We investigated the association between circulating microRNAs (miRNAs) potentially involved in the lung inflammatory process and fibrosis development among COVID-19-related acute respiratory distress ...syndrome (ARDS) survivors. At 4 ± 2 months from clinical recovery, COVID-19-related ARDS survivors matched for age, sex, and clinical characteristics underwent chest high-resolution computerized tomography (HRCT) and were selected based on imaging pattern evolution into fully recovered (N = normal), pulmonary opacities (PO) and fibrosis-like lesions (FL). Based on the previous literature, we performed plasma miRNA profiling of exosomal miRNAs belonging to the NLRP3-inflammasome platform with validated (miR-17-5p, miR-223-3p) and putative targets (miR-146a-5p), miRNAs involved in the post-transcriptional regulation of acute phase cytokines (miR128-3p, miR3168, miR125b-2-3p, miR106a-5p), miRNAs belonging to the NLRP4-inflammasome platform (miR-141-3p) and miRNAs related to post-transcriptional regulation of the fibrosis process (miR-21-5p). miR-17-5p, miR-223-3p, and miR-146a-5p were significantly down-regulated in patients with FL when compared to patients with PO. miR-146a-5p was also down-regulated in patients with FL than in N. The expression of the remaining miRNAs did not differ by group. In patients with long-term pulmonary radiological sequelae following COVID-19-related ARDS, a down-regulation of miR-17-5p, miR-146a-3p, and miR-223-3p correlated to fibrosis development in patients showing persistent hyper-reactivity to inflammatory stimulation. Our results support the hypothesis that NLRP3-Inflammasome could be implicated in the process of fibrotic evolution of COVID-19-associated ARDS.
Atrial fibrillation (AF), the commonest sustained cardiac arrhythmia affecting the adult population, is often casually discovered among hospitalized people. AF onset is indeed triggered by several ...clinical conditions such as acute inflammatory states, infections, and electrolyte disturbance, frequently occurring during the hospitalization. We aimed to evaluate whether systematic AF screening, performed through an automated oscillometric blood pressure (BP) device (Microlife WatchBP Office AFIB, Microlife AG, Switzerland), is effective for detecting AF episodes in subjects admitted to an Internal Medicine ward. 163 patients consecutively hospitalized at the Unit of Internal Medicine of the “Santa Maria” Terni University Hospital between November 2019 and January 2020 (mean age ± standard deviation: 77 ± 14 years, men proportion: 40%) were examined. Simultaneously with BP measurement and AF screening, a standard 12-lead electrocardiogram (ECG) was performed in all subjects. AF was diagnosed by ECG in 29 patients (18%). AF screening showed overall 86% sensitivity and 96% specificity. False negatives (
n
= 4) had RR-interval coefficient of variation lower than true positives (
n
= 25,
p
< 0.01), suggesting a regular ventricular rhythm during AF. The repeated evaluation substantially confirmed the same level of agreement. AF screening was positive in all patients with new-onset AF (
n
= 6, 100%). Systematic AF screening in patients admitted to Internal Medicine wards, performed using the Microlife WatchBP Office AFIB, is feasible and effective. The opportunity to implement such technology in daily routine clinical practice to prevent undiagnosed AF episodes in hospitalized patients should be the subject of further research.
Objective: The relationship between sodium consumption, central BP and the main dietary sources of daily sodium intake in adolescence has been poorly explored. We have evaluated sodium intake, ...central and peripheral BP in a population of Italian adolescents. Methods: 401 healthy adolescents aged 17±1 years (58% boys, average brachial/central BP: 124/67±11/7 mmHg, and 105/69±9/8 mmHg), attending a High School, Terni, Italy, were evaluated. Daily sodium intake was estimated from a single fasting urine by a validated formula. Sources of daily sodium intake were investigated by a self-administered food frequency questionnaire. Central BP was estimated by radial and brachial applanation tonometries, and calibrated to brachial MAP/DBP (SphygmoCor). Results: 24-h estimated urinary sodium (24-hUNa) was 13530 mmol/d (3.116 g/d). The 89% of the population showed excess sodium intake. 24-hUNa was directly correlated to brachial and central SBP (r=0.14 and r=0.15, both p<0.01), to brachial and central PP (r=0.19 and r=0.24, both p<0.01), and to central-to-peripheral PP amplification (r=−0.13, p<0.01), but not to central-to-peripheral SBP amplification (r=−0.01, p=0.85). In a fully-adjusted multivariate regression model, 24-hUNa (b=0.10, p=0.04) was independently related to central-to-peripheral PP amplification, but not to other measures of both peripheral and central BP. In a factorial analysis, the main daily dietary sources of sodium were bread, biscuits, and salt added to foods. Conclusions: Sodium intake has a direct relationship with both central and peripheral SBP and PP, and shows an independent association with central-to-peripheral PP amplification. The adverse effects of an excess of sodium intake are more pronounced in central than in peripheral PP.
