Impact of age on pulmonary artery systolic pressures at rest and with exercise

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Garvan C Kane

2016-06-01

Full Text Available Aim: It is not well known if advancing age influences normal rest or exercise pulmonary artery pressures. The purpose of the study was to evaluate the association of increasing age with measurements of pulmonary artery systolic pressure at rest and with exercise. Subjects and methods: A total of 467 adults without cardiopulmonary disease and normal exercise capacity (age range: 18–85 years underwent symptom-limited treadmill exercise testing with Doppler measurement of rest and exercise pulmonary artery systolic pressure. Results: There was a progressive increase in rest and exercise pulmonary artery pressures with increasing age. Pulmonary artery systolic pressures at rest and with exercise were 25 ± 5 mmHg and 33 ± 9 mmHg, respectively, in those <40 years, and 30 ± 5 mmHg and 41 ± 12 mmHg, respectively, in those ≥70 years. While elevated left-sided cardiac filling pressures were excluded by protocol design, markers of arterial stiffness associated with the age-dependent effects on pulmonary pressures. Conclusion: These data demonstrate that in echocardiographically normal adults, pulmonary artery systolic pressure increases with advancing age. This increase is seen at rest and with exercise. These increases in pulmonary pressure occur in association with decreasing transpulmonary flow and increases in systemic pulse pressure, suggesting that age-associated blood vessel stiffening may contribute to these differences in pulmonary artery systolic pressure.

Effects of parental smoking on exercise systolic blood pressure in adolescents.

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Hacke, Claudia; Weisser, Burkhard

2015-05-11

In adults, exercise blood pressure seems to be more closely related to cardiovascular risk than resting blood pressure; however, few data are available on the effects of familial risk factors, including smoking habits, on exercise blood pressure in adolescents. Blood pressure at rest and during exercise, parental smoking, and other familial risk factors were investigated in 532 adolescents aged 12 to 17 years (14.6±1.5 years) in the Kiel EX.PRESS. (EXercise PRESSure) Study. Exercise blood pressure was determined at 1.5 W/kg body weight using a standardized submaximal cycle ergometer test. Mean resting blood pressure was 113.1±12.8/57.2±7.1 mm Hg, and exercise blood pressure was 149.9±19.8/54.2±8.6 mm Hg. Parental smoking increased exercise systolic blood pressure (+4.0 mm Hg, 3.1 to 4.9; P=0.03) but not resting blood pressure of the subjects (adjusted for age, sex, height, body mass index percentile, fitness). Parental overweight and familial hypertension were related to both higher resting and exercise systolic blood pressure values, whereas associations with an inactive lifestyle and a low educational level of the parents were found only with adolescents' blood pressure during exercise. The cumulative effect of familial risk factors on exercise systolic blood pressure was more pronounced than on blood pressure at rest. Parental smoking might be a novel risk factor for higher blood pressure, especially during exercise. In addition, systolic blood pressure during a submaximal exercise test was more closely associated with familial risk factors than was resting blood pressure, even in adolescents. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Right Heart End-Systolic Remodeling Index Strongly Predicts Outcomes in Pulmonary Arterial Hypertension: Comparison With Validated Models.

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Amsallem, Myriam; Sweatt, Andrew J; Aymami, Marie C; Kuznetsova, Tatiana; Selej, Mona; Lu, HongQuan; Mercier, Olaf; Fadel, Elie; Schnittger, Ingela; McConnell, Michael V; Rabinovitch, Marlene; Zamanian, Roham T; Haddad, Francois

2017-06-01

Right ventricular (RV) end-systolic dimensions provide information on both size and function. We investigated whether an internally scaled index of end-systolic dimension is incremental to well-validated prognostic scores in pulmonary arterial hypertension. From 2005 to 2014, 228 patients with pulmonary arterial hypertension were prospectively enrolled. RV end-systolic remodeling index (RVESRI) was defined by lateral length divided by septal height. The incremental values of RV free wall longitudinal strain and RVESRI to risk scores were determined. Mean age was 49±14 years, 78% were female, 33% had connective tissue disease, 52% were in New York Heart Association class ≥III, and mean pulmonary vascular resistance was 11.2±6.4 WU. RVESRI and right atrial area were strongly connected to the other right heart metrics. Three zones of adaptation (adapted, maladapted, and severely maladapted) were identified based on the RVESRI to RV systolic pressure relationship. During a mean follow-up of 3.9±2.4 years, the primary end point of death, transplant, or admission for heart failure was reached in 88 patients. RVESRI was incremental to risk prediction scores in pulmonary arterial hypertension, including the Registry to Evaluate Early and Long-Term PAH Disease Management score, the Pulmonary Hypertension Connection equation, and the Mayo Clinic model. Using multivariable analysis, New York Heart Association class III/IV, RVESRI, and log NT-proBNP (N-Terminal Pro-B-Type Natriuretic Peptide) were retained (χ 2 , 62.2; P right heart metrics, RVESRI demonstrated the best test-retest characteristics. RVESRI is a simple reproducible prognostic marker in patients with pulmonary arterial hypertension. © 2017 American Heart Association, Inc.

Potential of right to left ventricular volume ratio measured on chest CT for the prediction of pulmonary hypertension: correlation with pulmonary arterial systolic pressure estimated by echocardiography

International Nuclear Information System (INIS)

Lee, Heon; Kim, Seok Yeon; Lee, Soo Jeong; Kim, Jae Kyun; Reddy, Ryan P.; Schoepf, U.J.

2012-01-01

To investigate the correlation of right ventricular (RV) to left ventricular (LV) volume ratio measured by chest CT with pulmonary arterial systolic pressure (PASP) estimated by echocardiography. 104 patients (72.47 ± 13.64 years; 39 male) who had undergone chest CT and echocardiography were divided into two groups (hypertensive and normotensive) based upon an echocardiography-derived PASP of 25 mmHg. RV to LV volume ratios (RV V /LV V ) were calculated. RV V /LV V was then correlated with PASP using regression analysis. The Area Under the Curve (AUC) for predicting pulmonary hypertension on chest CT was calculated. In the hypertensive group, the mean PASP was 46.29 ± 14.42 mmHg (29-98 mmHg) and there was strong correlation between the RV V /LV V and PASP (R = 0.82, p V /LV V were 0.990 and 0.892. RV V /LV V was 1.01 ± 0.44 (0.51-2.77) in the hypertensive and 0.72 ± 0.14 (0.52-1.11) in the normotensive group (P V /LV V , sensitivity and specificity for predicting pulmonary hypertension over 40 mmHg were 79.5 % and 90 %, respectively. The AUC for predicting pulmonary hypertension was 0.87 RV/LV volume ratios on chest CT correlate well with PASP estimated by echocardiography and can be used to predict pulmonary hypertension over 40 mmHg with high sensitivity and specificity. (orig.)

Second measurement of morning systolic blood pressure is more closely associated with albuminuria.

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Sakabe, Kazumi; Fukui, Michiaki; Ushigome, Emi; Hamaguchi, Masahide; Tanaka, Toru; Atsuta, Haruhiko; Ohnishi, Masayoshi; Oda, Yohei; Hasegawa, Goji; Nakamura, Naoto

2012-08-01

It is important to control blood pressure as well as to control blood glucose for the prevention of diabetic nephropathy. However, to our knowledge, there are no reports investigating which blood pressure, including morning, evening and clinic, is more closely associated with albuminuria and whether one measurement is sufficient or not in patients with Type 2 diabetes. We measured morning, evening and clinic blood pressure and compared the area under the curve (AUC) of blood pressure for urinary albumin excretion equal to or more than 30 mg/g creatinine using receiver-operating characteristic curve analyses and odds ratio for albuminuria defined as urinary albumin excretion equal to or more than 30 mg/g creatinine in 858 patients with Type 2 diabetes. Odds ratio (95% confidence interval (CI)) of morning, evening and clinic systolic blood pressure for albuminuria was 1.034 (1.024 - 1.044), 1.033 (1.023 - 1.043) and 1.013 (1.055 - 1.021), respectively (p AUC of morning, evening and clinic systolic blood pressure was 0.644 (0.628 - 0.700) (p AUC of the second morning systolic blood pressure was greater than the first (p = 0.033). The second measurement of morning systolic blood pressure is more closely associated with albuminuria than the first measurement of the morning in addition to clinic systolic blood pressure.

Potential of right to left ventricular volume ratio measured on chest CT for the prediction of pulmonary hypertension: correlation with pulmonary arterial systolic pressure estimated by echocardiography

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Lee, Heon [Soon Chun Hyang University, Department of Radiology, Bucheon (Korea, Republic of); Kim, Seok Yeon [Seoul Medical Center, Department of Cardiology, Seoul (Korea, Republic of); Lee, Soo Jeong [Terarecon Korea, Seoul (Korea, Republic of); Kim, Jae Kyun [Chung-Ang University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Reddy, Ryan P.; Schoepf, U.J. [Medical University of South Carolina, Department of Radiology and Radiological Science and Division of Cardiology, Department of Medicine, Charleston, SC (United States)

2012-09-15

To investigate the correlation of right ventricular (RV) to left ventricular (LV) volume ratio measured by chest CT with pulmonary arterial systolic pressure (PASP) estimated by echocardiography. 104 patients (72.47 {+-} 13.64 years; 39 male) who had undergone chest CT and echocardiography were divided into two groups (hypertensive and normotensive) based upon an echocardiography-derived PASP of 25 mmHg. RV to LV volume ratios (RV{sub V}/LV{sub V}) were calculated. RV{sub V}/LV{sub V} was then correlated with PASP using regression analysis. The Area Under the Curve (AUC) for predicting pulmonary hypertension on chest CT was calculated. In the hypertensive group, the mean PASP was 46.29 {+-} 14.42 mmHg (29-98 mmHg) and there was strong correlation between the RV{sub V}/LV{sub V} and PASP (R = 0.82, p < 0.001). The intraobserver and interobserver correlation coefficients for RV{sub V}/LV{sub V} were 0.990 and 0.892. RV{sub V}/LV{sub V} was 1.01 {+-} 0.44 (0.51-2.77) in the hypertensive and 0.72 {+-} 0.14 (0.52-1.11) in the normotensive group (P <0.05). With 0.9 as the cutoff for RV{sub V}/LV{sub V}, sensitivity and specificity for predicting pulmonary hypertension over 40 mmHg were 79.5 % and 90 %, respectively. The AUC for predicting pulmonary hypertension was 0.87 RV/LV volume ratios on chest CT correlate well with PASP estimated by echocardiography and can be used to predict pulmonary hypertension over 40 mmHg with high sensitivity and specificity. (orig.)

Relationship Between 24-Hour Ambulatory Central Systolic Blood Pressure and Left Ventricular Mass: A Prospective Multicenter Study.

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Weber, Thomas; Wassertheurer, Siegfried; Schmidt-Trucksäss, Arno; Rodilla, Enrique; Ablasser, Cornelia; Jankowski, Piotr; Lorenza Muiesan, Maria; Giannattasio, Cristina; Mang, Claudia; Wilkinson, Ian; Kellermair, Jörg; Hametner, Bernhard; Pascual, Jose Maria; Zweiker, Robert; Czarnecka, Danuta; Paini, Anna; Salvetti, Massimo; Maloberti, Alessandro; McEniery, Carmel

2017-12-01

We investigated the relationship between left ventricular mass and brachial office as well as brachial and central ambulatory systolic blood pressure in 7 European centers. Central systolic pressure was measured with a validated oscillometric device, using a transfer function, and mean/diastolic pressure calibration. M-mode images were obtained by echocardiography, and left ventricular mass was determined by one single reader blinded to blood pressure. We studied 289 participants (137 women) free from antihypertensive drugs (mean age: 50.8 years). Mean office blood pressure was 145/88 mm Hg and mean brachial and central ambulatory systolic pressures were 127 and 128 mm Hg, respectively. Mean left ventricular mass was 93.3 kg/m 2 , and 25.6% had left ventricular hypertrophy. The correlation coefficient between left ventricular mass and brachial office, brachial ambulatory, and central ambulatory systolic pressure was 0.29, 0.41, and 0.47, respectively ( P =0.003 for comparison between brachial office and central ambulatory systolic pressure and 0.32 for comparison between brachial and central ambulatory systolic pressure). The results were consistent for men and women, and young and old participants. The areas under the curve for prediction of left ventricular hypertrophy were 0.618, 0.635, and 0.666 for brachial office, brachial, and central ambulatory systolic pressure, respectively ( P =0.03 for comparison between brachial and central ambulatory systolic pressure). In younger participants, central ambulatory systolic pressure was superior to both other measurements. Central ambulatory systolic pressure, measured with an oscillometric cuff, shows a strong trend toward a closer association with left ventricular mass and hypertrophy than brachial office/ambulatory systolic pressure. URL: https://www.clinicaltrials.gov. Unique identifier: NCT01278732. © 2017 American Heart Association, Inc.

Analysis of the progression of systolic blood pressure using imputation of missing phenotype values

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Vaitsiakhovich, Tatsiana; Drichel, Dmitriy; Angisch, Marina; Becker, Tim; Herold, Christine; Lacour, André

2014-01-01

We present a genome-wide association study of a quantitative trait, "progression of systolic blood pressure in time," in which 142 unrelated individuals of the Genetic Analysis Workshop 18 real genotype data were analyzed. Information on systolic blood pressure and other phenotypic covariates was missing at certain time points for a considerable part of the sample. We observed that the dropout process causing missingness is not independent of the initial systolic blood pressure; that is, the ...

Analysis of end-systolic pressure-volume relation by gated radionuclide angiocardiography

International Nuclear Information System (INIS)

Adachi, Haruhiko; Sugihara, Horoki; Katsume, Hiroshi; Ijichi, Hamao; Miyanaga, Hajime

1982-01-01

Left ventricular end-systolic pressure-volume relation has been proved experimentally to b e an useful index of left ventricular contractility relatively independent of preload or afterload. But less clinical application has been reported because of its invasive nature, and we evaluated this relationship non-invasively using gated radionuclide angiocardiography as volume determination and cuff sphyngomanometer in the arm as pressure measurement. Gated equilibrium blood pool scintigrams were obtained at rest and during intravenous infusion of angiotensin or nitrate. Ventricular volumes were derived from ventricular activity and peripheral blood volume and activity. The peak systolic pressure (PSP) by cuff method to end-systolic volume index (ESVI) relations showed good linearity (r gt .930 in 84% of consecutive 50 cases) and were gentler in the groups with more impaired left ventricular function. Emax was related exponentially to ejection fraction (EF) and hyperbolically to end-diastolic volume index. The dead volume (VoI) was unfixed and fell into positive or negative value, and was not related to EF under control condition. PSP/ESVI in each loading condition was less variable with the alteration of blood pressure than EF. The linear relation was found between PSP/ESVI under control condition and Emax (PSP/ESVI = 0.651.Emax + 0.958, r = 0.841, p lt .001). Thus in measuring ventricular volume, gated radionuclide angiocardiography is a non-invasive method less affected by the geometry of the left ventricle. Non-invasive determination of end-systolic pressure-volume relation using the volume by radionuclide and the blood pressure by cuff method is clinically useful in the assessment of left ventricular contractility. (author)

Assessment of right ventricular longitudinal strain by 2D speckle tracking imaging compared with RV function and hemodynamics in pulmonary hypertension.

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Li, Yidan; Wang, Yidan; Meng, Xiangli; Zhu, Weiwei; Lu, Xiuzhang

2017-11-01

The right ventricular longitudinal strain (RVLS) of pulmonary hypertension (PH) patients and its relationship with RV function parameters measured by echocardiography and hemodynamic parameters measured by right heart catheterization was investigated. According to the WHO functional class (FC), 66 PH patients were divided into FC I/II (group 1) and III/IV (group 2). RV function parameters were measured by echocardiographic examinations. Hemodynamic parameters were obtained by right heart catheterization. Patients in group 2 had higher systolic pulmonary artery pressure (sPAP; P good sensitivity and specificity. Evidence has shown that RVLS measurement can provide the much-needed and reliable information on RV function and hemodynamics. Therefore, this qualifies as a patient-friendly approach for the clinical management of PH patients.

Systolic blood pressure is superior to other haemodynamic predictors of outcome in community acquired pneumonia.

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Chalmers, J D; Singanayagam, A; Hill, A T

2008-08-01

Admission blood pressure (BP) assessment is a central component of severity assessment for community acquired pneumonia. The aim of this study was to establish which readily available haemodynamic measure on admission is most useful for predicting severity in patients admitted with community acquired pneumonia. A prospective observational study of patients admitted with community acquired pneumonia was conducted in Edinburgh, UK. The measurements compared were systolic and diastolic BP, mean arterial pressure and pulse pressure. The outcomes of interest were 30 day mortality and the requirement for mechanical ventilation and/or inotropic support. Admission systolic BP pressure pressure AUC values for each predictor of 30 day mortality were as follows: systolic BP pressure pressure AUC values for each predictor of need for mechanical ventilation and/or inotropic support were as follows: systolic BP pressure pressure blood pressure AUC 0.76 vs 0.74) and to the standard CURB65 score (0.76 vs 0.76) for the prediction of 30 day mortality. The simplified CRB65 score was equivalent for prediction of mechanical ventilation and/or inotropic support to standard CRB65 (0.77 vs 0.77) and to CURB65 (0.77 vs 0.78). Systolic BP is superior to other haemodynamic predictors of 30 day mortality and need for mechanical ventilation and/or inotropic support in community acquired pneumonia. The CURB65 score can be simplified to a modified CRB65 score by omission of the diastolic BP criterion without compromising its accuracy.

