Lipoprotein(a) (Lp(a)) is considered an independent risk factor for cardiovascular diseases. The plasma concentration of Lp(a) is largely genetically determined but varies over a wide range within ...the population. This study investigated changes in Lp(a) levels after an acute myocardial infarction. Patients who underwent coronary angiography due to an ST elevation myocardial infarction were enrolled (n = 86), and Lp(a) levels were measured immediately after the intervention, one day, two days, and at a post-discharge follow-up visit at 3 to 6 months after the acute myocardial infarction. Median Lp(a) levels increased from a median of 7.9 mg/dL (3.8–37.1) at hospital admission to 8.4 mg/dL (3.9–35.4) on the following day, then to 9.3 mg/dL (3.7–39.1) on day two (p < 0.001), and to 11.2 mg/dL (4.4–59.6) at the post-discharge follow-up (p < 0.001). Lp(a) levels were the lowest during the acute myocardial infarction and started to increase significantly immediately thereafter, with the highest levels at the post-discharge follow-up. The moderate but significant increase in Lp(a) in people with acute myocardial infarction appears to be clinically relevant on an individual basis, especially when specific Lp(a) cut-off levels are supposed to determine the initiation of future treatment. Hence, a repeated measurement of Lp(a) after myocardial infarction should be performed.
Renal denervation (RDN) is a new procedure for treatment-resistant hypertensive patients. In order to monitor all procedures undergone in Austria, the Austrian Society of Hypertension established the ...investigator-initiated Austrian Transcatheter Renal Denervation (TREND) Registry. From April 2011 to September 2014, 407 procedures in 14 Austrian centres were recorded. At baseline, office and mean 24-h ambulatory blood pressure (ABP) were 171/94 and 151/89 mmHg, respectively, and patients were taking a median of 4 antihypertensive medications. Mean 24-h ABP changes after 2-6 weeks, 3, 6 and 12 months were -11/-6, -8/-4, -8/-5 and -10/-6 mmHg (p<0.05 at all measurements), respectively. The periprocedural complication rate was 2.5%. Incidence of long-term complications during follow-up (median 1 year) was 0.5%. Office BP and ABP responses showed only a weak correlation (Pearson coefficient 0.303). Based on the data from the TREND registry, ambulatory blood pressure monitoring in addition to office BP should be used for patient selection as well as for monitoring response to RDN. Furthermore, criteria for optimal patient selection are suggested.
Background:
Recently, arterial stiffness has been associated with cerebral small vessel disease (SVD), brain atrophy and vascular dementia. Arterial stiffness is assessed via pulse wave velocity ...(PWV) measurement and is strongly dependent on arterial blood pressure. While circadian blood pressure fluctuations are important determinants of end-organ damage, the role of 24-h PWV variability is yet unclear.
Objectives:
We here investigated the association between PWV and its circadian changes on brain morphology and cognitive function in community-dwelling individuals.
Design:
Single-centre, prospective, community-based follow-up study.
Methods:
The study cohort comprised elderly community-based participants of the Austrian Stroke Prevention Family Study which was started in 2006. Patients with any history of cerebrovascular disease or dementia were excluded. The study consists of 84 participants who underwent ambulatory 24-h PWV measurement. White matter hyperintensity volume and brain volume were evaluated by 3-Tesla magnetic resonance imaging (MRI). A subgroup of patients was evaluated for cognitive function using an extensive neuropsychological test battery.
Results:
PWV was significantly related to reduced total brain volume (p = 0.013), which was independent of blood pressure and blood pressure variability. We found no association between PWV with markers of cerebral SVD or impaired cognitive functioning. Only night-time PWV values were associated with global brain atrophy (p = 0.005).
Conclusions:
This study shows a relationship of arterial stiffness and reduced total brain volume. Elevations in PWV during night-time are of greater importance than day-time measures.
