Left ventricular diastolic dysfunction in normotensive postmenopausal women with type 2 diabetes mellitus

Background: The prevalence of heart failure among diabetic patients is high, also in those with normal blood pressure and without coronary artery disease, even when electrocardiogram (ECG) is normal. The goal of our study was to assess the prevalence of left ventricular diastolic dysfunction (LVDD) among diabetic women (DW) and its correlation with glycosylated hemoglobin (HbA1c) levels, obesity status, and ECG parameters. Methods: A group of 456 consecutive normotensive postmenopausal women affected by type 2 diabetes, diagnosed over 5 years, were enrolled. One hundred normotensive non-diabetic postmenopausal women were included as a control group (CG). Rest ECG and trans-thoracic echocardiogram and Doppler were performed. Results: LVDD was present in 103 (23.3%) out of 456 DW, and 8 out of 100 women in CG (8%), p < 0.001. There was no difference in mean age between the two groups: 56 ± 13 and 55 ± 3, respectively (p = 0.3). There were 191 (41.9%) DW with body mass index (BMI) > 30 kg/m2. Among those, there were 56 (12.3%) with significant prevalence of LVDD, while there were 49 (10.7%) with BMI < 30 kg/m2, p < 0.005. DW with HbA1c > 7.5% comprised a group of 243 (53.3%) patients. Among those, there were 45 (9.9%) with higher prevalence of LVDD, and 15 (3.3%) with HbA1c < 7.5%, p < 0.01. Out of a group of 147 (32.2%) DW with abnormal ECG , 21 had LVDD (4.6%), p = 0,1, and 84 (18.8%) had LVDD with normal ECG. Conclusions: Our data prove a high prevalence of LVDD in asymptomatic diabetic postmenopausal women. This finding is closely related with HbA1c levels and obesity status, not with abnormal ECG, which is a unique cardiologic test recommended by current guidelines in all diabetic patients. We conclude that early detection of high level of HbA1c and obesity (30 kg/m2) may identify women with major risk to develop LVDD. Furthermore, a simple ECG, when normal, is not enough to assess a normal LV diastolic function.

Left ventricular diastolic dysfunction in normotensive postmenopausal women with type 2 diabetes mellitus.

Background The prevalence of heart failure among diabetic patients is high, also in those with normal blood pressure and without coronary artery disease, even when electrocardiogram (ECG) is normal. The goal of our study was to assess the prevalence of left ventricular diastolic dysfunction (LVDD) among diabetic women (DW) and its correlation with glycosylated hemoglobin (HbA1c) levels, obesity status, and ECG parameters. Methods : A group of 456 consecutive normotensive postmenopausal women affected by type 2 diabetes, diagnosed over 5 years, were enrolled. One hundred normotensive non-diabetic postmenopausal women were included as a control group (CG). Rest ECG and trans-thoracic echocardiogram and Doppler were performed. Results : LVDD was present in 103 (23.3%) out of 456 DW, and 8 out of 100 women in CG (8%), p < 0.001. There was no difference in mean age between the two groups: 56 ± 13 and 55 ± 3, respectively (p = 0.3). There were 191 (41.9 %) DW with body mass index (BMI) > 30 kg/m2. Among those, there were 56 (12.3%) with significant prevalence of LVDD, while there were 49 (10.7%) with BMI < 30 kg/m2, p < 0.005. DW with HbA1c > 7.5% comprised a group of 243 (53.3%) patients. Among those, there were 45 (9.9%) with higher prevalence of LVDD, and 15 (3.3%) with HbA1c < 7.5%), p < 0.01. Out of a group of 147 (32.2%) DW with abnormal ECG , 21 had LVDD (4.6%), p = 0,1, and 84 (18.8%) had LVDD with normal ECG. Conclusions: Our data prove a high prevalence of LVDD in asymptomatic diabetic postmenopausal women. This finding is closely related with HbA1c levels and obesity status, not with abnormal ECG, which is a unique cardiologic test recommended by current guidelines in all diabetic patients. We conclude that early detection of high level of HbA1c and obesity (30 kg/m2) may identify women with major risk to develop LVDD. Furthermore, a simple ECG, when normal, is not enough to assess a normal LV diastolic function

Primary Prevention Of Cardiovascular Risk In Octogenarians By Risk Factors Control