Measurement of pulmonary arterial elastance in patients with systolic heart failure using Doppler echocardiography

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Taghavi, Sepideh; Esmaeilzadeh, Maryam; Amin, Ahmad; Naderi, Nasim; Abkenar, Hooman Bakhshandeh; Maleki, Majid; Mitra, Chitsazan

2016-01-01

Objective: A reliable and easy-to-perform method for measuring right ventricular (RV) afterload is desirable when scheduling patients with systolic heart failure to undergo heart transplantation. The present study aimed to investigate the accuracy of echocardiographically-derived pulmonary arterial elastance as a measurement of pulmonary vascular resistance by comparing it with invasive measures. Methods: Thirty-one patients with moderate to severe systolic heart failure, including 22 (71%) male patients, with a mean age of 41.16±15.9 years were enrolled in the study. Right heart catheterization and comprehensive echocardiography during the first hour after completion of cardiac catheterization were performed in all the patients. The pulmonary artery elastance was estimated using the ratio of end-systolic pressure (Pes) over the stroke volume (SV) by both cardiac catheterization [Ea (PV)-C] and echocardiography [Ea (PV)-E]. Results: The mean Ea (PV)-C and Ea (PV)-E were estimated to be 0.73±0.49 mm Hg/mL and 0.67±0.44 mm Hg/mL, respectively. There was a significant relation between Ea (PV)-E and Ea (PV)-C (r=0.897, pechocardiography and catheterization methods for estimating Ea (PV), investigated by the Bland-Altman method, showed a mean bias of -0.06, with 95% limits of agreement from -0.36 mm Hg/mL to 0.48 mm Hg/mL. Conclusion: Doppler echocardiography is an easy, non-invasive, and inexpensive method for measuring pulmonary arterial elastance, which provides accurate and reliable estimation of RV afterload in patients with systolic heart failure. PMID:26467379

The measurement of digital systolic blood pressure by strain gauge technique

DEFF Research Database (Denmark)

Nielsen, P E; Bell, G; Lassen, N A

1972-01-01

The systolic blood pressure on the finger, toe, and ankle has been measured by a strain gauge technique in 10 normal subjects aged 17-31 years and 14 normal subjects aged 43-57 years. The standard deviation in repeated measurements lies between 2 and 6 mm Hg. The finger pressure in the younger...... group was significantly higher than the corresponding arm pressure (+ 9.3 mm Hg, S.D. 6.8), but equalled this in the older group (- 0.5 mm Hg, S.D. 6.6). In the two groups the ankle pressures were + 19.3 mm Hg (S.D. 7.5) and + 23.6 mm Hg (S.D. 9.5) higher than the systolic arm pressures. The toe...... pressures were lower than the arm pressures, in the two groups - 4.8 mm Hg (S.D. 6.6) and - 9.8 mm Hg (S.D. 10.7) respectively. The ankle-toe gradient was in the younger group 24.3 mm Hg (S.D. 7.3) and in the older group 33.3 mm Hg (S.D. 12.1). Using mean minus 2.5 X S.D. as the lower limit of normality...

Right ventricular function during one-lung ventilation: effects of pressure-controlled and volume-controlled ventilation.

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Al Shehri, Abdullah M; El-Tahan, Mohamed R; Al Metwally, Roshdi; Qutub, Hatem; El Ghoneimy, Yasser F; Regal, Mohamed A; Zien, Haytham

2014-08-01

To test the effects of pressure-controlled (PCV) and volume-controlled (VCV) ventilation during one-lung ventilation (OLV) for thoracic surgery on right ventricular (RV) function. A prospective, randomized, double-blind, controlled, crossover study. A single university hospital. Fourteen pairs of consecutive patients scheduled for elective thoracotomy. Patients were assigned randomly to ventilate the dependent lung with PCV or VCV mode, each in a randomized crossover order using tidal volume of 6 mL/kg, I: E ratio 1: 2.5, positive end-expiratory pressure (PEEP) of 5 cm H2O and respiratory rate adjusted to maintain normocapnia. Intraoperative changes in RV function (systolic and early diastolic tricuspid annular velocity (TAV), end-systolic volume (ESV), end-diastolic volume (EDV) and fractional area changes (FAC)), airway pressures, compliance and oxygenation index were recorded. The use of PCV during OLV resulted in faster systolic (10.1±2.39 vs. 5.8±1.67 cm/s, respectively), diastolic TAV (9.2±1.99 vs. 4.6±1.42 cm/s, respectively) (prights reserved.

Total flying hours and risk of high systolic blood pressure in the civilian pilot in Indonesia

Directory of Open Access Journals (Sweden)

Ferdi Afian

2016-07-01

Full Text Available Abstrak Latar belakang: Tekanan darah sistolik tinggi di antara pilot sipil antara lain akan menyebabkan gangguan kardiovaskular sehingga akan mengganggu kelancaran penerbangan. Tujuan penelitian ini ialah untuk mengetahui faktor-faktor dominan terhadap tekanan darah sistolik tinggi pada pilot sipil. Metode: Penelitian potong lintang dengan metode sampling purposif pada pilot yang melakukan pemeriksaan kesehatan berkala di Balai Kesehatan Penerbangan pada tanggal 18-29 Mei 2015. Data yang dikumpulkan adalah karakteristik demografi dan pekerjaan, klinis, kebiasaan olahraga, kebiasaan makan, indeks massa tubuh dan riwayat penyakit. Tekanan darah sistolik tinggi ialah tekanan darah sistolik140 mmHg atau lebih. Hasil: Dari 690 pilot yang melakukan pemeriksaan kesehatan berkala, 428 pilot laki-laki bersedia berpartisipasi mengikuti penelitian ini. Usia dan riwayat penyakit hipertensi merupakan faktor risiko dominan yang berhubungan dengan tekanan darah sistolik tinggi. Jika dibandingkan dengan pilot usia 19-39 tahun, yang berusia 40-65 tahun mempunyai 15,1 kali lipat lebih besar risiko terkena tekanan darah sistolik tinggi [rasio odds suaian (ORa= 15,12; p= 0,001]. Pilot dengan riwayat penyakit hipertensi dibandingkan dengan yang tidak ada riwayat memiliki risiko tekanan darah sistolik tinggi 93,2 kali lipat lebih besar (ORa= 93,21; p= 0,001 Kesimpulan: Usia 40-65 tahun dan memiliki riwayat hipertensi meningkatkan risiko tekanan darah sistolik tinggi di antara pilot sipil di Indonesia. Kata kunci: tekanan darah sistolik, total jam terbang, pilot sipil, Indonesia.  Abstract Background: Systolic high blood pressure among civilian pilots among others will cause cardiovascular disease and this condition will disrupt the flight.The purpose of this study was to identified the dominant factors related to high systolic blood pressure in the civilian pilots. Methods: A cross-sectional study with a purposive sampling method on a pilot who performed periodic

Different systolic blood pressure targets for people with history of stroke or transient ischaemic attack: PAST-BP (Prevention After Stroke—Blood Pressure) randomised controlled trial

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McManus, Richard J; Roalfe, Andrea; Fletcher, Kate; Taylor, Clare J; Martin, Una; Virdee, Satnam; Greenfield, Sheila; Hobbs, F D Richard

2016-01-01

Objective To assess whether using intensive blood pressure targets leads to lower blood pressure in a community population of people with prevalent cerebrovascular disease. Design Open label randomised controlled trial. Setting 99 general practices in England, with participants recruited in 2009-11. Participants People with a history of stroke or transient ischaemic attack whose systolic blood pressure was 125 mm Hg or above. Interventions Intensive systolic blood pressure target (different target, patients in both arms were actively managed in the same way with regular reviews by the primary care team. Main outcome measure Change in systolic blood pressure between baseline and 12 months. Results 529 patients (mean age 72) were enrolled, 266 to the intensive target arm and 263 to the standard target arm, of whom 379 were included in the primary analysis (182 (68%) intensive arm; 197 (75%) standard arm). 84 patients withdrew from the study during the follow-up period (52 intensive arm; 32 standard arm). Mean systolic blood pressure dropped by 16.1 mm Hg to 127.4 mm Hg in the intensive target arm and by 12.8 mm Hg to 129.4 mm Hg in the standard arm (difference between groups 2.9 (95% confidence interval 0.2 to 5.7) mm Hg; P=0.03). Conclusions Aiming for target below 130 mm Hg rather than 140 mm Hg for systolic blood pressure in people with cerebrovascular disease in primary care led to a small additional reduction in blood pressure. Active management of systolic blood pressure in this population using a blood pressure. Trial registration Current Controlled Trials ISRCTN29062286. PMID:26919870

Isolated Systolic Hypertension: A Health Concern?

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Isolated systolic hypertension: A health concern? Is having a high top number (systolic) blood pressure, but a normal bottom number (diastolic) ... mm Hg, you have a common type of high blood pressure called isolated systolic hypertension. Isolated systolic hypertension can ...

Recruitment strategies and challenges in a large intervention trial: Systolic Blood Pressure Intervention Trial.

Science.gov (United States)

Ramsey, Thomas M; Snyder, Joni K; Lovato, Laura C; Roumie, Christianne L; Glasser, Steven P; Cosgrove, Nora M; Olney, Christine M; Tang, Rocky H; Johnson, Karen C; Still, Carolyn H; Gren, Lisa H; Childs, Jeffery C; Crago, Osa L; Summerson, John H; Walsh, Sandy M; Perdue, Letitia H; Bankowski, Denise M; Goff, David C

2016-06-01

The Systolic Blood Pressure Intervention Trial is a multicenter, randomized clinical trial of 9361 participants with hypertension who are ≥50 years old. The trial is designed to evaluate the effect of intensive systolic blood pressure control (systolic blood pressure goal recruitment strategies and lessons learned during recruitment of the Systolic Blood Pressure Intervention Trial cohort and five targeted participant subgroups: pre-existing cardiovascular disease, pre-existing chronic kidney disease, age ≥75 years, women, and minorities. In collaboration with the National Institutes of Health Project Office and Systolic Blood Pressure Intervention Trial Coordinating Center, five Clinical Center Networks oversaw clinical site selection, recruitment, and trial activities. Recruitment began on 8 November 2010 and ended on 15 March 2013 (about 28 months). Various recruitment strategies were used, including mass mailing, brochures, referrals from healthcare providers or friends, posters, newspaper ads, radio ads, and electronic medical record searches. Recruitment was scheduled to last 24 months to enroll a target of 9250 participants; in just over 28 months, the trial enrolled 9361 participants. The trial screened 14,692 volunteers, with 33% of initial screens originating from the use of mass mailing lists. Screening results show that participants also responded to recruitment efforts through referral by Systolic Blood Pressure Intervention Trial staff, healthcare providers, or friends (45%); brochures or posters placed in clinic waiting areas (15%); and television, radio, newspaper, Internet ads, or toll-free numbers (8%). The overall recruitment yield (number randomized/number screened) was 64% (9361 randomized/14,692 screened), 77% for those with cardiovascular disease, 79% for those with chronic kidney disease, 70% for those aged ≥75 years, 55% for women, and 61% for minorities. As recruitment was observed to lag behind expectations, additional

Urinary albumin excretion is associated with nocturnal systolic blood pressure in resistant hypertensives.

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Oliveras, Anna; Armario, Pedro; Martell-Clarós, Nieves; Ruilope, Luis M; de la Sierra, Alejandro

2011-03-01

Microalbuminuria is a known marker of subclinical organ damage. Its prevalence is higher in patients with resistant hypertension than in subjects with blood pressure at goal. On the other hand, some patients with apparently well-controlled hypertension still have microalbuminuria. The current study aimed to determine the relationship between microalbuminuria and both office and 24-hour ambulatory blood pressure. A cohort of 356 patients (mean age 64 ± 11 years; 40.2% females) with resistant hypertension (blood pressure ≥ 140 and/or 90 mm Hg despite treatment with ≥ 3 drugs, diuretic included) were selected from Spanish hypertension units. Patients with estimated glomerular filtration rate <30 mL/min/1.73 m(2) were excluded. All patients underwent clinical and demographic evaluation, complete laboratory analyses, and good technical-quality 24-hour ambulatory blood pressure monitoring. Urinary albumin/creatinine ratio was averaged from 3 first-morning void urine samples. Microalbuminuria (urinary albumin/creatinine ratio ≥ 2.5 mg/mmol in males or ≥ 3.5 mg/mmol in females) was detected in 46.6%, and impaired renal function (estimated glomerular filtration rate <60 mL/min/1.73 m(2)) was detected in 26.8%. Bivariate analyses showed significant associations of microalbuminuria with older age, reduced estimated glomerular filtration rate, increased nighttime systolic blood pressure, and elevated daytime, nighttime, and 24-hour diastolic blood pressure. In a logistic regression analysis, after age and sex adjustment, elevated nighttime systolic blood pressure (multivariate odds ratio, 1.014 [95% CI, 1.001 to 1.026]; P=0.029) and reduced estimated glomerular filtration rate (multivariate odds ratio, 2.79 [95% CI, 1.57 to 4.96]; P=0.0005) were independently associated with the presence of microalbuminuria. We conclude that microalbuminuria is better associated with increased nighttime systolic blood pressure than with any other office and 24-hour ambulatory blood

The correlation between psychological intervention and heart rate,systolic pressure in patients of cervical cancer treated with interventional chemoembolization

International Nuclear Information System (INIS)

Qiao Cuiyun; Lan Guiyun; Liu Shuang; Chen Bao'e; Liu Yali; Wang Zhujun

2010-01-01

Objective: To discuss the effect of psychological intervention on the heart rate, systolic pressure of the patients with cervical cancer who are treated with interventional chemoembolization. Methods: Eighty patients with cervical cancer were randomly and equally divided into two groups. Transcatheter arterial chemoembolization (TACE) was performed in all cases. Patients in study group (n=10) received systemic psychological intervention 30 minutes before TACE. The heart rate and systolic pressure of the patients were measured when TACE started. The results were compared with that obtained at the time of admission. Patients in control group (n=10) did not receive systemic psychological intervention before TACE and their heart rate and systolic pressure were measured in the same way as in study group. Results: At the time TACE started the heart rate and systolic pressure of the patients in study group were significantly lower than that in control group (P < 0.05). Conclusion: Preoperative psychological intervention is very helpful for reducing psychological stress and mental tension,in stabilizing heart rate and systolic pressure of the patients with cervical cancer who are treated with TACE. (authors)

Ratio of Systolic Blood Pressure to Right Atrial Pressure, a Novel Marker to Predict Morbidity and Mortality in Acute Systolic Heart Failure.

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Omar, Hesham R; Charnigo, Richard; Guglin, Maya

2017-04-01

Congestion is the main contributor to heart failure (HF) morbidity and mortality. We assessed the combined role of congestion and decreased forward flow in predicting morbidity and mortality in acute systolic HF. The Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness trial data set was used to determine if the ratio of simultaneously measured systolic blood pressure (SBP)/right atrial pressure (RAP) on admission predicted HF rehospitalization and 6-month mortality. One hundred ninety-five patients (mean age 56.5 years, 75% men) who received pulmonary artery catheterization were studied. The RAP, SBP, and SBP/RAP had an area under the curve (AUC) of 0.593 (p = 0.0205), 0.585 (p = 0.0359), and 0.621 (p = 0.0026), respectively, in predicting HF rehospitalization. The SBP/RAP was a superior marker of HF rehospitalization compared with RAP alone (difference in AUC 0.0289, p = 0.0385). The optimal criterion of SBP/RAP AUC 0.622, p = 0.0108, and a cut-off value of SBP/RAP <8 had a sensitivity of 61.9% and specificity 64.1% in predicting mortality. Multivariate analysis showed that an SBP/RAP <11 independently predicted rehospitalization for HF (estimated odds ratio 3.318, 95% confidence interval 1.692 to 6.506, p = 0.0005) and an SBP/RAP <8 independently predicted mortality (estimated hazard ratio 2.025, 95% confidence interval 1.069 to 3.833, p = 0.030). In conclusion, SBP/RAP ratio is a marker that identifies a spectrum of complications after hospitalization of patients with decompensated systolic HF, starting with increased incidence of HF rehospitalization at SBP/RAP <11 to increased mortality with SBP/RAP <8. Copyright © 2017 Elsevier Inc. All rights reserved.

Differential Systolic and Diastolic Regulation of the Cerebral Pressure-Flow Relationship During Squat-Stand Manoeuvres.

Science.gov (United States)

Smirl, Jonathan D; Wright, Alexander D; Ainslie, Philip N; Tzeng, Yu-Chieh; van Donkelaar, Paul

2018-01-01

Cerebral pressure-flow dynamics are typically reported between mean arterial pressure and mean cerebral blood velocity. However, by reporting only mean responses, potential differential regulatory properties associated with systole and diastole may have been overlooked. Twenty young adults (16 male, age: 26.7 ± 6.6 years, BMI: 24.9 ± 3.0 kg/m 2 ) were recruited for this study. Middle cerebral artery velocity was indexed via transcranial Doppler. Cerebral pressure-flow dynamics were assessed using transfer function analysis at both 0.05 and 0.10 Hz using squat-stand manoeuvres. This method provides robust and reliable measures for coherence (correlation index), phase (timing buffer) and gain (amplitude buffer) metrics. There were main effects for both cardiac cycle and frequency for phase and gain metrics (p flow relationship. The oscillations associated with systole are extensively buffered within the cerebrovasculature, whereas diastolic oscillations are relatively unaltered. This indicates that the brain is adapted to protect itself against large increases in systolic blood pressure, likely as a mechanism to prevent cerebral haemorrhages.

Cholecalciferol treatment to reduce blood pressure in older patients with isolated systolic hypertension: the VitDISH randomized controlled trial.

Science.gov (United States)

Witham, Miles D; Price, Rosemary J G; Struthers, Allan D; Donnan, Peter T; Messow, Claudia-Martina; Ford, Ian; McMurdo, Marion E T

2013-10-14

Observational data link low 25-hydroxyvitamin D levels to both prevalent blood pressure and incident hypertension. No clinical trial has yet examined the effect of vitamin D supplementation in isolated systolic hypertension, the most common pattern of hypertension in older people. To test whether high-dose, intermittent cholecalciferol supplementation lowers blood pressure in older patients with isolated systolic hypertension. Parallel group, double-blind, placebo-controlled randomized trial. Primary care clinics and hospital clinics. Patients 70 years and older with isolated systolic hypertension (supine systolic blood pressure >140 mm Hg and supine diastolic blood pressure blood pressure, 24-hour blood pressure, arterial stiffness, endothelial function, cholesterol level, insulin resistance, and b-type natriuretic peptide level during 12 months. A total of 159 participants were randomized (mean age, 77 years). Mean baseline office systolic blood pressure was 163/78 mm Hg. Mean baseline 25-hydroxyvitamin D level was 18 ng/mL. 25-Hydroxyvitamin D levels increased in the treatment group compared with the placebo group (+8 ng/mL at 1 year, P blood pressure (−1 [−6 to 4]/−2 [−4 to 1] mm Hg at 3 months and 1 [−2 to 4]/0 [−2 to 2] mm Hg overall treatment effect). No significant treatment effect was evident for any of the secondary outcomes (24-hour blood pressure, arterial stiffness, endothelial function, cholesterol level, glucose level, and walking distance). There was no excess of adverse events in the treatment group, and the total number of falls was nonsignificantly lower in the group receiving vitamin D (36 vs 46, P = .24). Vitamin D supplementation did not improve blood pressure or markers of vascular health in older patients with isolated systolic hypertension. isrctn.org Identifier: ISRCTN92186858.