To this day, there is no data concerning guideline adherence on P2Y12-inhibitors in Austria. Prasugrel and ticagrelor have been shown to be superior to clopidogrel in the treatment of acute coronary ...syndromes (ACS). However, recent data from European registries showed a reluctant prescription policy with rates of clopidogrel at discharge ranging from 35 to 55%.
In this prospective, multi-centre registry we assessed prescription rates of P2Y12-inhibitors in patients with ACS in four Austrian PCI centres. Parameters associated with the use of clopidogrel have been evaluated in multivariate logistic regression.
Between January and June 2015, 808 patients with ACS undergoing PCI were considered for further analysis. 416 (51.5%) presented with STEMI and 392 (48.5%) with NSTE-ACS. Mean age was 65.7 ± 12.4 and 240 (30.9%) were female. Twenty-eight (3.5%) died during the hospital stay. At discharge, 212 (27.2% of all patients) received clopidogrel, 260 (32.2%) prasugrel and 297 (36.8%) ticagrelor, while 11 (1.4%) did not receive any P2Y12-inhibitor. Of those patients, who were discharged with clopidogrel, 117 (55.2%) had no absolute contraindication against a more potent P2Y12-inhibitor. Diagnosis of NSTE-ACS (p<0.001), COPD (p = 0.049), and age (p<0.001) next to factors contributing to absolute contraindication were positively associated with the use of clopidogrel.
Despite a high level of care, a considerable number of patients were not treated with the more potent P2Y12-inhibitors. Parameters associated with a presumably higher risk of bleeding and side-effects against the more effective P2Y12 inhibitors were the most prominent factors for the prescription of clopidogrel.
Discordance between coronary angiographic findings and invasive functional significance is well-established. Yet, the prevalence of this mismatch in an era increasingly utilizing invasive functional ...assessments, such as fractional flow reserve (FFR), remains unclear. This study examines the extent of such discrepancies in current clinical practice.
This single-center prospective registry included consecutive patients with chronic coronary syndrome (CCS) who underwent elective coronary angiography, with or without revascularization. Coronary angiograms deemed not requiring FFR due to clear anatomical distinctions, either anatomically severe indicating a need for revascularization or mild suggesting no need for intervention, were selected for evaluation. These were then subjected to post-hoc analysis by three independent operators who were blinded to the definitive treatment strategies. Importantly, the post-hoc analysis was conducted in two distinct phases: firstly, a re-evaluation of coronary stenosis, and secondly, a separate functional assessment, each carried out independently. Coronary stenosis severity was assessed visually, while functional relevance was determined by quantitative flow ratio (QFR), calculated using a computational fluid dynamics algorithm applied to angiographic images. Analysis focused on discrepancies between QFR-based functional indications and revascularization strategies actually performed.
In 191 patients, 488 vessels were analyzed. Average diameter stenosis (DS) was 37 ± 34%, and QFR was 0.87 ± 0.15, demonstrating a moderate correlation (
= -0.84; 95% CI: -0.86 to -0.81,
< 0.01). Agreement with QFR at conventional anatomical cutoffs was 88% for 50% DS and 91% for 70% DS. Mismatches between revascularization decisions and QFR indications occurred in 10% of cases. Discrepancies were more frequent in the left anterior descending artery (14%) compared to the left circumflex (6%) and the right coronary artery (9%;
= 0.07).
In a cardiac-center where FFR utilization is high, discordance between coronary angiography and functional significance persists, even when operators are confident in their decisions
to use functional interrogation. This gap, most evident in the left anterior descending artery, highlights the potential need for integrated angiography-based functional assessments to refine revascularization decisions in CCS.