Primary prevention of cardiovascular events in older adults is a relevant problem, because of lack of evidence for safe and efficacious therapy, its costs and elderly quality of life, Italy's aging population is constantly increasing, so cardiovascular disease (CVD) primary prevention in the elderly is a prime objective. Life expectancy has dramatically increased over the last 2 decades,the proportion of individuals aged 80 years and older has grown rapidly in Europe and United States,but cost / effective ratio of CVD prevention through risk factors control is debated. It is therefore important to implement cardiovascular risk factors estimation in the elderly to maximize quality of life of patients and to lengthen their healthy life expectancy, choosing the better treatment for each patient sharing the choice with himself when it is possible, always remembering that elderly patients often have multiple co-morbidities that require a high number of concurrent medications; this may increase the risk for drug-drug interactions, thereby reducing the potential benefits of CVD prevention therapy. Anyway CVD are not an inevitable concomitant of aging. Sometimes autopsy in the elderly reveals atheroma-free coronary arteries,a normal-sized heart and unscarred valves. All primary prevention strategy decisions should consider estimated life expectancy and overall function not only cardiovascular event risks, magnitude and time to benefit or harm, potentially altered adverse effect profiles, and informed patient preferences.CVD primary prevention need to be more implemented in the elderly, this might contribute to improve health status and quality of life in this growing population if correctly performed

Left ventricular diastolic dysfunction in normotensive postmenopausal women with type 2 diabetes mellitus

Background: The prevalence of heart failure among diabetic patients is high, also in those with normal blood pressure and without coronary artery disease, even when electrocardiogram (ECG) is normal. The goal of our study was to assess the prevalence of left ventricular diastolic dysfunction (LVDD) among diabetic women (DW) and its correlation with glycosylated hemoglobin (HbA 1c ) levels, obesity status, and ECG parameters. Methods: A group of 456 consecutive normotensive postmenopausal women affected by type 2 diabetes, diagnosed over 5 years, were enrolled. One hundred normotensive non-diabetic postmenopausal women were included as a control group (CG). Rest ECG and trans-thoracic echocardiogram and Doppler were performed. Results: LVDD was present in 103 (23.3%) out of 456 DW, and 8 out of 100 women in CG (8%), p 30 kg/m 2 . Among those, there were 56 (12.3%) with significant prevalence of LVDD, while there were 49 (10.7%) with BMI 7.5% comprised a group of 243 (53.3%) patients. Among those, there were 45 (9.9%) with higher prevalence of LVDD, and 15 (3.3%) with HbA 1c < 7.5%, p < 0.01. Out of a group of 147 (32.2%) DW with abnormal ECG , 21 had LVDD (4.6%), p = 0,1, and 84 (18.8%) had LVDD with normal ECG. Conclusions: Our data prove a high prevalence of LVDD in asymptomatic diabetic postmenopausal women. This finding is closely related with HbA 1c levels and obesity status, not with abnormal ECG, which is a unique cardiologic test recommended by current guidelines in all diabetic patients. We conclude that early detection of high level of HbA 1c and obesity (30 kg/m 2 ) may identify women with major risk to develop LVDD. Furthermore, a simple ECG, when normal, is not enough to assess a normal LV diastolic function

Higher reliability of 18F-FDG target background ratio compared to standardized uptake value in vulnerable carotid plaque detection: a pilot study.