Systolic blood pressure estimation using PPG and ECG during physical exercise

NARCIS (Netherlands)

Sun, S.; Bezemer, R.; Long, X.; Muehlsteff, J.; Aarts, R.M.

2016-01-01

In this work, a model to estimate systolic blood pressure (SBP) using photoplethysmography (PPG) and electrocardiography (ECG) is proposed. Data from 19 subjects doing a 40 min exercise was analyzed. Reference SBP was measured at the finger based on the volume-clamp principle. PPG signals were

Investigating Cardiac MRI Based Right Ventricular Contractility As A Novel Non-Invasive Metric of Pulmonary Arterial Pressure

Science.gov (United States)

Menon, Prahlad G; Adhypak, Srilakshmi M; Williams, Ronald B; Doyle, Mark; Biederman, Robert WW

2014-01-01

BACKGROUND We test the hypothesis that cardiac magnetic resonance (CMR) imaging-based indices of four-dimensional (4D) (three dimensions (3D) + time) right ventricle (RV) function have predictive values in ascertaining invasive pulmonary arterial systolic pressure (PASP) measurements from right heart catheterization (RHC) in patients with pulmonary arterial hypertension (PAH). METHODS We studied five patients with idiopathic PAH and two age and sex-matched controls for RV function using a novel contractility index (CI) for amplitude and phase to peak contraction established from analysis of regional shape variation in the RV endocardium over 20 cardiac phases, segmented from CMR images in multiple orientations. RESULTS The amplitude of RV contractility correlated inversely with RV ejection fraction (RVEF; R2 = 0.64, P = 0.03) and PASP (R2 = 0.71, P = 0.02). Phase of peak RV contractility also correlated inversely to RVEF (R2 = 0.499, P = 0.12) and PASP (R2 = 0.66, P = 0.04). CONCLUSIONS RV contractility analyzed from CMR offers promising non-invasive metrics for classification of PAH, which are congruent with invasive pressure measurements. PMID:25624777

Three-Dimensional Echocardiography-Derived Non-Invasive Right Ventricular Pressure-Volume Analysis.

Science.gov (United States)

Huang, Kuan-Chih; Lin, Lian-Yu; Hwang, Juey-Jen; Lin, Lung-Chun

2017-09-01

In patients with pulmonary hypertension, repeated evaluations of right ventricular (RV) function are still required for clinical decision making, but the invasive nature of current pressure-volume analysis makes conducting regular follow-ups in a clinical setting infeasible. We enrolled 12 patients with pulmonary arterial hypertension (PAH) and 10 with pulmonary venous hypertension (PVH) May 2016-October 2016. All patients underwent a clinically indicated right heart catheterization (RHC), from which the yielded right ventricular pressure recordings were conjugated with RV volume by 3-D echocardiography to generate a pressure-volume loop. A continuous-wave Doppler envelope of tricuspid regurgitation was transformed into a pressure gradient recording by the simplified Bernoulli equation, and then a systolic pressure gradient-volume (PG-V) diagram was generated from similar methods. The area enclosed by the pressure-volume loop was calculated to represent semi-invasive right ventricular stroke work (RVSW RHC ). The area between the PG-V diagram and x-axis was calculated to estimate non-invasive RVSW (RVSW echo ). Patients with PAH have higher RV pressure, lower pulmonary arterial wedge pressure and larger RV volume that was contributed by the dilation of RV mid-cavity minor dimension. We found no significant difference of traditional parameters between these two groups, but RVSW values were significantly higher in PAH patients. The RVSW values of these two methods were significantly correlated by the equation RVSW echo  = 0.8447 RVSW RHC  + 129.38 (R 2  = 0.9151, p rights reserved.

Older Women with Controlled Isolated Systolic Hypertension: Exercise and Blood Pressure.

Science.gov (United States)

Ubolsakka-Jones, Chulee; Sangthong, Benjarat; Aueyingsak, Sahachat; Jones, David A

2016-06-01

Exercise is generally regarded as beneficial for health, but the consequent increases in blood pressure might pose a risk for hypertensive subjects. The purpose of this study was to determine blood pressure responses to dynamic exercise and sustained handgrip in patients with isolated systolic hypertension (ISH) who were stable on medication. Nineteen female ISH patients (66 ± 5 yr) and 19 age-matched normotensive (NT) female controls undertook a 5-min cycle exercise (60% heart rate reserve [HRR]) and a 2-min handgrip exercise (30% maximum voluntary contraction). Blood pressure responses were measured using an oscillometric cuff, together with heart rate and resting brachial pulse transit times. Systolic blood pressure (SBP) levels after cycle exercise were 194 ± 18 and 153 ± 19 mm Hg for ISH and NT, respectively, with the increase above resting being greater for ISH (P exercise, SBP rose to 168 ± 19 and 140 ± 8 mm Hg for ISH and NT, respectively. The increases above baseline were greater for ISH both during the exercise and postexercise circulatory occlusion (P = 0.017). The increase in DBP levels during exercise and postexercise occlusion were similar in ISH and NT, suggesting little difference in metaboreflex sensitivity. Pulse transit time was shorter for ISH compared with NT (166 ± 6 ms and 242 ± 24 ms, respectively, P exercises, which may constitute a risk for cardiovascular incidents.

Environmental lead exposure is associated with visit-to-visit systolic blood pressure variability in the US adults.

Science.gov (United States)

Faramawi, Mohammed F; Delongchamp, Robert; Lin, Yu-Sheng; Liu, Youcheng; Abouelenien, Saly; Fischbach, Lori; Jadhav, Supriya

2015-04-01

The association between environmental lead exposure and blood pressure variability, an important risk factor for cardiovascular disease, is unexplored and unknown. The objective of the study was to test the hypothesis that lead exposure is associated with blood pressure variability. American participants 17 years of age or older from National Health and Nutrition Examination Survey III were included in the analysis. Participants' blood lead concentrations expressed as micrograms per deciliter were determined. The standard deviations of visit-to-visit systolic and diastolic blood pressure were calculated to determine blood pressure variability. Multivariable regression analyses adjusted for age, gender, race, smoking and socioeconomic status were employed. The participants' mean age and mean blood lead concentration were 42.72 years and 3.44 mcg/dl, respectively. Systolic blood pressure variability was significantly associated with environmental lead exposure after adjusting for the effect of the confounders. The unadjusted and adjusted means of visit-to-visit systolic blood pressure variability and the β coefficient of lead exposure were 3.44, 3.33 mcg/dl, β coefficient = 0.07, P variability. Screening adults with fluctuating blood pressure for lead exposure could be warranted.

Efficacy and duration of benazepril plus amlodipine or hydrochlorothiazide on 24-hour ambulatory systolic blood pressure control.

Science.gov (United States)

Jamerson, Kenneth A; Devereux, Richard; Bakris, George L; Dahlöf, Björn; Pitt, Bertram; Velazquez, Eric J; Weir, Matthew; Kelly, Roxzana Y; Hua, Tsushung A; Hester, Allen; Weber, Michael A

2011-02-01

The combination of benazepril plus amlodipine was shown to be more effective than benazepril plus hydrochlorothiazide in reducing cardiovascular events in the Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) trial. There was a small difference in clinic systolic blood pressure between the treatment arms favoring benazepril plus amlodipine. Ambulatory blood pressure monitoring provides a more rigorous estimate of blood pressure effects. A subset of 573 subjects underwent ambulatory blood pressure monitoring during year 2. Readings were obtained every 20 minutes during a 24-hour period. Between-treatment differences (benazepril plus amlodipine versus benazepril plus hydrochlorothiazide) in mean values were analyzed using ANOVA. Treatment comparisons with respect to categorical variables were made using Pearson's χ². At year 2, the treatment groups did not differ significantly in 24-hour mean daytime or nighttime blood pressures (values of 123.9, 125.9, and 118.1 mm Hg for benazepril plus amlodipine group versus 122.3, 124.1, and 116.9 for the benazepril plus hydrochlorothiazide group), with mean between-group differences of 1.6, 1.8, and 1.2 mm Hg, respectively. Blood pressure control rates (24-hour mean systolic blood pressure <130 mm Hg on ambulatory blood pressure monitoring) were greater than 80% in both groups. Nighttime systolic blood pressure provided additional risk prediction after adjusting for the effects of drugs. The 24-hour blood pressure control was similar in both treatment arms, supporting the interpretation that the difference in cardiovascular outcomes favoring a renin angiotensin system blocker combined with amlodipine rather than hydrochlorothiazide shown in the ACCOMPLISH trial was not caused by differences in blood pressure, but instead intrinsic properties (metabolic or hemodynamic) of the combination therapies.

Decreasing systolic blood pressure and declining mortality rates in an untreated population

DEFF Research Database (Denmark)

Andersen, Ulla O; Marott, Jacob L; Jensen, Gorm B

2011-01-01

The aim of the present study was to evaluate developments in 30 years mortality risk that may be associated with developments in population systolic blood pressure (SBP) and to evaluate possible secular trends in BP-associated mortality risk in the untreated population....

Dairy consumption, systolic blood pressure, and risk of hypertension: Mendelian randomization study

Science.gov (United States)

This study examined whether previous observed inverse associations of dairy intake with systolic blood pressure and risk of hypertension were causal. A Mendelian randomization study was employed, using the single nucleotide polymorphism rs4988235 related to lactase persistence as an instrumental var...

Nicorandil prevents right ventricular remodeling by inhibiting apoptosis and lowering pressure overload in rats with pulmonary arterial hypertension.

Directory of Open Access Journals (Sweden)

Xiang-Rong Zuo

Full Text Available BACKGROUND: Most of the deaths among patients with severe pulmonary arterial hypertension (PAH are caused by progressive right ventricular (RV pathological remodeling, dysfunction, and failure. Nicorandil can inhibit the development of PAH by reducing pulmonary artery pressure and RV hypertrophy. However, whether nicorandil can inhibit apoptosis in RV cardiomyocytes and prevent RV remodeling has been unclear. METHODOLOGY/PRINCIPAL FINDINGS: RV remodeling was induced in rats by intraperitoneal injection of monocrotaline (MCT. RV systolic pressure (RVSP was measured at the end of each week after MCT injection. Blood samples were drawn for brain natriuretic peptide (BNP ELISA analysis. The hearts were excised for histopathological, ultrastructural, immunohistochemical, and Western blotting analyses. The MCT-injected rats exhibited greater mortality and less weight gain and showed significantly increased RVSP and RV hypertrophy during the second week. These worsened during the third week. MCT injection for three weeks caused pathological RV remodeling, characterized by hypertrophy, fibrosis, dysfunction, and RV mitochondrial impairment, as indicated by increased levels of apoptosis. Nicorandil improved survival, weight gain, and RV function, ameliorated RV pressure overload, and prevented maladaptive RV remodeling in PAH rats. Nicorandil also reduced the number of apoptotic cardiomyocytes, with a concomitant increase in Bcl-2/Bax ratio. 5-hydroxydecanoate (5-HD reversed these beneficial effects of nicorandil in MCT-injected rats. CONCLUSIONS/SIGNIFICANCE: Nicorandil inhibits PAH-induced RV remodeling in rats not only by reducing RV pressure overload but also by inhibiting apoptosis in cardiomyocytes through the activation of mitochondrial ATP-sensitive K(+ (mitoK(ATP channels. The use of a mitoK(ATP channel opener such as nicorandil for PAH-associated RV remodeling and dysfunction may represent a new therapeutic strategy for the amelioration of RV

Morning pulse pressure is associated more strongly with elevated albuminuria than systolic blood pressure in patients with type 2 diabetes mellitus: post hoc analysis of a cross-sectional multicenter study.

Science.gov (United States)

Ushigome, Emi; Fukui, Michiaki; Hamaguchi, Masahide; Matsumoto, Shinobu; Mineoka, Yusuke; Nakanishi, Naoko; Senmaru, Takafumi; Yamazaki, Masahiro; Hasegawa, Goji; Nakamura, Naoto

2013-09-01

Recently, focus has been directed toward pulse pressure as a potentially independent risk factor for micro- and macrovascular disease. This study was designed to examine the relationship between pulse pressure taken at home and elevated albuminuria in patients with type 2 diabetes. This study is a post hoc analysis of a cross-sectional multicenter study. Home blood pressure measurements were performed for 14 consecutive days in 858 patients with type 2 diabetes. We investigated the relationship between systolic blood pressure or pulse pressure in the morning or in the evening and urinary albumin excretion using univariate and multivariate analyses. Furthermore, we measured area under the receiver-operating characteristic curve (AUC) to compare the ability to identify elevated albuminuria, defined as urinary albumin excretion equal to or more than 30 mg/g creatinine, of systolic blood pressure or pulse pressure. Morning systolic blood pressure (β=0.339, Ppressure (β=0.378, PAUC for elevated albuminuria in morning systolic blood pressure and morning pulse pressure were 0.668 (0.632-0.705; PAUC of morning pulse pressure was significantly greater than that of morning systolic blood pressure (P=0.040). Our findings implicate that morning pulse pressure is associated with elevated albuminuria in patients with type 2 diabetes, which suggests that lowering morning pulse pressure could prevent the development and progression of diabetic nephropathy. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Systolic hypertension: an increasing clinical challenge in Asia

Science.gov (United States)

Park, Jeong Bae; Kario, Kazuomi; Wang, Ji-Guang

2015-01-01

Systolic hypertension, the predominant form of hypertension in patients aged over 50–60 years, is a growing health issue as the Asian population ages. Elevated systolic blood pressure is mainly caused by arterial stiffening, resulting from age-related vascular changes. Elevated systolic pressure increases the risk of cardiovascular disease, mortality and renal function decline, and this risk may increase at lower systolic pressure levels in Asian than Western subjects. Hence, effective systolic pressure lowering is particularly important in Asians yet blood pressure control remains inadequate despite the availability of numerous antihypertensive medications. Reasons for poor blood pressure control include low awareness of hypertension among health-care professionals and patients, under-treatment, and tolerability problems with antihypertensive drugs. Current antihypertensive treatments also lack effects on the underlying vascular pathology of systolic hypertension, so novel drugs that address the pathophysiology of arterial stiffening are needed for optimal management of systolic hypertension and its cardiovascular complications. PMID:25503845

Prevalence and implications of a difference in systolic blood pressure between one arm and the other in vascular surgical patients.

Science.gov (United States)

Durrand, J W; Batterham, A M; O'Neill, B R; Danjoux, G R

2013-12-01

Inter-arm differences in blood pressure may confound haemodynamic management in vascular surgery. We evaluated 898 patients in the vascular pre-assessment clinic to determine the prevalence of inter-arm differences in systolic and mean arterial pressure, quantify the consequent risk of clinical error in siting monitoring peri-operatively and evaluate systolic inter-arm difference as a predictor of all-cause mortality (median follow-up 49 months). The prevalence of a systolic inter-arm difference ≥ 15 mmHg was 26% (95% CI 23-29%). The prevalence of an inter-arm mean arterial pressure difference ≥ 10 mmHg was 26% (95% CI 23-29%) and 11% (95% CI 9-13%) for a difference ≥ 15 mmHg. Monitoring could be erroneously sited in an arm reading lower for systolic pressure once in every seven to nine patients. The hazard ratio for a systolic inter-arm difference ≥ 15 mmHg vs arm blood pressure differences are common in this population, with a high potential for monitoring errors. Systolic inter-arm difference was not associated with medium-term mortality. [Correction added on 17 October 2013, after first online publication: In the Summary the sentence beginning 'We evaluated 898 patients' was corrected from (median (IQR [range]) follow-up 49 months) to read (median follow up 49 months)]. © 2013 The Association of Anaesthetists of Great Britain and Ireland.

Longitudinal Patterns of Change in Systolic Blood Pressure and Incidence of Cardiovascular Disease: The Atherosclerosis Risk in Communities Study.

Science.gov (United States)

Petruski-Ivleva, Natalia; Viera, Anthony J; Shimbo, Daichi; Muntner, Paul; Avery, Christy L; Schneider, Andrea L C; Couper, David; Kucharska-Newton, Anna

2016-06-01

Elevated blood pressure in midlife contributes significantly to the risk of cardiovascular disease. However, patterns of blood pressure increase may differ among individuals and may result in differential risk. Our goal was to examine the contribution of longitudinal patterns of blood pressure change to incidence of heart failure, coronary heart disease, stroke, and cardiovascular disease mortality. Latent class growth models were used to identify patterns of change in blood pressure across 4 clinical examinations (1987-1998) among 9845 Atherosclerosis Risk in Communities (ARIC) cohort participants (mean age, 53.7 [SD 5.7] years). Patterns of change in systolic blood pressure included slowly and steeply increasing, a decreasing and a sustained elevated blood pressure. Changes in diastolic and mid-blood pressure (½ systolic+½ diastolic) were less pronounced. The association of blood pressure pattern group membership with incidence of clinical outcomes was examined in follow-up from the fourth clinical examination (1996-1998) to December 31, 2011, using Poisson regression models adjusted for demographic and metabolic characteristics, and hypertension medication use. A gradient of rates of all events was observed across the identified patterns. Associations were attenuated after adjustment for covariates. Cumulative systolic blood pressure load, rather than the temporal pattern of change in systolic blood pressure itself, plays a role in determining the risk of cardiovascular disease, in particular, of heart failure and cardiovascular disease mortality, independent of blood pressure level measured at one point in time. © 2016 American Heart Association, Inc.

