocardial perfusion imaging using PET between January and October 2016. The Canadian Study of Health and Ageing Clinical Frailty Scale was used to assess frailty. Patients were considered frail if they had a score of four or higher. Multivariate adjusted logistic regression model was used to determine the independent predictors of elderly frail patients. Results: In this cohort, the median age of the included patients was 61 years and the prevalence of the frailty was 40%. The frail patients were older, more frequently females and had a higher body mass index. Additionally, frailty was associated with higher prevalence of cardiovascular risk factors: hypertension, diabetes and dyslipidaemia (85%, 75%, and 46%, respectively). In fully adjusted logistic regression model, female gender, high body mass index (⩾30 kg/m2), hypertension and reduced coronary flow reserve were independent predictors of elderly frail patients. Conclusion: With the aging of the Saudi population, frailty prevalence is expected to increase. Elderly obese hypertensive females have the highest risk of developing frailty. Interventions to reduce frailty should be focused on this high-risk population

The role of cardiac imaging in the management of non-ischemic cardiovascular diseases in human immunodeficiency virus infection

Infection with human immunodeficiency virus (HIV) has become the pandemic of the new century. About 36.9 million people are living with HIV worldwide. The introduction of antiretroviral therapy in 1996 has dramatically changed the global landscape of HIV care, resulting in significantly improved survival and changing HIV to a chronic disease. With near-normal life expectancy, contemporary cardiac care faces multiple challenges of cardiovascular diseases, disorders specific to HIV/AIDS, and those related to aging and higher prevalence of traditional risk factors. Non-ischemic cardiovascular diseases are major components of cardiovascular morbidity and mortality in HIV/AIDS. Non-invasive cardiac imaging plays a pivotal role in the management of these diseases. This review summarizes the non-ischemic presentation of the HIV cardiovascular spectrum focusing on the role of cardiac imaging in the management of these disorders