Objective: To evaluate the role of [18F]-fluorodeoxyglucose positron emission tomography/computer tomography [18F-FDG PET/CT] comparing target background ratio (TBR) and standardized uptake value (SUV) with the histopathological inflammatory status of the carotid plaques. Background: Vulnerable carotid plaques are the primary cause of acute cerebrovascular events. 18F-FDG PET/CT represents a morpho-functional technique able to identify the highly inflamed and most vulnerable carotid plaques. Several literature studies experimented this new method to identify vascular inflammation, but few have effectively compared PET/CT results with plaque histological data and no studies had directly compared TBR to SUV. Methods: Thirty-two consecutive patients (20 men and 12 women, mean age 74 ± 8 years) undergoing carotid endarterectomy were enrolled and studied with carotid 18F-FDG PET/CT. Maximum and mean SUV and TBR were used to quantify 18F-FDG uptake while surgical specimens were analyzed by optical microscopy to identify inflamed carotid plaques, with evaluation of macrophages infiltration by mean of immunohistochemistry. On the basis of the presence of inflammation at the histological analysis, we divided population in two groups: group A (n = 12) patients with inflamed carotid plaques and group B (n = 20) patients with non-inflamed ones, then crossed and evaluated the histological data with 18F-FDG PET/CT findings. Results: SUV max and SUV mean values resulted higher in group A (respectively, 2.14 ± 0.77 and 1.99 ± 0.68) than in group B (respectively, 1.79 ± 0.37 and 1.64 ± 0.34) without reaching a statistical significance (p = ns). TBR max and TBR mean values resulted higher in group A (respectively, 1.42 ± 0.32 and 1.34 ± 0.26) than in group B (respectively, 1.16 ± 0.19 and 1.03 ± 0.20) with a statistically significant differences between the two groups and carotid inflammation (respectively, p < 0.01 and p < 0.001). Conclusion: TBR (max and mean values) is a more reliable parameter than SUV in identifying inflamed plaques. Although limited by the small population analyzed, our results suggest the important role of 18F-FDG PET/CT, using TBR, in identification of high-risk carotid atherosclerotic plaques. © 2014 The Japanese Society of Nuclear Medicine

Neutrophil-dependent pentraxin-3 and reactive oxygen species production modulate endothelial dysfunction in haemodialysis patients.

BACKGROUND: The aim of this study was to investigate neutrophil activation and its role in long pentraxin-3 (PTX3) release and oxidative stress generation during haemodialysis (HD) and to correlate neutrophil PTX3 and oxidant expression with endothelial dysfunction. METHODS: Forty-seven uraemic patients on stable HD, 12 healthy subjects and 15 patients with congestive heart failure (New York Heart Association classes III and IV) were enrolled. Neutrophil PTX3 protein expression was evaluated by confocal microscopy. l-selectin expression, intracellular PTX3 localization and reactive oxygen species (ROS) generation in human neutrophils were measured by flow cytometry. NADPH-dependent superoxide generation was investigated by chemiluminescence. PTX3 plasma concentrations were measured by ELISA. Endothelial dysfunction was studied by flow-mediated dilation (FMD). RESULTS: The low baseline levels of FMD significantly improved after HD, but worsened by 24 h. A significant up-regulation of PTX3 protein expression, localized within secondary granules, was detected in neutrophils isolated at 30 and 240 min of HD, along with an increase in l-selectin expression. The up-regulation in intracellular PTX3 in neutrophils was associated with a significant increase in PTX3 plasma concentrations at 240 min. HD increased ROS production and NADPH oxidase activity in neutrophils. In a univariate analysis, pre-treatment with FMD was inversely correlated with PTX3 expression and ROS generation in neutrophils. In a multivariate analysis, both circulating pre-HD PTX3 and intracellular ROS generation by neutrophils were independent predictors of abnormal FMD. CONCLUSIONS: Neutrophil overexpression of PTX3 is associated with ROS overproduction and endothelial dysfunction and may represent an emerging marker of vascular damage progression in HD patients. © The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved

Doppler ultrasound venous mapping of the lower limbs

Aldo Innocente Galeandro1, Giovanni Quistelli2, Pietro Scicchitano2, Michele Gesualdo2, Annapaola Zito2, Paola Caputo2, Rosa Carbonara2, Giuseppe Galgano3, Francesco Ciciarello4, Sandro Mandolesi4, Claude Franceschi5, Marco Matteo Ciccone21Centro Diagnostica Globale and ASL-TA, Taranto, Italy; 2Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy; 3Cardiovascular Diseases Section, Ente Ecclesiastico Ospedale Generale Regionale F Miulli, Acquaviva delle Fonti, Bari, Italy; 4Cardiology Department, Policlinico Umberto I, Sapienza University of Rome, Italy; 5Vascular Laboratories of Hospitals Saint Joseph and Piti&amp;eacute;-Salp&amp;eacute;tri&amp;egrave;re, Paris, FranceBackground: The study aim was to test the accuracy (intra and interobserver variability), sensitivity, and specificity of a simplified noninvasive ultrasound methodology for mapping superficial and deep veins of the lower limbs.Methods: 62 consecutive patients, aged 62 &amp;plusmn; 11 years, were enrolled. All underwent US-examinations, performed by two different investigators, of both legs, four anatomical parts, and 17 veins, to assess the interobserver variability of evaluation of superficial and deep veins of the lower limbs.Results: Overall the agreement between the second versus the first operator was very high in detecting reflux (sensitivity 97.9, specificity 99.7, accuracy 99.5; P = 0.80 at McNemar test). The higher CEAP classification stages were significantly associated with reflux (odds ratio: 1.778, 95% confidence interval: 1.552&amp;ndash;2.038; P &amp;lt; 0.001) as well as with thrombosis (odds ratio: 2.765, 95% confidence interval: 1.741&amp;ndash;4.389; P &amp;lt; 0.001). Thus, our findings show a strict association between the symptoms of venous disorders and ultrasound evaluation results for thrombosis or reflux.Conclusion: This study demonstrated that our venous mapping protocol is a reliable method showing a very low interobserver variability, which makes it accurate and reproducible for the assessment of the morphofunctional status of the lower limb veins.Keywords: venous mapping, new methodology, sensitivity, specificity, accurac