Clinical application of a right ventricular pressure-volume loop determined by gated blood-pool imaging and simultaneously measured right ventricular pressure

International Nuclear Information System (INIS)

Yasue, Takao; Watanabe, Sachiro; Sugishita, Nobuyoshi; Tanaka, Tsutomu; Yokoyama, Hideo

1983-01-01

The data obtained by ECG-gated radionuclide angiography were collected simultaneously with right ventricular pressure and thermal cardiac output (CO) obtained by a Swan-Ganz catheter in Scintipac 1200 (Shimazu Co) in order to create a right ventricular pressure-volume (RV P-V) loop. Subjects consisted of 15 patients with old myocardial infarction (MI group), seven with angina pectoris (AP group), six with congestive cardiomyopathy (CCM group) and five with neurocirculatory asthenia (NCA group). Right ventricular end-diastolic volume (RVEDV) was calculated as RVEDV = CO/(EF x HR) (CO = cardiac output; HR = heart rate). Systolic work (W sub(S)), diastolic work (W sub(D)) and net work (W sub(N)) were calculated from a RV P-V loop by Simpson's method. The measurements were performed before and 5 min after sublingual administration of nitroglycerin (NG) (0.3 mg). The results were as follows: 1. RV P-V loops shifted towards the left lower part of the P-V plane after sublingual administration of nitroglycerin, indicating the reduction of pressure and volume of the right ventricle. 2. Right ventricular ejection fraction (RVEF) in the MI, AP and CCM groups showed smaller values than that of the NCA group. 3. Right ventricular end-diastolic volume index (RVEDVI) showed a converse relation with RVEF. 4. Cardiac index in all groups decreased after NG and a statistical significance was seen in the MI, AP and NCA groups (p<0.05). 5. RV W sub(S), RV W sub(D) and RV W sub(N) showed no difference among each groups in the control state, and significantly decreased after NG. We conclude that the present method using RV P-V loop might be useful as a noninvasive bedside monitoring and permits the evaluation of RV function in a clinical setting

Development of Deterministic and Probabilistic Fracture Mechanics Analysis Code PROFAS-RV for Reactor Pressure Vessel - Progress of the Work

Energy Technology Data Exchange (ETDEWEB)

Kim, Jong Min; Lee, Bong Sang [KAERI, Daejeon (Korea, Republic of)

2016-05-15

In this study, a deterministic/probabilistic fracture mechanics analysis program for reactor pressure vessel, PROFAS-RV, is developed. This program can evaluate failure probability of RPV using recent radiation embrittlement model of 10CFR50.61a and stress intensity factor calculation method of RCC-MRx code as well as the required basic functions of PFM program. Applications of some new radiation embrittlement model, material database, calculation method of stress intensity factors, and others which can improve fracture mechanics assessment of RPV are introduced. The purpose of this study is to develop a probabilistic fracture mechanics (PFM) analysis program for RPV considering above modification and application of newly developed models and calculation methods. In this paper, it deals with the development progress of the PFM analysis program for RPV, PROFAS-RV. The PROFAS-RV is being tested with other codes, and it is expected to revise and upgrade by reflecting the latest model and calculation method continuously. These efforts can minimize the uncertainty of the integrity evaluation for the reactor pressure vessel.

Sildenafil enhances systolic adaptation, but does not prevent diastolic dysfunction, in the pressure-loaded right ventricle

NARCIS (Netherlands)

Borgdorff, Marinus A. J.; Bartelds, Beatrijs; Dickinson, Michael G.; Weij, Michel; Zandvoort, Andre; Sillje, Herman H. W.; Steendijk, Paul; de Vroomen, Maartje; Berger, Rolf M. F.; Boersma, B.

Right ventricular (RV) failure due to pressure or volume overload is a major risk factor for early mortality in congenital heart disease and pulmonary hypertension, but currently treatments are lacking. We aimed to demonstrate that the phosphodiesterase 5A inhibitor sildenafil can prevent adverse

Aircraft vibration and other factors related to high systolic blood pressure in Indonesian Air Force pilots

Directory of Open Access Journals (Sweden)

Minarma Siagian

2013-05-01

Full Text Available AbstrakLatar belakang: Penerbangan dapat berdampak pada sistem kardiovaskular manusia. Penerbang terpajan antara lain pada bising dan vibrasi pesawat. Penelitian bertujuan untuk mengetahui pengaruh beberapa faktor penerbangan pada tekanan darah sistolik.Metode: Penelitian nested case-control dilakukan pada penerbang Angkatan Udara Republik Indonesia yang melakukan pemeriksaan fisik tahunan di Lembaga Kesehatan Penerbangan dan Ruang Angkasa (LAKESPRA Saryanto tahun 2003–2008. Data yang diperoleh dari rekam medik berupa umur, jumlah jam terbang, jenis pesawat, kadar glukosa puasa dan kadar kholesterol darah, lingkaran pinggang, tinggi dan berat badan, tinggi badan, serta tekanan darah.Hasil: Dari 336 penerbang, terdapat 16 penerbanga dengan tekanan sistolik ³ 140 mmHg. Penerbang dengan rata-rata jam penerbangan 300-622 jam per tahun dibandingkan dengan 29-299 jam per tahun mempunyai risiko peningkatan tekanan darah sistolik tinggi sebesarf 5 kali [rasio odds suaian (ORa = 5,05, 95% interval kepercayaan (CI = 0,88 -23,30, P = 0,070]. Menurut jam terbang total, mereka yang memiliki 1.401-1,1125 jam dibandingkan 147-1.400 jam berisiko 3,6 kali mengalami tekanan darah sistolik tinggi (ORa = 3,58, 95% CI = 1,24-10,38. Selain itu, mereka dengan denyut nadi istirahat tinggi dibandingkan dengan denyut nadi normal istirahat memiliki 2,4 kali mengalami tekanan darah sistolik tinggi (ORa = 2,37, CI = 0,74-7,50 95, P = 0,147].Kesimpulan: Vibrasi pesawat terbang tinggi, rata-rata jam terbang per tahun tinggi, dan frekuensi nadi istirahat yang tinggi meningkatkan risiko tekanan sistolik tinggi.Kata kunci:tekanan darah sistolik, vibrasi pesawat terbang, frekuensi nadi istirahat, pilotAbstractBackground:Flight may affect the human cardiovascular system. Pilots are exposed among others to aircraft noise and vibration. This study aimed to investigate the effects of aircraft flight on systolic blood pressure.Methods:A nested case-control study was conducted on

Systolic blood pressure reactivity during submaximal exercise and acute psychological stress in youth

Science.gov (United States)

Background: Studies in youth show an association between systolic blood-pressure (SBP) reactivity to acute psychological stress and carotid artery intima-media thickness (CIMT). However, it has not yet been determined whether SBP reactivity during submaximal exercise is also associated with CIMT i...

Studying of the function of expected ABC transporter Rv1458c-Rv1457c-Rv1456c in mycobacteria; Studium funkcie predpokladaneho ABC transportera Rv1458c-Rv1457c-Rv1456c v mykobakteriach

Energy Technology Data Exchange (ETDEWEB)

Sarkan, M; Mikusova, K; Kordulakova, J [Univerzita Komenskeho v Bratislave, Prirodovedecka fakulta, Katedra biochemie, 84215 Bratislava (Slovakia)

2012-04-25

The bacterium Mycobacterium tuberculosis - the originator of tuberculosis in humans - is characterized by a complex cell wall, which is responsible for a high bacteria resistant to adverse external environmental conditions, as well as to the common antibiotics. The structure of the cell wall components and enzymes involved into its biosynthesis are relatively well described, but there is no information on the transfer of intermediate products of its biosynthetic across the plasmatic membrane. Orthologues of genes rv1459c-rv1458c-rv1457c-rv1456c of M. tuberculosis are in the same configuration in genomes of all previously sequenced mycobacterial strains. Rv1459c gene encodes a probable glycosyltransferases and genes rv1458c, rv1457c rv1456c code nucleotide binding and transmembrane subunits of expected ABC transporter. In our work we focused on the study of the function of expected ABC transporter Rv1458c-Rv1457c-Rv1456c, through analysis of phenotypes of strains M. Smegmatis. They have orthologues of genes encoding the transmembrane subunits of this transporter suspended by fragment encoding resistance to kanamycin. (authors)

Central aortic systolic blood pressure can predict prolonged QTc duration better than brachial artery systolic blood pressure in rural community residents.

Science.gov (United States)

Huang, Yuqing; Tang, Songtao; Chen, Ji-Yan; Huang, Cheng; Li, Jie; Cai, An-Ping; Feng, Yingqing

2018-01-01

Previous studies have suggested that prolonged electrocardiogram QTc duration was independent risk factor for both increased cardiovascular and all-cause mortality, but there was no dating about the relationship between central aortic systolic blood pressure (CASP) and QTc duration. The aim of this study was to analyze the relationship between CASP and QTc duration, and assess whether CASP can predict prolonged QTc duration more than BSBP. A total of 500 patients were enrolled in this study, central and brachial aortic blood pressure and electrocardiogram QTc duration were measured. Pearson correlation was assessed for determining the associations of QTc duration with clinical conditions. Multivariate logistic regression analyses were performed to determine the independent predictor of prolonged QTc duration. Receiver operating characteristic (ROC) curve was used to evaluate the utility of blood pressure for prolonged QTc duration. We found QTc durations were significantly positive with CASP (r = 0.308, p AUC: 0.771 vs. 0.646, p < 0.001) BSBP. Our results suggested that the non-invasive CASP is independently correlated with QTc duration, and CASP can predict prolonged QTc duration more than BSBP.

The importance of capillary density-stroke work mismatch for right ventricular adaptation to chronic pressure overload.

Science.gov (United States)

Noly, Pierre-Emmanuel; Haddad, François; Arthur-Ataam, Jennifer; Langer, Nathaniel; Dorfmüller, Peter; Loisel, Fanny; Guihaire, Julien; Decante, Benoit; Lamrani, Lilia; Fadel, Elie; Mercier, Olaf

2017-12-01

Mechanisms of right ventricular (RV) adaptation to chronic pressure overload are not well understood. We hypothesized that a lower capillary density (CD) to stroke work ratio would be associated with more fibrosis and RV maladaptive remodeling. We induced RV chronic pressure overload over a 20-week period in 2 piglet models of pulmonary hypertension; that is, a shunt model (n = 5) and a chronic thromboembolic pulmonary hypertension model (n = 5). We assessed hemodynamic parameters and RV remodeling as well as RV CD, fibrosis, and angiogenic factors expression. Although RV was similarly hypertrophied in both models, maladapted RV remodeling with impaired systolic function was only seen in chronic thromboembolic pulmonary hypertension group members who had lower CD (484 ± 99 vs 1213 ± 74 cap/mm 2 ; P work ratio (0.29 ± 0.07 vs 0.82 ± 0.16; P = .02), higher myocardial fibrosis (15.4% ± 3.8% vs 8.0% ± 2.5%; P work ratio) was associated with greater degree of myocardial fibrosis and RV dysfunction and could be a promising index of RV maladaptation. Further studies are needed to understand the underlying mechanisms. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Exercise capacity in young adults with hypertension and systolic blood pressure difference between right arm and leg after repair of coarctation of the aorta.

Science.gov (United States)

Instebø, Arne; Norgård, Gunnar; Helgheim, Vegard; Røksund, Ola Drange; Segadal, Leidulf; Greve, Gottfried

2004-10-01

Coarctation of the aorta represents 5-7% of congenital heart defects. Symptoms and prognosis depend on the degree of stenosis, age at surgery, surgical method and the presence of other heart defects. Postoperative complications are hypertension, restenosis and an abnormal blood pressure response during exercise. This study includes 41 patients, 15-40 years old, operated in the period 1975-1996. All were exercised on a treadmill until maximal oxygen consumption was achieved. Blood pressure was measured in the right arm and leg before and immediately after exercise, and in the right arm during exercise. Oxygen consumption was monitored and we defined an aerobic phase, an isocapnic buffering phase and a hypocapnic hyperventilation phase. The resting systolic blood pressure correlates with the resting systolic blood pressure difference between right arm and leg. A resting systolic blood pressure difference between the right arm and leg of 0.13 kPa (1 mmHg) to 2.67 kPa (20 mmHg) corresponds with a slight increase in resting systolic blood pressure. This rise in blood pressure increases the aerobic phase of the exercise test, helping the patients to achieve higher maximal oxygen consumption. A resting systolic blood pressure difference of more than 2.67 kPa (20 mmHg) corresponds with severe hypertension and causes reduction in the aerobic phase and maximal oxygen consumption. Resting systolic blood pressure and resting systolic blood pressure difference between the right arm and leg are not indicators for blood pressure response during exercise. Exercise testing is important to reveal exercise-induced hypertension and to monitor changes in transition from aerobic to anaerobic exercise and limitation to exercise capacity.

NSAID-antihypertensive drug interactions: Which outpatients are at risk for a rise in systolic blood pressure?

NARCIS (Netherlands)

Floor-Schreudering, Annemieke; De Smet, Peter Agm; Buurma, Henk; Kramers, Cornelis; Tromp, P. Chris; Belitser, Svetlana V.; Bouvy, Marcel L.

2015-01-01

Background: Management guidelines for drug-drug interactions between non-steroidal anti-inflammatory drugs (NSAIDs) and antihypertensives recommend blood pressure monitoring in hypertensive patients. We measured the short-term effect of initiating NSAIDs on systolic blood pressure (SBP) in users of

NSAID-antihypertensive drug interactions: which outpatients are at risk for a rise in systolic blood pressure?

NARCIS (Netherlands)

Floor-Schreudering, A.; Smet, P.A.G.M. de; Buurma, H.; Kramers, C.; Tromp, P.C.; Belitser, S.V.; Bouvy, M.L.

2015-01-01

BACKGROUND: Management guidelines for drug-drug interactions between non-steroidal anti-inflammatory drugs (NSAIDs) and antihypertensives recommend blood pressure monitoring in hypertensive patients. We measured the short-term effect of initiating NSAIDs on systolic blood pressure (SBP) in users of

Accuracy and interobserver concordance of echocardiographic assessment of right ventricular size and systolic function: a quality control exercise.

Science.gov (United States)

Ling, Lee Fong; Obuchowski, Nancy A; Rodriguez, Leonardo; Popovic, Zoran; Kwon, Deborah; Marwick, Thomas H

2012-07-01

Accurate assessment of right ventricular (RV) size (RVS) and RV systolic function (RVSF) is vital in the management of various conditions, but their assessment is challenging using echocardiography. The aim of this study was to determine the accuracy and interobserver concordance of qualitative and quantitative RV echocardiography. Fifteen readers evaluated RV function in 12 patients (360 readings) who underwent echocardiography and cardiac magnetic resonance for RV assessment. Readers qualitatively estimated RVS and RVSF as normal, mild, moderate, or severe and then reassessed quantitatively by adding RV dimensions, fractional area change, S', tricuspid annular plane systolic excursion, and RV index of myocardial performance. Cardiac magnetic resonance was used as the reference standard for grading RVS and RVSF. Quantitative measurements increased accuracy and interreader agreement compared to qualitative assessment alone, especially in normal categories. Readers' accuracy for diagnosing normal and severe RVS increased from 38% to 78% (P = .001) and from 70% to 97% (P = .018), and readers' accuracy for diagnosing normal and mild RVSF increased from 52% to 84% (P value of 0.40 to 0.77 (fair to good agreement) for RVS and from 0.43 to 0.66 (moderate to good agreement) for RVSF. Visual estimation of RVS and RVSF is inaccurate and has wide interobserver variability. Quantitation improves accuracy and reliability, especially in distinction of normal and abnormal. The reliability of mild and moderate grades remains inadequate, and further guidance is needed for the classification of abnormal categories. Copyright © 2012 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.

Target blood pressure for treatment of isolated systolic hypertension in the elderly: valsartan in elderly isolated systolic hypertension study.

Science.gov (United States)

Ogihara, Toshio; Saruta, Takao; Rakugi, Hiromi; Matsuoka, Hiroaki; Shimamoto, Kazuaki; Shimada, Kazuyuki; Imai, Yutaka; Kikuchi, Kenjiro; Ito, Sadayoshi; Eto, Tanenao; Kimura, Genjiro; Imaizumi, Tsutomu; Takishita, Shuichi; Ueshima, Hirotsugu

2010-08-01

In this prospective, randomized, open-label, blinded end point study, we aimed to establish whether strict blood pressure control ( or =140 mm Hg to or =2 years. The strict control (1545 patients) and moderate control (1534 patients) groups were well matched (mean age: 76.1 years; mean blood pressure: 169.5/81.5 mm Hg). Median follow-up was 3.07 years. At 3 years, blood pressure reached 136.6/74.8 mm Hg and 142.0/76.5 mm Hg, respectively. The blood pressure difference between the 2 groups was 5.4/1.7 mm Hg. The overall rate of the primary composite end point was 10.6 per 1000 patient-years in the strict control group and 12.0 per 1000 patient-years in the moderate control group (hazard ratio: 0.89; [95% CI: 0.60 to 1.34]; P=0.38). In summary, blood pressure targets of or = 70 years of age with isolated systolic hypertension, although our trial was underpowered to definitively determine whether strict control was superior to less stringent blood pressure targets.

Assessment of right ventricular overload using 99mTc-hexakis-methoxy-2-isobutylisonitrile (MIBI) and 123I-β-methyl iodophenyl pentadecanoic acid (BMIPP) myocardial scintigraphy

International Nuclear Information System (INIS)

Matsumoto, Katsushige

2002-01-01

Thallium-201 myocardial imaging is known to be useful for evaluating right ventricular (RV) overload. The degree of RV wall visualization has been shown to reflect RV myocardial mass and the right-to-left ventricular pressure ratio. Recently, 99m Tc-hexakis-methoxy-2-isobutylisonitrile (MIBI) and 123 I-β-methyl iodophenyl pentadecanoic acid (BMIPP) were developed and have been used to evaluate ischemic heart disease. The purpose of this study was to evaluate the RV pressure and myocardial fatty acid metabolism in the right ventricle in patients with chronic RV overloading using 99m Tc-MIBI and 123 I-BMIPP myocardial imaging. 99m Tc-MIBI myocardial scintigraphy (planar and SPECT) was performed in 76 patients with RV overloading, and 123 I-BMIPP SPECT was performed in 33 patients with RV overloading. The degree of RV wall visualization using 99m Tc-MIBI planar imaging was correlated with the elevation of RV systolic pressure. The right atrium was visualized with a high frequency in patients with RV overloading, and the degree of the right atrial wall visualization was correlated with the elevation of RV end-diastolic pressure. A count ratio of right-to-left ventricular free wall (RV/LV ratio) using 99m Tc-MIBI SPECT correlated well with a systolic pressure ratio of right-to-left ventricle (sRVp/sLVp). On the other hand, no significant correlation was found between RV/LV ratio using 123 I-BMIPP SPECT and sRVp/sLVp. For the patients with RV overloading at a RV systolic pressure of 70 mmHg or more, impaired fatty acid metabolism in the RV myocardium was noted using the quantitative analysis of 123 I-BMIPP SPECT. In conclusion, RV pressure can be evaluated by quantitative analysis using 99m Tc-MIBI myocardial scintigraphy. Myocardial metabolism in the RV wall may be impaired in patients with severe RV overloading. (author)

Systolic hypertension in adult nigerians with hypertension

International Nuclear Information System (INIS)

Opadijo, O.G.; Salami, T.A.T.; Sanya, E.O.; Omotoso, A.B.O.