Background: Heart rate (HR) is directly associated to central-to-peripheral pulse wave amplification. We aimed at evaluating the associations between heart rate and each BP component in a cohort of ...healthy adolescents. Objective: 470 healthy adolescents (17±1.4 years, 56% boys, brachial BP 123/67±11/7 mmHg, HR 72±12 bpm) were enrolled in the present study. Brachial BP was measured on 3 occasions by validated devices. Central BP was estimated by radial and brachial applanation tonometries, and calibrated to brachial MAP/DBP (SphygmoCor). Results: Brachial and central BP were 123/67±11/7 mmHg and 105/69±9/8 mmHg. SBPamp was 1.17±0.04, PPamp was 1.57±0.13, while DBP amplification was 0.97±0.01 (DBP attenuation). HR had a direct correlation with brachial and central DBP (r=0.38 and r=0.46, both p<0.01) and central SBP (r=0.09, p=0.04), but not with peripheral SBP (p=0.59), and a negative one with brachial and central PP (r=−0.24 and r=−0.37, both p<0.01). HR had a positive association with PPamp (r=0.38, p<0.01), and a negative one with SBPamp (r=−0.14, p<0.01) and DBPamp (r=−0.55, p<0.01). The slope of BP change for each 10-bpm HR increase was steeper for central DBP (2.8±0.3 mmHg), than for peripheral DBP (2.2±0.3 mmHg, p for difference between regression coefficients <0.01), and for central and brachial DBP than for central SBP (0.7±0.3 mmHg, both p<0.01). Conclusions: HR is associated with more pronounced changes in DBP than in SBP, and in central than peripheral DBP. Increasing HR may attenuate DBP from centre to periphery. The assumption that DBP is constant along the arterial tree may not be valid during dynamic conditions.
Objectives
Smoking has an unfavorable effect on arterial properties. Vascular aging is an independent predictor of cardiovascular risk. We examined the effect of quitting smoking on the progression ...of arterial stiffness.
Methods
142 subjects (mean age 51.9 ± 10.8 years, 94 men) with no established cardiovascular disease were investigated in 2 examinations over a 2-year period. Subjects were categorized in current smokers, non-smokers and ex-smokers. Ex–smokers were further categorized according to the time elapsed since smoking (<5 years, 5–15 years and > 15 years). Subjects had at the beginning and end of the study determinations of carotid-femoral pulse wave velocity (PWV) and common carotid intima-media thickness. Based on these measurements the annual absolute changes were calculated.
Results
Smoking at baseline was not associated with statistically significant differences in PWV and CIMT. However, the annual change of PWV was statistically different between the groups of smokers, non-smokers and the 3 groups of ex-smokers (p = 0.041)after adjustment for relevant confounders. Specifically, smokers had 0.23 m/s/year (95% CI: 0.10 to 0.35), non-smokers 0.17 m/s/year (95% CI: 0.08 to 0.25), quitters (<5 years) had 0.28 m/s/year (95% CI: 0.07 to 0.49), quitters (5–15 years) had 0.35 m/s/year (95% CI: 0.11 to 0.59) and quitters (>15 years) −0.07 m/s/year (95% CI: −0.26 to 0.13). Similar trend for slower progression was observed for CIMT in past smokers (>5 years) but this was not statistically significant.
Conclusions
Quitting smoking slows down progression of vascular aging after many years, implying a period of adjustment for former deleterious effects of smoking.