Non-alcoholic fatty liver disease is associated with early left ventricular dysfunction in childhood acute lymphoblastic leukaemia survivors.

Background: Childhood acute lymphoblastic leukaemia (ALL) survivors have an increased risk of metabolic and cardiovascular disease. We aimed to assess the presence of non-alcoholic fatty liver disease (NAFLD) in childhood ALL and if it is associated with early cardiovascular dysfunction. Methods: In total, 53 childhood ALL survivors and 34 controls underwent auxological evaluation, biochemical assay, liver, heart and vascular ultrasound study. Results: NAFLD was more frequent in ALL patients than in controls (39.6% vs 11.7%, P &lt; 0.01). Patients with NAFLD were more obese and insulin resistant than patients without NAFLD. Flow-mediated dilatation and interventricular septum were lower in the ALL group than those in the control group (P &lt; 0.001 for both). The patients with NAFLD showed lower left ventricular ejection fraction than those without NAFLD (P = 0.011). In ALL survivors, BMI-SDS and subcutaneous fat were the strongest predictors of NAFLD, whereas preperitoneal adipose tissue and C-reactive protein were the strongest predictors of left ventricular ejection fraction. Conclusions: Childhood ALL survivors had higher prevalence of NAFLD than healthy controls, which is associated with early left ventricular impairment. In the case of fatty liver, a comprehensive heart evaluation is mandatory. We strongly recommend to prevent visceral adiposity in ALL survivors, to search for metabolic syndrome or its components and to reinforce the need of intervention on diet and lifestyle during the follow-up of these patients

Endothelial and Metabolic Function Interactions in Overweight/Obese Children.

AIM: Although the underlined mechanisms are still unknown, metabolic/coagulation alterations related to childhood obesity can induce vascular impairments. The aim of this study was to investigate the relationship between metabolic/coagulation parameters and endothelial function/vascular morphology in overweight/obese children. METHODS: Thirty-five obese/overweight children (22 pre-pubertal, mean age: 9.52±3.35 years) were enrolled. Body mass index (BMI), homeostasis model assessment index (HOMAIR), metabolic and coagulation parameters, [adiponectin, fibrinogen, high molecular weight adiponectin (HMW), endothelin-1, and vonWillebrand factor antigen] ultrasound early markers of atherosclerosis [flow-mediated dilatation (FMD), common carotid intima-media thickness (C-IMT), and anteroposterior diameter of infra-renal abdominal aorta (APAO)] were assessed. RESULTS: APAO was related to anthropometric (age: r=0.520, p=0.001; height: r=0.679, p＜0.001; weight: r=0.548, p=0.001; BMI: r=0.607, p＜0.001; SBP: r=0.377, p=0.026) and metabolic (HOMAIR: r=0.357, p=0.035; HMW: r=－0.355, p=0.036) parameters. Age, height, and systolic blood pressure were positively related to increased C-IMT (r=0.352, p=0.038; r=0.356, p=0.036; r=0.346, p=0.042, respectively). FMD was not related to any clinical and biochemical characteristics of the pediatric population. Age, HOMAIR, fasting glucose levels, and HMW were independent predictors for APAO increase. Each unit decrease in HMW concentrations (1 μg/ml) induced a 0.065 mm increase in APAO. CONCLUSION: High molecular weight adiponectin is related to cardiovascular risk in overweight/obese children