2007-01-01

To determine the prevalence of both systolic and diastolic hypertensions in relation to age and their impacts on target organ among adult Nigerians with hypertension. Newly diagnosed adult hypertensives, with blood pressure 140/90mm Hg, taken twice with mercury column sphygmomanometer at 3 weeks interval, were studied. The total number of hypertensive patients treated over this period was also taken into consideration. The newly diagnosed hypertensives were classified using JNC VI classification. The frequency of occurrence of target organ damage such as Left Ventricular Hypertrophy (LVH), heart failure, renal impairment etc. was charted according to systolic and or diastolic pressures. The occurrence of systolic or diastolic blood pressure was also related with the age of the patients. Blood metabolic parameters were compared in both systolic and diastolic blood pressures for their possible contributory role. Two thousand seven hundred and ninety-two adult hypertensive patients were managed over the study period. Of them, 218 (7.8%) were newly diagnosed and studied. There were 94 males and 124 females. Seventy-seven (35.3%) were aged 60 years and above with equal frequency in the gender. One hundred and seventy-eight (81.7%) cases had combined systolic and diastolic pressures. Twenty-nine (13.3%) patients had systolic hypertension. Twenty-five (86.2%) of these 29 were aged 50 years and above and 20 (69.0%) were aged 60 years and above. Eleven (5.0%) patients had isolated diastolic hypertension and they were all in the age bracket 40-49 years. Systolic blood pressure was found to be rising with advancing age while diastolic blood pressure peaked at mid 40's and declined. Target organ damage occurred more frequently with systolic hypertension and advancing age than with diastolic hypertension. Systolic hypertension occurred more frequently in this series of adult Nigerians with hypertension. It was higher with advancing age and associated with more target organ

Microalbuminuria in patients with non-insulin-dependent diabetes mellitus relates to nocturnal systolic blood pressure.

LENUS (Irish Health Repository)

Mitchell, T H

2012-02-03

PURPOSE: Microalbuminuria predicts early mortality in non-insulin-dependent-diabetes mellitus patients (NIDDM). Our objective in the present study was to compare and assess the relationship between 24-hour, day and nocturnal ambulatory blood pressure (BP) and urinary albumin excretion rate (UAE) in microalbuminuric and normoalbuminuric NIDDM and in normal control subjects. PATIENTS AND METHODS: In the present cross-sectional study, 24 hour ambulatory BP (daytime BP and nocturnal BP) and HbA1c were compared in microalbuminuric (n = 10) and nonmicroalbuminuric NIDDM patients (n = 10) and in nondiabetic controls (n = 9). None of the patients were taking antihypertensive agents. RESULTS: In the microlbuminuric group, whereas 24 hour and daytime systolic BP differed significantly from control values (P < 0.025 and P < 0.05 respectively), there was no difference between diabetic groups. However, nocturnal systolic BP in the microalbuminuric group was significantly higher than in the normoalbuminuric diabetic patients (139 vs. 125) (P < 0.05) and a significant difference was also found between the NIDDM patients and the control group (139, 125 vs. 114) (P < 0.025). In multiple regression analysis, only nocturnal systolic BP showed a significant relationship with UAE (P < 0.05). CONCLUSIONS: We suggest that the higher nocturnal systolic blood pressure seen in our microalbuminuric NIDDM patients may contribute to the increased morbidity in this group.

Thallium-201 myocardial imaging for evaluation of right-ventricular overloading

International Nuclear Information System (INIS)

Kondo, M.; Kubo, A.; Yamazaki, H.; Ohsuzu, F.; Handa, S.; Tsugu, T.; Masaki, H.; Kinoshita, F.; Hashimoto, S.

1978-01-01

This study evaluated the specificity and sensitivity of Tl-201 myocardial imaging in the detection of right-ventricular (RV) overloading. Right-ventricular visualization (RVV) after administration of Tl-201 chloride was studied on 99 patients with various heart diseases. Tracer uptake in the free wall of the RV was graded in four degrees. The degree of RVV was compared with the findings of cardiac catheterization. The comparisons indicated that the uptake increased in step with the inreases in RV systolic pressure, RV end-diastolic pressure, mean pulmonary arterial pressure, total pulmonary vascular resistance, and stroke-work index of the right ventricle (P < 0.05--P < 0.001). Of the patients with visible RV, all but three had RV overloading, and all but three of those without RVV had normal RV systolic pressure. Myocardial images also reflect the type of RV overloading. In patients with RV pressure overloading, the septum showed a tendency to appear straight. In patients with atrial septal defect leading to RV volume overloading, the RV cavity was dilated, the LV image small, and the septum convex toward the RV cavity. These results indicate that Tl-201 myocardial imaging is a sensitive and specific method for the study of RV overloading

Effect of hematocrit and systolic blood pressure on cerebral blood flow in newborn infants

International Nuclear Information System (INIS)

Younkin, D.P.; Reivich, M.; Jaggi, J.L.; Obrist, W.D.; Delivoria-Papadopoulos, M.

1987-01-01

The effects of hematocrit and systolic blood pressure on cerebral blood flow were measured in 15 stable, low birth weight babies. CBF was measured with a modification of the xenon-133 ( 133 Xe) clearance technique, which uses an intravenous bolus of 133 Xe, an external chest detector to estimate arterial 133 Xe concentration, eight external cranial detectors to measure cephalic 133 Xe clearance curves, and a two-compartmental analysis of the cephalic 133 Xe clearance curves to estimate CBF. There was a significant inverse correlation between hematocrit and CBF, presumably due to alterations in arterial oxygen content and blood viscosity. Newborn CBF varied independently of systolic blood pressure between 60 and 84 mm Hg, suggesting an intact cerebrovascular autoregulatory mechanism. These results indicate that at least two of the factors that affect newborn animal CBF are operational in human newborns and may have important clinical implications

Direct measured systolic pressure gradients across the aorto-iliac segment in multiple-level-obstruction arteriosclerosis

DEFF Research Database (Denmark)

Noer, Ivan; Praestholm, J; Tønnesen, K H

1981-01-01

Patients with severe ischemia due to multi-level obstructions in the leg arteries both above and below the region were assessed preoperatively by intraarterial brachial and femoral artery pressure measurements. The systolic pressure drop along aorto-iliac obstructions was compared to the angiogra....... Due to large variations, however, the angiographic information was found to be useless in the individual patient. No difference in the pressure drop was found between cases in which rich and poor collateral networks were visualized....

Reliability of Doppler and stethoscope methods of determining systolic blood pressures: considerations for calculating an ankle-brachial index.

Science.gov (United States)

Chesbro, Steven B; Asongwed, Elmira T; Brown, Jamesha; John, Emmanuel B

2011-01-01

The purposes of this study were to: (1) identify the interrater and intrarater reliability of systolic blood pressures using a stethoscope and Doppler to determine an ankle-brachial index (ABI), and (2) to determine the correlation between the 2 methods. Peripheral arterial disease (PAD) affects approximately 8 to 12 million people in the United States, and nearly half of those with this disease are asymptomatic. Early detection and prompt treatment of PAD will improve health outcomes. It is important that clinicians perform tests that determine the presence of PAD. Two individual raters trained in ABI procedure measured the systolic blood pressures of 20 individuals' upper and lower extremities. Standard ABI measurement protocols were observed. Raters individually recorded the systolic blood pressures of each extremity using a stethoscope and a Doppler, for a total of 640 independent measures. Interrater reliability of Doppler measurements to determine SBP at the ankle was very strong (intraclass correlation coefficient [ICC], 0.93-0.99) compared to moderate to strong reliability using a stethoscope (ICC, 0.64-0.87). Agreement between the 2 devices to determine SBP was moderate to very weak (ICC, 0.13-0.61). Comparisons of the use of Doppler and stethoscope to determine ABI showed weak to very weak intrarater correlation (ICC, 0.17-0.35). Linear regression analysis of the 2 methods to determine ABI showed positive but weak to very weak correlations (r2 = .013, P = .184). A Doppler ultrasound is recommended over a stethoscope for accuracy in systolic pressure readings for ABI measurements.

On-Treatment Blood Pressure and Cardiovascular Outcomes in Older Adults With Isolated Systolic Hypertension.

Science.gov (United States)

Yano, Yuichiro; Rakugi, Hiromi; Bakris, George L; Lloyd-Jones, Donald M; Oparil, Suzanne; Saruta, Takao; Shimada, Kazuyuki; Matsuoka, Hiroaki; Imai, Yutaka; Ogihara, Toshio

2017-02-01

Our aim was to assess optimal on-treatment blood pressure (BP) at which cardiovascular disease (CVD) and all-cause mortality risks are minimized in Japanese older adults with isolated systolic hypertension. We used data from the VALISH study (Valsartan in Elderly Isolated Systolic Hypertension) that recruited older adults (n=3035; mean age, 76 years) with systolic BP (SBP) of ≥160 mm Hg and diastolic BP of secondary outcome being all-cause mortality. Cox proportional hazards models were used to assess the CVD risk for each group. Over a median 3-year follow-up (8022 person-years), 93 CVD events and 52 deaths occurred. Using the on-treatment SBP of 130 to hypertension, SBP in the range between 130 and 144 mm Hg was associated with minimal adverse outcomes and a reduction in CVD and all-cause mortality. The BP range will need to be confirmed in randomized controlled trials. URL: https://www.clinicaltrials.gov. Unique identifier: NCT00151229. © 2017 American Heart Association, Inc.

Resistance training alone reduces systolic and diastolic blood pressure in prehypertensive and hypertensive individuals: meta-analysis.

Science.gov (United States)

de Sousa, Evitom Corrêa; Abrahin, Odilon; Ferreira, Ana Lorena Lima; Rodrigues, Rejane Pequeno; Alves, Erik Artur Cortinhas; Vieira, Rodolfo Paula

2017-11-01

The purpose of this study was to evaluate the effects of resistance training alone on the systolic and diastolic blood pressure in prehypertensive and hypertensive individuals. Our meta-analysis, followed the guidelines of PRISMA. The search for articles was realized by November 2016 using the following electronic databases: BIREME, PubMed, Cochrane Library, LILACS and SciELO and a search strategy that included the combination of titles of medical affairs and terms of free text to the key concepts: 'hypertension' 'hypertensive', 'prehypertensive', 'resistance training', 'strength training', and 'weight-lifting'. These terms were combined with a search strategy to identify randomized controlled trials (RCTs) and identified a total of 1608 articles: 644 articles BIREME, 53 SciELO, 722 PubMed, 122 Cochrane Library and 67 LILACS. Of these, five RCTs met the inclusion criteria and provided data on 201 individuals. The results showed significant reductions for systolic blood pressure (-8.2 mm Hg CI -10.9 to -5.5;I 2 : 22.5% P valor for heterogeneity=0.271 and effect size=-0.97) and diastolic blood pressure (-4.1 mm Hg CI -6.3 to -1.9; I 2 : 46.5% P valor for heterogeneity=0.113 and effect size=-0.60) when compared to group control. In conclusion, resistance training alone reduces systolic and diastolic blood pressure in prehypertensive and hypertensive subjects. The RCTs studies that investigated the effects of resistance training alone in prehypertensive and hypertensive patients support the recommendation of resistance training as a tool for management of systemic hypertension.

Use of milrinone to treat cardiac dysfunction in infants with pulmonary hypertension secondary to congenital diaphragmatic hernia: a review of six patients.

Science.gov (United States)

Patel, Neil

2012-01-01

Pulmonary hypertension and secondary cardiac dysfunction are important contributors of morbidity and mortality in infants with congenital diaphragmatic hernia (CDH). Milrinone, a phosphodiesterase-3 inhibitor, may be useful in this setting for its combined actions as a pulmonary vasodilator and to improve systolic and diastolic function. This study aimed to assess the effects of milrinone on cardiac function and pulmonary artery pressure in infants with CDH. A retrospective review of echocardiograms performed on infants with CDH who received milrinone was performed. Tissue Doppler imaging velocities were used to assess systolic and diastolic function. Pulmonary artery pressure was assessed from the pattern and velocity of ductal shunting. Six infants with CDH and severe pulmonary hypertension were identified. Systolic and diastolic myocardial velocities were reduced in the right ventricle (RV) and interventricular septum (IVS) at baseline. In the 72 h after commencement of milrinone, there was a significant increase in early diastolic myocardial velocities in the RV, accompanied by increasing systolic velocities in the RV and IVS. Oxygenation index was significantly reduced, blood pressure unchanged, and ductal shunt velocity minimally altered over the same time period. Milrinone use was associated with an improvement in systolic and diastolic function in the RV, corresponding to an improvement in clinical status. Copyright © 2012 S. Karger AG, Basel.

Measuring systolic arterial blood pressure. Possible errors from extension tubes or disposable transducer domes.

Science.gov (United States)

Rothe, C F; Kim, K C

1980-11-01

The purpose of this study was to evaluate the magnitude of possible error in the measurement of systolic blood pressure if disposable, built-in diaphragm, transducer domes or long extension tubes between the patient and pressure transducer are used. Sinusoidal or arterial pressure patterns were generated with specially designed equipment. With a long extension tube or trapped air bubbles, the resonant frequency of the catheter system was reduced so that the arterial pulse was amplified as it acted on the transducer and, thus, gave an erroneously high systolic pressure measurement. The authors found this error to be as much as 20 mm Hg. Trapped air bubbles, not stopcocks or connections, per se, lead to poor fidelity. The utility of a continuous catheter flush system (Sorenson, Intraflow) to estimate the resonant frequency and degree of damping of a catheter-transducer system is described, as are possibly erroneous conclusions. Given a rough estimate of the resonant frequency of a catheter-transducer system and the magnitude of overshoot in response to a pulse, the authors present a table to predict the magnitude of probable error. These studies confirm the variability and unreliability of static calibration that may occur using some safety diaphragm domes and show that the system frequency response is decreased if air bubbles are trapped between the diaphragms. The authors conclude that regular procedures should be established to evaluate the accuracy of the pressure measuring systems in use, the transducer should be placed as close to the patient as possible, the air bubbles should be assiduously eliminated from the system.

Diastolic And Systolic Right Ventricular Dysfunction Precedes Left Ventricular Dysfunction In Patients Paced From Right Ventricular Apex

Directory of Open Access Journals (Sweden)

Dwivedi SK

2006-07-01

Full Text Available Background: Cardiac dysfunction after right ventricular (RV apical pacing is well known but its extent, time frame of appearance and individual effect on left ventricular (LV, RV systolic and diastolic parameters has not evaluated in a systematic fashion. Methods: Patients with symptomatic bradycardia and ACC-AHA Class I indication for permanent pacemaker implantation (PPI were implanted a single chamber (VVI pacemaker. They were followed prospectively by echocardiographic examination which was done at baseline, 1 week, 1 month and 6 months after implantation. Parameters observed were chamber dimensions (M-line, chamber volumes, cardiac output (modified Simpson's method, systolic functions (ejection fraction, pre-ejection period, ejection time and ratio and diastolic functions( isovolumic relaxation time & deceleration time of left and right heart. Results: Forty eight consecutive patients (mean age 65.6±11.8 yrs, 66.7% males, mean EF 61.82±10.36% implanted a VVI pacemaker were enrolled in this study. The first significant change to appear in cardiac function after VVI pacing was in diastolic properties of RV as shown by increase in RV isovolumic relaxation time (IVRT from 65.89±15.93 to 76.58±17.00 ms,(p<0.001 at 1week and RV deceleration time (DT from 133.84±38.13 to 153.09±31.41 ms, (p=0.02 at 1 month. Increase in RV internal dimension (RVID from 1.26±0.41 to 1.44±0.44, (p<0.05 was also noticed at 1 week. The LV diastolic parameters were significantly altered after 1 month with increase in LV-IVRT from 92.36±21.47 to 117.24±27.21ms, (p<0.001 and increase in LV DT from 147.56±31.84 to 189.27±28.49ms,(p<0.01. This was followed by LV systolic abnormality which appeared at 6 months with an increase in LVPEP from 100.33±14.43 to 118.41±21.34ms, (p<0.001 and increase in LVPEP/LVET ratio from 0.34±0.46 to 0.44±0.10, (p<0.001]. The reduction in LV EF was manifested at 6 months falling from 61.82±10.36% to52.52±12.11%, (p<0

Comparison of noninvasive assessments of central blood pressure using general transfer function and late systolic shoulder of the radial pressure wave.

Science.gov (United States)

Wohlfahrt, Peter; Krajcoviechová, Alena; Seidlerová, Jitka; Mayer, Otto; Filipovsky, Jan; Cífková, Renata

2014-02-01

Central systolic blood pressure (cSBP) can be derived by the general transfer function of the radial pressure wave, as used in the SphygmoCor device, or by regression equation from directly measured late systolic shoulder of the radial pressure wave (pSBP2), as used in the Omron HEM-9000AI device. The aim of this study was to compare the SphygmoCor estimates of cSBP with 2 estimates of cSBP provided by the Omron HEM-9000AI (cSBP, pSBP2) in a large cohort of the white population. In 391 patients aged 52.3±13.5 years (46% men) from the Czech post-MONICA Study, cSBP was measured using the SphygmoCor and Omron HEM-9000AI devices in random order. Omron cSBP and pSBP2 were perfectly correlated (r = 1.0; P wave provides a comparable accuracy with the validated general transfer function. When comparing Omron HEM-9000AI and SphygmoCor estimates of cSBP, Omron pSBP2 should be used. The difference between both devices in cSBP may be explained by differences in calibration.