Introduction
In men with hypertension, obstructive sleep apnea (OSA) is associated with increased arterial stiffness. However, it is not clear if the impact of OSA on patients with hypertension is ...similar in women.
Methods
We recruited consecutive patients with established diagnosis of hypertension under a standardized antihypertensive treatment (hydrochlorothiazide plus enalapril or losartan). All patients were submitted to full polysomnography and carotid-femoral pulse wave velocity (PWV). We performed analysis according to the presence of OSA (defined by an apnea-hypopnea index ≥15 events/hour of sleep) and by gender (male and females).
Results
Ninety-five patients were studied (14males without OSA; 28 males with OSA, 29 females without OSA and 24 females with OSA). OSA frequency was 66% in males group versus 45% in females group (p = 0.02). The age of female with OSA (59±10yrs) was significantly higher than female without OSA(52±10yrs), while the age did not differ between the male with(58±10yrs) or without OSA(56±8yrs). The BMI was also significantly greater in female with OSA (32.8±5 vs. 28.7±5kg/m
2
), while was similar in male with(30.5±4.5) or without OSA(29.5±2.5). The blood pressure was not different in the patients with or without OSA. PWV was significantly higher in both male(12.7m/s) and female(13.2m/s) with OSA than the couterparts without OSA(male-11 m/s, female-11.7 m/s) even after adjustments by age. The multivariate linear regression showed that OSA was independently associated with PWV(p = 0.008).
Conclusions
In patients with hypertension, the presence of OSA is associated with higher PWV regardless of gender.
Objective: Serum myostatin (sMSTN) is a proteic compound that regulates muscle growth and production of extracellular matrix. sMSTN also exerts profibrotic and antihypertrophic effects on smooth ...muscle cells and fibroblasts. Aortic-brachial pulse wave velocity ratio (PWVr) is a pressure-independent measure of arterial stiffness gradient between the aorta and peripheral muscular arteries, known to reflect early arterial ageing and to be associated with cardiovascular (CV) risk. We explored the association between sMSTN and arterial stiffness gradient, measured through the PWVr, in a cohort of healthy adolescents. Design and method: 128 healthy subjects (mean age 17 ± 2 years, 59% men) were randomly recruited among participants of the Metabolic And Cardiovascular Investigation at School, TErni (MACISTE) study, a cross-sectional survey conducted at the “Renato Donatelli” High School in Terni, Italy. sMSTN was measured through enzyme-linked immunosorbent assay. PWV was measured by applanation tonometry (SphygmoCor) along the carotid-femoral (cf-PWV, aortic) and the carotid-radial (cr-PWV, brachial) pathways and expressed as the ratio between cf-PWV and cr-PWV. Blood pressure (BP) was recorded at the same time of PWV measurement and expressed as systolic/diastolic BP percentiles (z-score) based on age, sex and height. Results: Mean BP was 126 ± 12/68 ± 8 mmHg (z-score 1.2 ± 0.9/0.3 ± 0.7). Mean Cf-PWV was 5.1 ± 0.9 m/s, cr-PWV was 6.9 ± 0.9 m/s. PWVr was 0.75 ± 0.12. PWVr increased linearly at increasing quartiles of sMSTN (0.71 ± 0.09, 0.74 ± 0.13, 0.75 ± 0.14, 0.78 ± 0.12, p for trend = 0.03, Figure 1). Subjects with PWVr above average had higher BMI (21.7 ± 2.6 Kg/m2 vs 20.8 ± 2.3 Kg/m2, p = 0.04) and SBP (1.39 ± 0.97 vs 0.97 ± 0.91, p = 0.01), whereas they did not differ in terms of age, sex, heart rate, measures of adiposity, and other CV risk factors. In a multivariate linear model, PWVr was independently predicted by SBP and sMSTN, both if expressed as continuous variable (beta = 0.21, p = 0.018) or in quartiles (beta = 0.26, p = 0.011). Conclusions: In a cohort of healthy Italian adolescents, sMSTN was positively and independently associated to increased PWVr, a measure of arterial stiffness gradient. Our preliminary results raise the hypothesis that sMSTN might differentially interfere with structural and functional components of the arterial wall, and ultimately might contribute to the accelerated arterial ageing in adolescents.
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