OBJECTIVE:--About one of five patients with coronary artery disease (CAD) suffers from previously unknown, predominantly postprandial type 2 diabetes. In the process of atherogenesis and the ...subsequent increased cardiovascular mortality of diabetic patients, endothelial dysfunction is suspected to play an important role, and it is observed in diabetic as well as insulin-resistant states. Thus, the aim of our study was to investigate the effect of pioglitazone on endothelial dysfunction, insulin sensitivity, and glucose control in newly detected type 2 diabetic patients with CAD. RESEARCH DESIGN AND METHODS--We investigated 42 patients (39 men and 3 women, age 60.25 ± 7.5 years, HbAsubscript 1c 6.1 ± 0.5%) with manifest CAD and newly detected type 2 diabetes. A randomized, double-blind, placebo-controlled, parallel study with pioglitazone (30 mg/day for 12 weeks) was performed. At study entry and end, we performed an oral glucose tolerance test and measurements of endothelial dysfunction by photoplethysmographic pulse wave analysis. RESULTS:--Endothelial dysfunction was severely impaired at baseline in both groups. After 12 weeks, endothelial dysfunction was significantly better in the pioglitazone group (change of reflection index 6.5 ± 5.1 vs. 1.6 ± 2.9%, P = 0.002) compared with placebo. Insulin sensitivity, as assessed by homeostasis model assessment (2.20 ± 1.62 vs. 3.61 ± 1.87, P = 0.01), or the change of insulin sensitivity index from baseline to study end (0.021 ± 0.023 vs. -0.003 ± 0.012 micromol · kg⁻¹ · min⁻¹ per pmol/l, P = 0.0001) and {szligbeta}-cell function (57.42 ± 49.86 vs. 21.78 ± 18.54 mU/l per mmol/l, P = 0.0014) significantly improved in the pioglitazone group, with no change observed after placebo. CONCLUSIONS:--Pioglitazone improves endothelial dysfunction independently from the observed benefits on insulin sensitivity and {szligbeta}-cell function in patients with newly diagnosed type 2 diabetes and CAD.
Background: Physical activity and cardiorespiratory fitness relate to better cognitive performance. Little is known about the effects of fitness on structural brain abnormalities in the elderly. ...Objective: Assess the association between maximal oxygen consumption (VO2max), white matter lesion (WML) volume and brain parenchymal fraction (BPF) in a large cohort of community-dwelling elderly individuals. Methods: The study population consisted of 715 participants of the Austrian Stroke Prevention Study who underwent brain MRI with semi-automated measurement of WML volume (cm3) and automated assessment of BPF (%) by the use of SIENAX. A maximal exercise stress test was done on a bicycle ergometer. VO2max was calculated based on maximum and resting heart rate. Results: After adjustment for possible confounders, VO2max was independently associated with WML volume (β = –0.10; p = 0.02); no significant relationship existed with silent cerebral infarcts and BPF. Associations between VO2max and WML load were only significant in men, but not in women. Conclusion: Our findings may have important preventive implications because WMLs are known to be a major determinant of cognitive decline and disability in old age.
Background
Conventional brachial cuff BP is known to vary according to age and gender, but the influence of these factors on 24-hour ambulatory central BP is unknown. We sought to determine this in a ...large healthy population from 11 centers in Europe and Asia.
Methods
24-hour ambulatory BP using a validated oscillometric device (Mobilo-graph, I.E.M, Stolberg, Germany) was performed in 1645 individuals free from anti-hypertensive drugs. Participants were categorized as young (Y: 13–39 years; M/F:219/112), middle-aged (MA: 40–66 years; M/F:545/553), and older (O: 67–104 years; M/F:86/130). Nighttime/daytime difference (N/D) was defined as nighttime (01.00–06.00) minus daytime (09.00–21.00) values / daytime values.
Results
Averaged 24-hour brachial BP was 125/79 (Y), 128/83 (MA), and 127/77 (O) mmHg. N/D for brachial SBP was -10.3% (Y), -6.4% (MA), and -4.7% (O), but was significantly less pronounced for central SBP: -1% (Y), -3.1% (MA), and -1.9% (O). Men, compared to women, had higher brachial and central SBPs, mainly in younger participants. Brachial pulse pressure (PP) displayed limited and age-dependent circadian variations, whereas central PP was substantially higher at nighttime: N/D was 24% (Y), 9% (MA), and 5.9% (O). Brachial and central PPs were higher in men in the younger group, but higher in women in middle-aged and older groups.