Closure of digital arteries in high vascular tone states as demonstrated by measurement of systolic blood pressure in the fingers

DEFF Research Database (Denmark)

Krähenbühl, B; Nielsen, S L; Lassen, N A

1977-01-01

by direct cooling or intra-arterial noradrenaline infusion caused a marked drop in FSP in the exposed fingers, but not in the non-exposed fingers of the same hand. The fact that the non-exposed fingers retained the normal (arm systolic) pressure level is taken to indicate that palmar arch blood pressure......Finger systolic blood pressure (FSP) was measured indirectly in normal subjects and patients with primary Raynaud phenomenon by applying a thin-walled plastic cuff around the finger and a strain gauge more distally to detect volume changes. Inducing a high vascular tone in one or more fingers...... also remained normal. In the high vascular tone state, a large transmural pressure difference must apparently be established before the digital arteries are forced open. The lowered opening pressure constitutes a manifestation of the closure phenomenon of the digital arteries described in patients...

Impact of right ventricular distensibility on congestive heart failure with preserved left ventricular ejection fraction in the elderly.

Science.gov (United States)

Harada, Daisuke; Aasanoi, Hidetsugu; Ushijima, Ryuichi; Noto, Takahisa; Takagawa, Junya; Ishise, Hisanari; Inoue, Hiroshi

2018-06-01

To elucidate involvement of age-related impairments of right ventricular (RV) distensibility in the elderly congestive heart failure (CHF), we examined the prevalence of less-distensible right ventricle in patients with preserved left ventricular ejection fraction (LVEF) over a wide range of ages. In 893 patients aged from 40 to 102 years, we simultaneously recorded electrocardiogram, phonocardiogram, and jugular venous pulse wave. Using signal-processing techniques, the prominent 'Y' descent of jugular pulse waveform was detected as a hemodynamic sign of a less-distensible right ventricle. Prevalence of less-distensible right ventricle and elevated RV systolic pressure increased along with aging from the 50s to the 90s in an exponential fashion from 3.3 and 12% up to 33 and 61%, respectively (p right ventricle (Odds ratio, 1.05 per 1 year, p = 0.003; and 1.03 per 1 mmHg, p = 0.026, respectively). The elderly CHF was associated with high prevalence of the less-distensible right ventricle and higher RV systolic pressure, both of which were independent risk factors for CHF (Odds ratio, 5.27, p = 0.001, and 1.08 per 1 mmHg, p right ventricle and a high RV systolic pressure seems to be related to developing CHF. The less-distensible right ventricle and elevated RV systolic pressure are closely associated with CHF with preserved LVEF in the elderly patients.

Humoral Responses to Rv1733c, Rv0081, Rv1735c, and Rv1737c DosR Regulon-Encoded Proteins of Mycobacterium tuberculosis in Individuals with Latent Tuberculosis Infection

Directory of Open Access Journals (Sweden)

Simon G. Kimuda

2017-01-01

Full Text Available Latent tuberculosis infection (LTBI is evidence of immunological control of tuberculosis. Dormancy survival regulator (DosR regulon-encoded proteins may have a role in the maintenance of LTBI. T cell responses to Rv1733c, Rv0081, Rv1735c, and Rv1737c DosR regulon-encoded proteins were found to be most frequent among household contacts of TB cases from Uganda compared to other DosR proteins, but antibody responses were not described. We characterized antibody responses to these proteins in individuals from Uganda. Antibodies to Rv1733c, Rv0081, Rv1735c, and Rv1737c DosR regulon-encoded proteins were measured in 68 uninfected individuals, 62 with LTBI, and 107 with active pulmonary tuberculosis (APTB cases. There were no differences in the concentrations of antibodies to Rv0081, Rv1735c, and Rv1737c DosR regulon-encoded proteins between individuals with LTBI and APTB and those who were uninfected. LTBI was associated with higher concentrations of antibodies to Rv1733c in female participants [adjusted geometric mean ratio: 1.812, 95% confidence interval (CI: 1.105 2.973, and p=0.019] but not in males (p value for interaction = 0.060. Antibodies to the four DosR regulon-encoded proteins investigated may not serve as good biomarkers of LTBI in the general population. More of the M.tb proteome needs to be screened to identify proteins that induce strong antibody responses in LTBI.

Reciprocal Interaction of 24-Hour Blood Pressure Variability and Systolic Blood Pressure on Outcome in Stroke Thrombolysis.

Science.gov (United States)

Kellert, Lars; Hametner, Christian; Ahmed, Niaz; Rauch, Geraldine; MacLeod, Mary J; Perini, Francesco; Lees, Kennedy R; Ringleb, Peter A

2017-07-01

Significance and management of blood pressure (BP) changes in acute stroke care are unclear. Here, we aimed to investigate the impact of 24-hour BP variability (BPV) on outcome in patients with acute ischemic stroke treated with intravenous thrombolysis. From the Safe Implementation of Treatment in Stroke International Stroke Thrombolysis registry, 28 976 patients with documented pre-treatment systolic BP at 2 and 24 hours were analyzed. The primary measure of BP variability was successive variability. Data were preprocessed using coarsened exact matching. We assessed early neurological improvement, symptomatic intracerebral hemorrhage (SICH), and long-term functional outcome (modified Rankin Scale [mRS] at 90 days) by binary and ordinal regression analyses. Attempts to explain successive variation for analysis of BPV with patients characteristics at admission found systolic BP (5.5% variance) to be most influential, yet 92% of BPV variance remained unexplained. Independently from systolic BP, successive variation for analysis of BPV was associated with poor functional outcome mRS score of 0 to 2 (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.90-0.98), disadvantage across the shift of mRS (OR, 1.04; 95% CI, 1.01-1.08), mortality (OR, 1.10; 95% CI, 1.01-1.08), SICH SITS (OR, 1.14; 95% CI, 1.06-1.23), and SICH ECASS (OR, 1.24; 95% CI, 1.10-1.40; ECASS [European Cooperative Acute Stroke Study 2]). Analyzing successive variation for analysis of BPV as a function of pre-treatment, systolic BP significantly improved the prediction of functional outcome (mRS score of 0-1, mRS score of 0-2, neurological improvement, mRS-shift: all P interaction accounting for pre-treatment BP and the acute BP course (ie, BPV) to achieve best possible outcome for the patient. © 2017 American Heart Association, Inc.

Pulmonary arterial pressure and right ventricular dilatation independently determine tricuspid valve insufficiency severity in pre-capillary pulmonary hypertension.

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De Meester, Pieter; Van De Bruaene, Alexander; Delcroix, Marion; Belmans, Ann; Herijgers, Paul; Voigt, Jens-Uwe; Budts, Werner

2012-11-01

Elevated pulmonary artery systolic pressure (PASP) causes functional tricuspid valve insufficiency (TI). However, the differential contribution of pressure load and right ventricular (RV) dilatation is not well established. The study aim was to evaluate both variables in relation to TI. A cross-sectional study was performed of consecutive transthoracic echocardiographic studies of patients with pre-capillary pulmonary hypertension (PH). Both, demographic data and echocardiographic RV parameters were reviewed. TI was graded semi-quantitatively with color Doppler flow imaging. Trend analyses for TI severity (TI grade 0/4, 1/4, 2/4, 3/4, or 4/4) were performed. A proportional odds logistic regression analysis was carried out to identify independent predictors of TI severity. Eighty-one patients (56 females, 25 males; mean age 60 +/- 15 years) with pre-capillary PH were evaluated. Patients with more severe TI had a significantly lower body mass index, a lower mean systemic blood pressure, a shorter pulmonary acceleration time, a higher tricuspid regurgitant gradient, and a more dilated right ventricle. From the echocardiographic parameters, RV dilatation (p = 0.0143) and the tricuspid regurgitant gradient (p = 0.0026) were independently related to the degree of TI. In patients with pre-capillary PH, PASP and RV dilatation were both related to the increasing severity of TI. When focusing on TI to improve the prognosis of patients with pre-capillary PH, both PASP and RV dimensions should be taken into consideration.

Echocardiographic assessment of systolic pulmonary arterial pressure in HIV-positive patients.

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Mehrnaz Rasoulinejad

2014-11-01

Full Text Available Pulmonary hypertension is rare but is one of the complications that occur due to HIV infection. Symptoms of HIV-associated pulmonary arterial hypertension are often non-specific but the main symptom of the disease is dyspnea. In this cross-sectional study, we measured systolic pulmonary arterial pressure (SPAP by echocardiographic methods among HIV-positive patients who received ART. This research is a descriptive, cross-sectional study of 170 HIV-positive patients that was conducted in Imam-Khomeini hospital, Tehran, Iran during 2011-2013. All patients regularly received antiretroviral therapy at least for recent 2 years. There were not any cardiopulmonary symptoms (cough, dyspnea, exertional fatigue and chest discomfort in these patients. All participants underwent echocardiography to estimate SPAP. The participants comprised 108 males (63.5% and 62 females (46.5%. The mean age of patients was 41 years old, and the mean duration of HIV infection was 5.5 years. The mean CD4 cell count was 401 cell/µl. The principal regimen of antiretroviral therapy included two nucleoside reverse transcriptase inhibitor (NRTI and one non-nucleoside reverse transcriptase inhibitor (NNRTI in the hospital. The mean of systolic pulmonary arterial pressure was 25 mmHg in the participants; 156 (93.4% of them had SPAP ≤ 30 mmHg (normal, six (3.6% had SPAP: 31-35 mmHg (borderline and five (3% had SPAP > 35 mmHg (pulmonary hypertension. Our results indicated a significant increase of pulmonary hypertension in asymptomatic HIV-positive patients that had no association with any other risk factor. Also, antiretroviral therapy was not a risk factor for pulmonary hypertension in this study.

Ischemic preconditioning of the lower extremity attenuates the normal hypoxic increase in pulmonary artery systolic pressure.

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Foster, Gary P; Westerdahl, Daniel E; Foster, Laura A; Hsu, Jeffrey V; Anholm, James D

2011-12-15

Ischemic pre-condition of an extremity (IPC) induces effects on local and remote tissues that are protective against ischemic injury. To test the effects of IPC on the normal hypoxic increase in pulmonary pressures and exercise performance, 8 amateur cyclists were evaluated under normoxia and hypoxia (13% F(I)O(2)) in a randomized cross-over trial. IPC was induced using an arterial occlusive cuff to one thigh for 5 min followed by deflation for 5 min for 4 cycles. In the control condition, the resting pulmonary artery systolic pressure (PASP) increased from a normoxic value of 25.6±2.3 mmHg to 41.8±7.2 mmHg following 90 min of hypoxia. In the IPC condition, the PASP increased to only 32.4±3.1 mmHg following hypoxia, representing a 72.8% attenuation (p=0.003). No significant difference was detected in cycle ergometer time trial duration between control and IPC conditions with either normoxia or hypoxia. IPC administered prior to hypoxic exposure was associated with profound attenuation of the normal hypoxic increase of pulmonary artery systolic pressure. Published by Elsevier B.V.

Life course path analysis of birth weight, childhood growth, and adult systolic blood pressure

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Gamborg, Michael; Andersen, Per Kragh; Baker, Jennifer L

2009-01-01

body size, and thereby the total effect, of size and changes in size on later outcomes. Using data on childhood body size and adult systolic blood pressure from a sample of 1,284 Danish men born between 1936 and 1970, the authors compared results from path analysis with results from 3 standard...... regression methods. Path analysis produced easily interpretable results, and compared with standard regression methods it produced a noteworthy gain in statistical power. The effect of change in relative body size on adult blood pressure was more pronounced after age 11 years than in earlier childhood....... These results suggest that increases in body size prior to age 11 years are less harmful to adult blood pressure than increases occurring after this age....

Skin perfusion pressure measured by isotope washout in legs with arterial occlusive disease. Evaluation of different tracers, comparison to segmental systolic pressure, angiography and transcutaneous oxygen tension and variations during changes in systemic blood pressure

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Holstein, P; Trap-Jensen, J; Bagger, H

1983-01-01

Hg (range 18-98) (P less than 0.02). The average washout constant for the three different tracers were approximately equal and correlated statistically significant with the SPP; (2) In 59 legs with AOD, segmental SPP was compared to segmental systolic blood pressures on the thigh, calf, ankle and first...... digit (strain gauge technique). The two different methods correlated statistically significant at all four levels, but the systolic blood pressures were higher than the SPP in particular in diabetic legs; (3) Angiograms in 35 legs with AOD showed that the SPP on the ankle was only consistently decreased...

Perceived Social Standing, Medication Nonadherence, and Systolic Blood Pressure in the Rural South.

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Cummings, Doyle M; Wu, Jia-Rong; Cene, Crystal; Halladay, Jacquie; Donahue, Katrina E; Hinderliter, Alan; Miller, Cassandra; Garcia, Beverly; Penn, Dolly; Tillman, Jim; DeWalt, Darren

2016-01-01

Little is known about how perceived social standing versus traditional socioeconomic characteristics influence medication adherence and blood pressure (BP) among African American and white patients with hypertension in the rural southeastern United States. Perceived social standing, socioeconomic characteristics, self-reported antihypertensive medication adherence, and BP were measured at baseline in a cohort of rural African American and white patients (n = 495) with uncontrolled hypertension attending primary care practices. Multivariate models examined the relationship of perceived social standing and socioeconomic indicators with medication adherence and systolic BP. Medication nonadherence was reported by 40% of patients. Younger age [β = 0.20; P = .001], African American race [β = -0.30; P = .03], and lower perceived social standing [β = 0.08; P = .002] but not sex or traditional socioeconomic characteristics including education and household income, were significantly associated with lower medication adherence. Race-specific analyses revealed that this pattern was limited to African Americans and not observed in whites. In stepwise modeling, older age [β = 0.57, P = .001], African American race [β = 4.4; P = .03], and lower medication adherence [β = -1.7, P = .01] but not gender, education, or household income, were significantly associated with higher systolic BP. Lower perceived social standing and age, but not traditional socioeconomic characteristics, were significantly associated with lower medication adherence in African Americans. Lower medication adherence was associated with higher systolic BP. These findings suggest the need for tailored, culturally relevant medication adherence interventions in rural communities. © 2015 National Rural Health Association.

Spectral analyses of systolic blood pressure and heart rate variability and their association with cognitive performance in elderly hypertensive subjects.

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Santos, W B; Matoso, J M D; Maltez, M; Gonçalves, T; Casanova, M; Moreira, I F H; Lourenço, R A; Monteiro, W D; Farinatti, P T V; Soares, P P; Oigman, W; Neves, M F T; Correia, M L G

2015-08-01

Systolic hypertension is associated with cognitive decline in the elderly. Altered blood pressure (BP) variability is a possible mechanism of reduced cognitive performance in elderly hypertensives. We hypothesized that altered beat-to-beat systolic BP variability is associated with reduced global cognitive performance in elderly hypertensive subjects. In exploratory analyses, we also studied the correlation between diverse discrete cognitive domains and indices of systolic BP and heart rate variability. Disproving our initial hypothesis, we have shown that hypertension and low education, but not indices of systolic BP and heart rate variability, were independent predictors of lower global cognitive performance. However, exploratory analyses showed that the systolic BP variability in semi-upright position was an independent predictor of matrix reasoning (B = 0.08 ± .03, P-value = 0.005), whereas heart rate variability in semi-upright position was an independent predictor of the executive function score (B = -6.36 ± 2.55, P-value = 0.02). We conclude that myogenic vascular and sympathetic modulation of systolic BP do not contribute to reduced global cognitive performance in treated hypertensive subjects. Nevertheless, our results suggest that both systolic BP and heart rate variability might be associated with modulation of frontal lobe cognitive domains, such as executive function and matrix reasoning.

Value of systolic pulmonary arterial pressure as a prognostic factor of death in the systemic sclerosis EUSTAR population

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Hachulla, Eric; Clerson, Pierre; Airò, Paolo

2015-01-01

OBJECTIVE: The aim of this study was to assess the prognostic value of systolic pulmonary artery pressure (sPAP) estimated by echocardiography in the multinational European League Against Rheumatism Scleroderma Trial and Research (EUSTAR) cohort. METHODS: Data for patients with echocardiography...

Load Adaptability in Patients With Pulmonary Arterial Hypertension.

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Amsallem, Myriam; Boulate, David; Aymami, Marie; Guihaire, Julien; Selej, Mona; Huo, Jennie; Denault, Andre Y; McConnell, Michael V; Schnittger, Ingela; Fadel, Elie; Mercier, Olaf; Zamanian, Roham T; Haddad, Francois

2017-09-01

Right ventricular (RV) adaptation to pressure overload is a major prognostic factor in patients with pulmonary arterial hypertension (PAH). The objectives were first to define the relation between RV adaptation and load using allometric modeling, then to compare the prognostic value of different indices of load adaptability in PAH. Both a derivation (n = 85) and a validation cohort (n = 200) were included. Load adaptability was assessed using 3 approaches: (1) surrogates of ventriculo-arterial coupling (e.g., RV area change/end-systolic area), (2) simple ratio of function and load (e.g., tricuspid annular plane systolic excursion/right ventricular systolic pressure), and (3) indices assessing the proportionality of adaptation using allometric pressure-function or size modeling. Proportional hazard modeling was used to compare the hazard ratio for the outcome of death or lung transplantation. The mean age of the derivation cohort was 44 ± 11 years, with 80% female and 74% in New York Heart Association class III or IV. Mean pulmonary vascular resistance index (PVRI) was 24 ± 11 with a wide distribution (1.6 to 57.5 WU/m 2 ). Allometric relations were observed between PVRI and RV fractional area change (R 2  = 0.53, p adaptation. In right heart parameters, RVESAI was the strongest predictor of outcomes (hazard ratio per SD = 1.93, 95% confidence interval 1.37 to 2.75, p adaptability indices provided stronger discrimination of outcome than simple RV adaptation metrics in either the derivation or the validation cohort. In conclusion, allometric modeling enables quantification of the proportionality of RV load adaptation but offers small incremental prognostic value to RV end-systolic dimension in PAH. Copyright © 2017 Elsevier Inc. All rights reserved.

A CROSS SECTIONAL STUDY TO FIND THE DIFFERENCE IN SYSTOLIC BLOOD PRESSURE BETWEEN ARMS AS A RISK MARKER FOR DIABETIC NEPHROPATHY IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

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Uday Subhash Bande

2016-08-01

Full Text Available BACKGROUND Diabetic nephropathy is the commonest cause of end-stage renal disease in the developed world. Recent studies have demonstrated that a difference in systolic blood pressure between arms is associated with cardiovascular disease and microalbuminuria. It is considered a predictor for cardiovascular disease and a surrogate marker for early kidney damage among patients with both type 2 diabetes and hypertension. AIMS AND OBJECTIVES The aim was to investigate an association between arm difference in systolic blood pressure and microalbuminuria which can serve as a marker for diabetic nephropathy. MATERIALS AND METHOD This study was conducted on 200 patients with diabetes mellitus and an inter-arm difference in systolic blood pressure was present in 35.7% of the study population. Presence of systolic blood pressure difference of more than 10 mmHg between arms correlated with microalbuminuria and duration of diabetes mellitus with a p value of <0.001. We also found a correlation between arm difference in blood pressure and duration of diabetes mellitus, presence of hypertension and body mass index. CONCLUSION The inter-arm difference in blood pressure could serve as a risk marker for renal damage in diabetes mellitus.

Adaptation to periodic pressure chamber hypoxia and its influence on systolic and diastolic functions in chronic heart failure

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Dmitrieva М.К.

2012-06-01

Full Text Available Research objective is to determine the influence of adaptation method to periodic pressure chamber hypoxia on dynamics of systolic and diastolic functions of myocardium in patients with early stages of chronic heart failure. Materials and Methods: 100 men with post-infarction cardiosclerosis at the age of 40-65 years with I and IIA stages and l-ll functional classes (NYHA of chronic heart failure have been examined. Results: Positive dynamics of systolic and diastolic cardiac functions and other parameters of echocardioscopy under the influence of the hypoxic therapy in comparison with classical physical rehabilitation have been obtained. Furthermore, a more significant effect has been observed in patients with CHF IIA. Conclusion: Improvement in the geometry of the heart has proved that adaptation method to periodic pressure chamber hypoxia could be recommended for rehabilitation of patients with heart failure of early stages.

Effects of verapamil on left ventricular systolic and diastolic function in patients with hypertrophic cardiomyopathy: pressure-volume analysis with a nonimaging scintillation probe.

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Bonow, R O; Ostrow, H G; Rosing, D R; Cannon, R O; Lipson, L C; Maron, B J; Kent, K M; Bacharach, S L; Green, M V

1983-11-01

To investigate the effects of verapamil on left ventricular systolic and diastolic function in patients with hypertrophic cardiomyopathy, we studied 14 patients at catheterization with a nonimaging scintillation probe before and after serial intravenous infusions of low-, medium-, and high-dose verapamil (total dose 0.17 to 0.72 mg/kg). Percent change in radionuclide stroke counts after verapamil correlated well with percent change in thermodilution stroke volume (r = .87), and changes in diastolic and systolic counts were used to assess relative changes in left ventricular volumes after verapamil. Verapamil produced dose-related increases in end-diastolic counts (19 +/- 9% increase; p less than .001), end-systolic counts (91 +/- 54% increase; p less than .001), and stroke counts (7 +/- 10% increase; p less than .02). This was associated with a decrease in ejection fraction (83 +/- 8% control, 73 +/- 10% verapamil; p less than .001) and, in the 10 patients with left ventricular outflow tract gradients, a reduction in gradient (62 +/- 27 mm Hg control, 32 +/- 35 mm Hg verapamil; p less than .01). The end-systolic pressure-volume relation was shifted downward and rightward in all patients, suggesting a negative inotropic effect. In 10 patients, left ventricular pressure-volume loops were constructed with simultaneous micromanometer pressure recordings and the radionuclide time-activity curve. In five patients, verapamil shifted the diastolic pressure-volume curve downward and rightward, demonstrating improved pressure-volume relations despite the negative inotropic effect, and also increased the peak rate of rapid diastolic filling. In the other five patients, the diastolic pressure-volume relation was unaltered by verapamil, and increased end-diastolic volumes occurred at higher end-diastolic pressures; in these patients, the peak rate of left ventricular diastolic filling was not changed by verapamil. The negative inotropic effects of intravenous verapamil are

Effect of atrial systole on canine and porcine coronary blood flow.

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Bellamy, R F

1981-09-01

A feature of phasic coronary flow patterns recorded in conscious chronically instrumented dogs is the atrial cove--a transient depression of arterial flow that occurs during atrial systole. The association between the hemodynamic effects of atrial systole and the atrial cove was studied in anesthetized dogs and pigs with complete heart block. Many atrial coves are available for study in these preparations because atrial activity continues unabated during the diastolic ventricular arrest that follows cessation of electrical pacing. The effect of atrial systole is to translate the pressure-flow relation found during diastole to a higher intercept pressure without change in slope. The increase in the intercept pressure equals the increase in intramyocardial pressure measured with microtransducers embedded in the left ventricular wall. The decrement in flow during the atrial cove is a direct function of the change in intramyocardial pressure and an inverse function of coronary vascular resistance. Each atrial systole is associated with a forward flow transient in the coronary veins, the peak of which occurs at the same instant as does the nadir of atrial flow. These data suggest that the coronary vessels are acting as collapsible tubes and that the waterfall model of the coronary circulation is applicable. The following sequence is proposed to account for the atrial cove. Atrial systole ejects a bolus of blood into the left ventricle increasing both ventricular cavity and intramyocardial pressures. The increase in intramyocardial pressure raises the back pressure opposing coronary flow, reducing the arterial perfusion pressure gradient and causing flow to fall.

Functional and geometrical interference and interdependency between the right and left ventricle in cor pulmonale: an experimental study on simultaneous measurement of biventricular geometry of acute right ventricular pressure overload.

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Yamashita, H; Onodera, S; Imamoto, T; Obara, A; Tanazawa, S; Takashio, T; Morimoto, H; Inoue, H

1989-10-01

To clarify the effects of right ventricular (RV) pressure overload on functional and geometrical interference and interdependency between the right and left ventricle, both ventricular internal diameters were measured by the microcrystal technique during lycopodium induced pulmonary embolization in the dog. By repeated embolization, RV systolic pressure was increased progressively until it reached a peak value of about 60-70 mmHg, then it began to fall. At the same time, the hemodynamics deteriorated progressively resulting in death. During the experiment, gradual leftward displacement of the interventricular septum (IVS) without any change in left ventricular (LV) free wall geometry was observed. In pulmonary embolic shock, which showed a fall in LV pressure to about 60 mmHg and cardiac output to about 40% of control, the leftward displacement of IVS became marked, and the cooperative movement of IVS to LV contraction disappeared. The IVS position during acute RV pressure overload was able to account for the transseptal pressure gradient. The importance of IVS position and motion in cardiac function during acute RV pressure overload was stressed. Furthermore, to establish the theoretical treatment in acute cardiopulmonary resuscitation, ligation of the descending aorta (AoL) or norepinephrine ("N") or isoproterenol ("I") administration were examined in a canine pulmonary embolic shock model. AoL or "N" improved the deteriorated hemodynamics with restoration of biventricular geometry. However, "I" did not restore the biventricular geometry despite the transiently improved hemodynamics, and the experimental animals were unable to survive. These results suggest the importance of the maintainance of systemic pressure for the restoration of failed RV function. Further integrated studies are required to understand biventricular interference and interdependency.

Physiological Responses Associated with Nordic-Walking Training in Systolic Hypertensive Postmenopausal Women

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Latosik Ewelina

2014-12-01

Full Text Available Loss of physical strength and hypertension are among the most pronounced detrimental factors accompanying aging. The aim of this study was to evaluate the influence of a supervised 8-week Nordic-walking training program on systolic blood pressure in systolic-hypertensive postmenopausal women. This study was a randomized control trial on a sample of 24 subjects who did not take any hypertension medications. There was a statistically significant decrease in systolic blood pressure and an increase in lower and upper-body strength in the group following Nordic-walking training. There was a decrease in serum levels of total cholesterol, triglycerides, and low-density cholesterol. The obtained results indicate that an 8-week Nordic-walking program may be efficiently employed for counteracting systolic hypertension through a direct abatement of systolic blood pressure and an increase of maximal aerobic capacity.

Valuation of Normal Range of Ankle Systolic Blood Pressure in Subjects with Normal Arm Systolic Blood Pressure.

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Gong, Yi; Cao, Kai-wu; Xu, Jin-song; Li, Ju-xiang; Hong, Kui; Cheng, Xiao-shu; Su, Hai

2015-01-01

This study aimed to establish a normal range for ankle systolic blood pressure (SBP). A total of 948 subjects who had normal brachial SBP (90-139 mmHg) at investigation were enrolled. Supine BP of four limbs was simultaneously measured using four automatic BP measurement devices. The ankle-arm difference (An-a) on SBP of both sides was calculated. Two methods were used for establishing normal range of ankle SBP: the 99% method was decided on the 99% reference range of actual ankle BP, and the An-a method was the sum of An-a and the low or up limits of normal arm SBP (90-139 mmHg). Whether in the right or left side, the ankle SBP was significantly higher than the arm SBP (right: 137.1 ± 16.9 vs 119.7 ± 11.4 mmHg, P<0.05). Based on the 99% method, the normal range of ankle SBP was 94~181 mmHg for the total population, 84~166 mmHg for the young (18-44 y), 107~176 mmHg for the middle-aged(45-59 y) and 113~179 mmHg for the elderly (≥ 60 y) group. As the An-a on SBP was 13 mmHg in the young group and 20 mmHg in both middle-aged and elderly groups, the normal range of ankle SBP on the An-a method was 103-153 mmHg for young and 110-160 mmHg for middle-elderly subjects. A primary reference for normal ankle SBP was suggested as 100-165 mmHg in the young and 110-170 mmHg in the middle-elderly subjects.

Simultaneous inter-arm and inter-leg systolic blood pressure differences to diagnose peripheral artery disease: a diagnostic accuracy study.

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Herráiz-Adillo, Ángel; Soriano-Cano, Alba; Martínez-Hortelano, José Alberto; Garrido-Miguel, Miriam; Mariana-Herráiz, Julián Ángel; Martínez-Vizcaíno, Vicente; Notario-Pacheco, Blanca

2018-04-01

Inter-arm systolic blood pressure differences (IASBPD) and inter-leg systolic blood pressure differences (ILSBPD) have arisen as potential tools to detect peripheral artery disease (PAD) and individuals at high cardiovascular risk. This study aims to evaluate the diagnostic accuracy of IASBPD and ILSBPD to detect PAD, and whether IASBPD or ILSBPD improves diagnostic accuracy of the oscillometric ankle-brachial index (ABI). In this prospective study, eligible for inclusion were consecutive adults, with at least one of the following cardiovascular risk factors: diabetes, dyslipidemia, hypertension, smoking habit or age ≥65. IASBPD, ILSBPD and ankle-brachial index (ABI) were measured in all participants through four-limb simultaneous oscillometric measurements and compared with Doppler ABI (reference test, positive cut-off: ≤ 0.9). Of 171 subjects included, PAD was confirmed in 23 and excluded in 148. Thirteen and 38 subjects had IASBPD and ILSBPD ≥10 mmHg, respectively. Pearson correlation with Doppler ABI of IASBPD and ILSBPD was 0.073 (P = .343) and -0.628 (P blood pressure measurements in upper limbs are not possible.

Effects of mercury on the arterial blood pressure of anesthetized rats

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Rossoni L.V.

1999-01-01

Full Text Available The available data suggests that hypotension caused by Hg2+ administration may be produced by a reduction of cardiac contractility or by cholinergic mechanisms. The hemodynamic effects of an intravenous injection of HgCl2 (5 mg/kg were studied in anesthetized rats (N = 12 by monitoring left and right ventricular (LV and RV systolic and diastolic pressures for 120 min. After HgCl2 administration the LV systolic pressure decreased only after 40 min (99 ± 3.3 to 85 ± 8.8 mmHg at 80 min. However, RV systolic pressure increased, initially slowly but faster after 30 min (25 ± 1.8 to 42 ± 1.6 mmHg at 80 min. Both right and left diastolic pressures increased after HgCl2 treatment, suggesting the development of diastolic ventricular dysfunction. Since HgCl2 could be increasing pulmonary vascular resistance, isolated lungs (N = 10 were perfused for 80 min with Krebs solution (continuous flow of 10 ml/min containing or not 5 µM HgCl2. A continuous increase in pulmonary vascular resistance was observed, suggesting the direct effect of Hg2+ on the pulmonary vessels (12 ± 0.4 to 29 ± 3.2 mmHg at 30 min. To examine the interactions of Hg2+ and changes in cholinergic activity we analyzed the effects of acetylcholine (Ach on mean arterial blood pressure (ABP in anesthetized rats (N = 9 before and after Hg2+ treatment (5 mg/kg. Using the same amount and route used to study the hemodynamic effects we also examined the effects of Hg2+ administration on heart and plasma cholinesterase activity (N = 10. The in vivo hypotensive response to Ach (0.035 to 10.5 µg was reduced after Hg2+ treatment. Cholinesterase activity (µM h-1 mg protein-1 increased in heart and plasma (32 and 65%, respectively after Hg2+ treatment. In conclusion, the reduction in ABP produced by Hg2+ is not dependent on a putative increase in cholinergic activity. HgCl2 mainly affects cardiac function. The increased pulmonary vascular resistance and cardiac failure due to diastolic

Comparison between radionuclide ventriculography and echocardiography for quantification of left ventricular systolic function in rats exposed to doxorubicin

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Oliveira, Luciano Fonseca Lemos de; Carvalho, Eduardo Elias Vieira de; Romano, Minna Moreira Dias; Maciel, Benedito Carlos; Simões, Marcus Vinicius, E-mail: msimoes@fmrp.usp.br [Universidade de Sao Paulo (USP), Ribeirao Preto, SP (Brazil). Centro de Cardiologia; O' Connell, João Lucas; Pulici, Érica Carolina Campos [Universidade Federal de Uberlândia (UFU), MG (Brazil)

2017-01-15

Background: Radionuclide ventriculography (RV) is a validated method to evaluate the left ventricular systolic function (LVSF) in small rodents. However, no prior study has compared the results of RV with those obtained by other imaging methods in this context. Objectives: To compare the results of LVSF obtained by RV and echocardiography (ECHO) in an experimental model of cardiotoxicity due to doxorubicin (DXR) in rats. Methods: Adult male Wistar rats serving as controls (n = 7) or receiving DXR (n = 22) in accumulated doses of 8, 12, and 16 mg/kg were evaluated with ECHO performed with a Sonos 5500 Philips equipment (12-MHz transducer) and RV obtained with an Orbiter-Siemens gamma camera using a pinhole collimator with a 4-mm aperture. Histopathological quantification of myocardial fibrosis was performed after euthanasia. Results: The control animals showed comparable results in the LVSF analysis obtained with ECHO and RV (83.5 ± 5% and 82.8 ± 2.8%, respectively, p > 0.05). The animals that received DXR presented lower LVSF values when compared with controls (p < 0.05); however, the LVSF values obtained by RV (60.6 ± 12.5%) were lower than those obtained by ECHO (71.8 ± 10.1%, p = 0.0004) in this group. An analysis of the correlation between the LVSF and myocardial fibrosis showed a moderate correlation when the LVSF was assessed by ECHO (r = -0.69, p = 0.0002) and a stronger correlation when it was assessed by RV (r = -0.79, p < 0.0001). On multiple regression analysis, only RV correlated independently with myocardial fibrosis. Conclusion: RV is an alternative method to assess the left ventricular function in small rodents in vivo. When compared with ECHO, RV showed a better correlation with the degree of myocardial injury in a model of DXR-induced cardiotoxicity. (author)

Comparison between radionuclide ventriculography and echocardiography for quantification of left ventricular systolic function in rats exposed to doxorubicin

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Oliveira, Luciano Fonseca Lemos de; Carvalho, Eduardo Elias Vieira de; Romano, Minna Moreira Dias; Maciel, Benedito Carlos; Simões, Marcus Vinicius

2017-01-01

Background: Radionuclide ventriculography (RV) is a validated method to evaluate the left ventricular systolic function (LVSF) in small rodents. However, no prior study has compared the results of RV with those obtained by other imaging methods in this context. Objectives: To compare the results of LVSF obtained by RV and echocardiography (ECHO) in an experimental model of cardiotoxicity due to doxorubicin (DXR) in rats. Methods: Adult male Wistar rats serving as controls (n = 7) or receiving DXR (n = 22) in accumulated doses of 8, 12, and 16 mg/kg were evaluated with ECHO performed with a Sonos 5500 Philips equipment (12-MHz transducer) and RV obtained with an Orbiter-Siemens gamma camera using a pinhole collimator with a 4-mm aperture. Histopathological quantification of myocardial fibrosis was performed after euthanasia. Results: The control animals showed comparable results in the LVSF analysis obtained with ECHO and RV (83.5 ± 5% and 82.8 ± 2.8%, respectively, p > 0.05). The animals that received DXR presented lower LVSF values when compared with controls (p < 0.05); however, the LVSF values obtained by RV (60.6 ± 12.5%) were lower than those obtained by ECHO (71.8 ± 10.1%, p = 0.0004) in this group. An analysis of the correlation between the LVSF and myocardial fibrosis showed a moderate correlation when the LVSF was assessed by ECHO (r = -0.69, p = 0.0002) and a stronger correlation when it was assessed by RV (r = -0.79, p < 0.0001). On multiple regression analysis, only RV correlated independently with myocardial fibrosis. Conclusion: RV is an alternative method to assess the left ventricular function in small rodents in vivo. When compared with ECHO, RV showed a better correlation with the degree of myocardial injury in a model of DXR-induced cardiotoxicity. (author)

Comparison between Radionuclide Ventriculography and Echocardiography for Quantification of Left Ventricular Systolic Function in Rats Exposed to Doxorubicin

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Luciano Fonseca Lemos de Oliveira

Full Text Available Abstract Background: Radionuclide ventriculography (RV is a validated method to evaluate the left ventricular systolic function (LVSF in small rodents. However, no prior study has compared the results of RV with those obtained by other imaging methods in this context. Objectives: To compare the results of LVSF obtained by RV and echocardiography (ECHO in an experimental model of cardiotoxicity due to doxorubicin (DXR in rats. Methods: Adult male Wistar rats serving as controls (n = 7 or receiving DXR (n = 22 in accumulated doses of 8, 12, and 16 mg/kg were evaluated with ECHO performed with a Sonos 5500 Philips equipment (12-MHz transducer and RV obtained with an Orbiter-Siemens gamma camera using a pinhole collimator with a 4-mm aperture. Histopathological quantification of myocardial fibrosis was performed after euthanasia. Results: The control animals showed comparable results in the LVSF analysis obtained with ECHO and RV (83.5 ± 5% and 82.8 ± 2.8%, respectively, p > 0.05. The animals that received DXR presented lower LVSF values when compared with controls (p < 0.05; however, the LVSF values obtained by RV (60.6 ± 12.5% were lower than those obtained by ECHO (71.8 ± 10.1%, p = 0.0004 in this group. An analysis of the correlation between the LVSF and myocardial fibrosis showed a moderate correlation when the LVSF was assessed by ECHO (r = -0.69, p = 0.0002 and a stronger correlation when it was assessed by RV (r = -0.79, p < 0.0001. On multiple regression analysis, only RV correlated independently with myocardial fibrosis. Conclusion: RV is an alternative method to assess the left ventricular function in small rodents in vivo. When compared with ECHO, RV showed a better correlation with the degree of myocardial injury in a model of DXR-induced cardiotoxicity.