Conclusion
Both age and gender each have a significant influence on 24hour variability of central BP, but is different than variability in brachial BP. These data have potential implications for refining hypertension diagnosis and management.
Background
There is evidence of a closer relation between 24 hour aortic systolic blood pressure (aSBP) and left ventricular mass (LVM) compared with 24 hour brachial SBP. However, sample sizes are ...relatively small and there is some inconsistency in findings. We sought to address this by pooling data from 16 centers in Asia, Europe and Latin America to determine the relationship between LVM and brachial office, as well as brachial and aortic 24 hour ambulatory SBP.
Methods
In all centers, brachial and aortic SBP was measured with the same validated oscillometric device, using a transfer function for aortic pressure, and mean/diastolic pressure calibration. LVM was determined by echocardiography.
Results
We studied 2092 participants (972 women) with a mean age of 52 years. Mean brachial office BP was 137/84 mmHg, and mean 24 hour bSBP and aSBP was 126 118;134 and 131 120;137 mm Hg, respectively. Mean LVM indexed to body surface area was 88.4 g/m and 27.2% of participants had left ventricular hypertrophy (LVH). The correlation coefficients between LVM and brachial office SBP, 24 hour bSBP, and 24 hour aSBP were 0.24, 0.35, and 0.43, respectively (
p
< 0.001 for differences). The areas under the curve for prediction of LVH were 0.62, 0.67, and 0.70 for brachial office SBP, 24 hour bSBP, and 24 hour aSBP, respectively (
p
< 0.001 for differences).
Conclusion
In this pooled analysis of international data, we demonstrate that aortic ambulatory SBP, measured with an oscillometric cuff, shows a significantly closer association with hypertensive cardiac organ damage (left ventricular mass and hypertrophy) than brachial office/brachial ambulatory systolic blood pressure.
Pulsatile Hemodynamics in Patients With Exertional Dyspnea Weber, Thomas, MD; Wassertheurer, Siegfried, DI; O'Rourke, Michael F., MD ...
Journal of the American College of Cardiology,
05/2013, Letnik:
61, Številka:
18
Journal Article
Recenzirano
Odprti dostop
Objectives This study sought to test whether measures of pulsatile arterial function are useful for diagnosing heart failure with preserved ejection fraction (HFPEF), in comparison with and in ...addition to tissue Doppler echocardiography (TDE). Background Increased arterial stiffness and wave reflections are present in most patients with HFPEF. Methods Patients with dyspnea as a major symptom were categorized as having HFPEF or no HFPEF, based on invasively derived filling pressures and natriuretic peptide levels. Pulse wave velocity (PWV) was measured invasively (aortic PWV). Aortic pulse pressure (aoPP) and its components (incident pressure wave height, forward wave amplitude; augmented pressure; backward wave amplitude Pb) were quantified noninvasively. Results Seventy-one patients were classified as HFPEF and 65 as no HFPEF (223 patients had intermediate results). Patients with HFPEF were older, more often had hypertension and diabetes, and had larger left atria and higher left ventricular mass. Brachial pulse pressure (bPP), aoPP, and all measures of arterial stiffness and wave reflections were higher in HFPEF patients. Receiver-operating curve analysis–derived area under the curve (AUC) values for separating HFPEF from no HFPEF were 0.823 for E/E′ at the medial annulus, the best TDE parameter; 0.816 for bPP; and 0.867, 0.851, and 0.825 for aortic PWV, aoPP, and Pb, respectively. Adding measures of pulsatile function to TDE resulted in an increase in AUC to 0.875 (bPP; p = 0.03) and 0.901 (aoPP; p = 0.005). In comparison with a TDE-based algorithm, net reclassification improvement was 32.9% (p < 0.0001). Conclusions Measures of pulsatile arterial hemodynamics may complement TDE for the diagnosis of HFPEF. (Pulsatile and Steady State Hemodynamics in Diastolic Heart Failure; NCT00720525 )
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