Validation of noninvasive indices of global systolic function in patients with normal and abnormal loading conditions: a simultaneous echocardiography pressure-volume catheterization study.

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Yotti, Raquel; Bermejo, Javier; Benito, Yolanda; Sanz-Ruiz, Ricardo; Ripoll, Cristina; Martínez-Legazpi, Pablo; del Villar, Candelas Pérez; Elízaga, Jaime; González-Mansilla, Ana; Barrio, Alicia; Bañares, Rafael; Fernández-Avilés, Francisco

2014-01-01

Noninvasive indices based on Doppler echocardiography are increasingly used in clinical cardiovascular research to evaluate left ventricular global systolic chamber function. Our objectives were to clinically validate ultrasound-based methods of global systolic chamber function to account for differences between patients in conditions of abnormal load, and to assess their sensitivity to load confounders. Twenty-seven patients (8 dilated cardiomyopathy, 10 normal ejection fraction, and 9 end-stage liver disease) underwent simultaneous echocardiography and left heart catheterization with pressure-conductance instrumentation. The reference index, maximal elastance (Emax), was calculated from pressure-volume loop data obtained during acute inferior vena cava occlusion. A wide range of values were observed for left ventricular systolic chamber function (Emax: 2.8±1.0 mm Hg/mL), preload, and afterload. Among the noninvasive indices tested, the peak ejection intraventricular pressure difference showed the best correlation with Emax (R=0.75). A significant but weaker correlation with Emax was observed for ejection fraction (R=0.41), midwall fractional shortening (R=0.51), global circumferential strain (R=-0.53), and strain rate (R=-0.46). Longitudinal strain and strain rate failed to correlate with Emax, as did noninvasive single-beat estimations of this index. Principal component and multiple regression analyses demonstrated that peak ejection intraventricular pressure difference was less sensitive to load, whereas ejection fraction and longitudinal strain and strain rate were heavily influenced by afterload. Current ultrasound methods have limited accuracy to characterize global left ventricular systolic chamber function in a given patient. The Doppler-derived peak ejection intraventricular pressure difference should be preferred for this purpose because it best correlates with the reference index and is more robust in conditions of abnormal load.

Comparing the Efficacy of Tadalafil Versus Placebo on Pulmonary Artery Systolic Pressure and Right Ventricular Function in Patients with Beta-Thalassaemia Intermedia.

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Jalalian, Rozita; Moghadamnia, Ali Akbar; Tamaddoni, Ahmad; Khafri, Soraya; Iranian, Mohammadreza

2017-07-01

Conventional oral therapies in the management of pulmonary hypertension in people without haemoglobinopathies are of limited value in thalassaemia patients because of toxicity and poor effectiveness. This study was conducted to assess the effect of tadalafil on pulmonary artery pressure and right ventricular systolic function in patients with beta-thalassaemia intermedia. Forty-four patients with beta-thalassaemia intermedia with pulmonary hypertension based on transthoracic echocardiography (TTE) were entered in the study. Patients with hepatic or renal insufficiency and also patients who were treated with organic nitrates or alpha-blockers were excluded. The patients were randomly divided into two groups (n=22) and they were treated for six weeks with tadalafil (40mg daily) or placebo. The pulmonary artery systolic pressure (PASP), tricuspid regurgitation velocity (TRV) and parameters related to systolic function of the right ventricle were measured by the TTE before and after treatment. Significant improvement in TRV (3.02±0.02 m/s-2.52±0.06 m/s), PASP (45.31±0.66 mmHg-34.26±1.15mmHg) and parameters related to systolic function of the right ventricle were observed in the group who received tadalafil compared to placebo (pintermedia. Likewise, tadalafil improved right ventricular systolic function in the patients. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Decreased systolic blood pressure is associated with increased risk of all-cause mortality in patients with type 2 diabetes and renal impairment: A nationwide longitudinal observational study of 27,732 patients based on the Swedish National Diabetes Register.

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Svensson, Maria K; Afghahi, Henri; Franzen, Stefan; Björk, Staffan; Gudbjörnsdottir, Soffia; Svensson, Ann-Marie; Eliasson, Björn

2017-05-01

Previous studies have shown a U-shaped relationship between systolic blood pressure and risk of all-cause of mortality in patients with type 2 diabetes and renal impairment. To evaluate the associations between time-updated systolic blood pressure and time-updated change in systolic blood pressure during the follow-up period and risk of all-cause mortality in patients with type 2 diabetes and renal impairment. A total of 27,732 patients with type 2 diabetes and renal impairment in the Swedish National Diabetes Register were followed for 4.7 years. Time-dependent Cox models were used to estimate risk of all-cause mortality. Time-updated mean systolic blood pressure is the average of the baseline and the reported post-baseline systolic blood pressures. A time-updated systolic blood pressure blood pressure > 10 mmHg between the last two observations was associated with higher risk of all-cause mortality (-10 to -25 mmHg; hazard ratio: 1.24, 95% confidence interval: 1.17-1.32). Both low systolic blood pressure and a decrease in systolic blood pressure during the follow-up are associated with a higher risk of all-cause mortality in patients with type 2 diabetes and renal impairment.

The effect of heart failure and left ventricular assist device treatment on right ventricular mechanics: a computational study.

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Park, Jun I K; Heikhmakhtiar, Aulia Khamas; Kim, Chang Hyun; Kim, Yoo Seok; Choi, Seong Wook; Song, Kwang Soup; Lim, Ki Moo

2018-05-22

Although it is important to analyze the hemodynamic factors related to the right ventricle (RV) after left ventricular assist device (LVAD) implantation, previous studies have focused only on the alteration of the ventricular shape and lack quantitative analysis of the various hemodynamic parameters. Therefore, we quantitatively analyzed various hemodynamic parameters related to the RV under normal, heart failure (HF), and HF incorporated with continuous flow LVAD therapy by using a computational model. In this study, we combined a three-dimensional finite element electromechanical model of ventricles, which is based on human ventricular morphology captured by magnetic resonance imaging (MRI) with a lumped model of the circulatory system and continuous flow LVAD function in order to construct an integrated model of an LVAD implanted-cardiovascular system. To induce systolic dysfunction, the magnitude of the calcium transient function under HF condition was reduced to 70% of the normal value, and the time constant was reduced by 30% of the normal value. Under the HF condition, the left ventricular end systolic pressure decreased, the left ventricular end diastolic pressure increased, and the pressure in the right atrium (RA), RV, and pulmonary artery (PA) increased compared with the normal condition. The LVAD therapy decreased the end-systolic pressure of the LV by 41%, RA by 29%, RV by 53%, and PA by 71%, but increased the right ventricular ejection fraction by 52% and cardiac output by 40%, while the stroke work was reduced by 67% compared with the HF condition without LVAD. The end-systolic ventricular tension and strain decreased with the LVAD treatment. LVAD enhances CO and mechanical unloading of the LV as well as those of the RV and prevents pulmonary hypertension which can be induced by HF.

Right ventricular longitudinal strain correlates well with right ventricular stroke work index in patients with advanced heart failure referred for heart transplantation.

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Cameli, Matteo; Lisi, Matteo; Righini, Francesca Maria; Tsioulpas, Charilaos; Bernazzali, Sonia; Maccherini, Massimo; Sani, Guido; Ballo, Piercarlo; Galderisi, Maurizio; Mondillo, Sergio

2012-03-01

Right ventricular (RV) systolic function has a critical role in determining the clinical outcome and success of using left ventricular assist devices (LVADs) in patients with refractory heart failure. Tissue Doppler and M-mode measurements of tricuspid systolic motion (tricuspid S' and tricuspid annular plane systolic excursion [TAPSE]) are the most currently used methods for the quantification of RV longitudinal function; RV deformation analysis by speckle-tracking echocardiography (STE) has recently allowed the analysis of global RV longitudinal function. Using cardiac catheterization as the reference standard, this study aimed at exploring the correlation between RV longitudinal function by STE and RV stroke work index (RVSWI) in patients referred for cardiac transplantation. Right-side heart catheterization and transthoracic echo Doppler were simultaneously performed in 41 patients referred for cardiac transplantation evaluation for advanced systolic heart failure. Thermodilution RV stroke volume and invasive pulmonary pressures were used to obtain RVSWI. RV longitudinal strain (RVLS) by STE was assessed averaging all segments in apical 4-chamber view (global RVLS) and by averaging RV free-wall segments (free-wall RVLS). Tricuspid S' and TAPSE were also calculated. No significant correlations were found for TAPSE or tricuspid S' with RVSWI (r = 0.14; r = 0.06; respectively). Close negative correlations between global RVLS and free-wall RVLS with the RVSWI were found (r = -0.75; r = -0.82; respectively; both P rights reserved.

Prevalence of systolic inter-arm differences in blood pressure for different primary care populations: systematic review and meta-analysis.

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Clark, Christopher E; Taylor, Rod S; Shore, Angela C; Campbell, John L

2016-11-01

Various prevalence figures have been reported for inter-arm differences in blood pressure (IAD); variation may be explained by differing population vascular risk and by measurement method. To review the literature to derive robust estimates of IAD prevalence relevant to community populations. Systematic review and meta-analysis. MEDLINE, Embase, and CINAHL were searched for cross-sectional studies likely to represent general or primary care populations, reporting prevalence of IAD and employing a simultaneous method of measurement. Using study-level data, pooled estimates of mean prevalence of systolic IADs were calculated and compared using a random effects model. Eighty IAD studies were identified. Sixteen met inclusion criteria: pooled estimates of prevalence for systolic IAD ≥10 mmHg were 11.2% (95% confidence interval [CI] = 9.1 to 13.6) in hypertension, 7.4% (95% CI = 5.8 to 9.2) in diabetes, and 3.6% (95% CI = 2.3 to 5.0) for a general adult population (Pdifferences). Differences persisted for higher cut-off values. Prevalences were lower for East Asian than for Western populations and were overestimated by sequential measurement where this could be compared with simultaneous measurement within studies (relative risk for IAD: 2.9 [95% CI = 2.1 to 4.1]). Studies with higher mean absolute systolic pressures had higher prevalences for a systolic IAD ≥10 mmHg (P = 0.04). Prevalences of IADs rise in relation to underlying cardiovascular comorbidities of the population studied, and are overestimated threefold when sequential measurement is used. Population-specific variation in prevalences of IAD should be taken into account in delivering clinical care and in planning future studies. © British Journal of General Practice 2016.

Effect of Self-monitoring and Medication Self-titration on Systolic Blood Pressure in Hypertensive Patients at High Risk of Cardiovascular Disease

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McManus, Richard J.; Mant, Jonathan; Haque, M. Sayeed; Bray, Emma P.; Bryan, Stirling; Greenfield, Sheila M.; Jones, Miren I.; Jowett, Sue; Little, Paul; Penaloza, Cristina; Schwartz, Claire; Shackleford, Helen; Shovelton, Claire; Varghese, Jinu; Williams, Bryan

2014-01-01

IMPORTANCE: Self-monitoring of blood pressure with self-titration of antihypertensives (self-management) results in lower blood pressure in patients with hypertension, but there are no data about patients in high-risk groups.\\ud \\ud OBJECTIVE: To determine the effect of self-monitoring with self-titration of antihypertensive medication compared with usual care on systolic blood pressure among patients with cardiovascular disease, diabetes, or chronic kidney disease.\\ud \\ud DESIGN, SETTING, AN...

Relationship of right- to left-sided ventricular filling pressures in advanced heart failure: insights from the ESCAPE trial.

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Drazner, Mark H; Velez-Martinez, Mariella; Ayers, Colby R; Reimold, Sharon C; Thibodeau, Jennifer T; Mishkin, Joseph D; Mammen, Pradeep P A; Markham, David W; Patel, Chetan B

2013-03-01

Although right atrial pressure (RAP) and pulmonary capillary wedge pressure (PCWP) are correlated in heart failure, in a sizeable minority of patients, the RAP and PCWP are not tightly coupled. The basis of this variability in the RAP/PCWP ratio, and whether it conveys prognostic value, is not known. We analyzed the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial database. Baseline characteristics, including echocardiographic assessment of right ventricular (RV) structure and function, and invasively measured hemodynamic parameters, were compared among tertiles of the RAP/PCWP ratio. Multivariable Cox proportional hazard models assessed the association of RAP/PCWP ratio with the primary ESCAPE outcome (6-month death or hospitalization [days]) adjusting for systolic blood pressure, blood urea nitrogen, 6-minute walk distance, and PCWP. The RAP/PCWP tertiles were 0.27 to 0.4 (tertile 1); 0.41 to 0.615 (tertile 2), and 0.62 to 1.21 (tertile 3). Increasing RAP/PCWP was associated with increasing median right atrial area (23, 26, 29 cm2, respectively; P<0.005), RV area in diastole (21, 27, 27 cm2, respectively; P<0.005), and pulmonary vascular resistance (2.4, 2.9, 3.6 woods units, respectively; P=0.003), and lower RV stroke work index (8.6, 8.4, 5.5 g·m/m2 per beat, respectively; P<0.001). RAP/PCWP ratio was associated with death or hospitalization within 6 months (hazard ratio, 1.16 [1, 1.4]; P<0.05). Increased RAP/PCWP ratio was associated with higher pulmonary vascular resistance, reduced RV function (manifest as a larger right atrium and ventricle and lower RV stroke work index), and an increased risk of adverse outcomes in patients with advanced heart failure.

Increased postdialysis systolic blood pressure is associated with extracellular overhydration in hemodialysis outpatients.

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Nongnuch, Arkom; Campbell, Neil; Stern, Edward; El-Kateb, Sally; Fuentes, Laura; Davenport, Andrew

2015-02-01

Recently, intradialytic hypertension was reported to be associated with increased mortality for hemodialysis patients. To determine whether volume status plays a role in dialysis-associated hypertension, we prospectively audited 531 patients that had volume assessments measured by multiple-frequency bioelectrical impedance during their midweek dialysis session. Mean pre- and postdialysis weights were 73.2 vs 71.7 kg, and systolic blood pressures (SBPs) 140.5 vs. 130.3 mm Hg, respectively. Patients were divided into groups based on a fall in SBP of 20 mm Hg or more (32%), an increased SBP of 10 mm Hg or more (18%), and a stable group (50%). There were no differences in patient demographics, dialysis prescriptions, predialysis weight, total body (TBW), and extracellular (ECW) and intracellular water (ICW). However, the change in weight was significantly less in the increased blood pressure group (1.01 kg vs. stable 1.65, and 1.7 hypotensive). The ratio of ECW to TBW was significantly higher in the increased blood pressure group, particularly post dialysis (39.1 vs. stable 38.7% and fall in blood pressure group 38.7%). ECW overhydration was significantly greater in the increased blood pressure group post dialysis (0.7 (0.17 to 1.1) vs. stable 0.39 (-0.2 to 0.95) and fall in blood pressure group 0.38 (-0.19 to 0.86) liter). We found that patients who had increased blood pressure post dialysis had greater hydration status, particularly ECW. Thus, patients who increase their blood pressure post dialysis should have review of target weight, consideration of lowering the post-dialysis weight, and may benefit from increasing dialysis session time or frequency.

Validity of Some Anthropometric Indicators in the Prediction of High Systolic Blood Pressure among Indian Adolescents

Directory of Open Access Journals (Sweden)

Shobha Rao

2008-01-01

Full Text Available Background In view of the increasing prevalence of obesity in children, it is necessary to investigate the relative performance of different indicators used for its assessment and health consequences. Objectives To examine concordance between various indicators used for assessing obesity among adolescents and to examine their ability to predict risk of high systolic blood pressure. Design Cross-sectional study, from two schools catering to affluent class. Subjects Children in age 9–16 yr (n = 1146 boys and 1036 girls. Measurements Body weight, height, skinfold thickness at triceps (TSFT and body fat percent by trained investigators and blood pressure measurement by a pediatrician using sphygmomanometer. Results Prevalence of overweight was lowest with criterion of TSFT (11.7% in boys; 7.6% in girls and was highest using criterion of body fat percent (53.7% in boys and 28.4% in girls. Body mass index (BMI had high significant correlation with each of the indicator and with systolic blood pressure (SBP as well, in both sexes. All the indicators with conventional cut offs showed poor sensitivity for predicting high SBP. However, receiver operating characteristics (ROC cut-offs improved sensitivity considerably, but the values were much lower compared to conventional cut-offs. Conclusions There is considerable disparity in the estimates of overweight children obtained by different indicators. Lower values of ROC cut-offs highlights the need for population specific customized classification systems for assessing obesity in view of the probable population differences in relative risks of non-communicable adult diseases.

Hypertension Treatment and Concern About Falling: Baseline Data from the Systolic Blood Pressure Intervention Trial.

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Berlowitz, Dan R; Breaux-Shropshire, Tonya; Foy, Capri G; Gren, Lisa H; Kazis, Lewis; Lerner, Alan J; Newman, Jill C; Powell, James R; Riley, William T; Rosman, Robert; Wadley, Virginia G; Williams, Julie A

2016-11-01

To determine the extent of concern about falling in older adults with hypertension, whether lower blood pressure (BP) and greater use of antihypertensive medications are associated with greater concern about falling, and whether lower BP has a greater effect on concern about falling in older and more functionally impaired individuals. Secondary analysis involving cross-sectional study of baseline characteristics of participants enrolled in the Systolic Blood Pressure Intervention Trial (SPRINT). Approximately 100 outpatient sites. SPRINT enrollees aged 50 and older (mean age 69) diagnosed with hypertension (N = 2,299). Concern about falling was determined using the shortened version of the Falls Efficacy Scale International as measured at the baseline examination. Mild concern about falling was present in 29.3% of participants and moderate to severe concern in 17.9%. Neither low BP (systolic BPconcern about falling (P > .10). Participants with moderate to severe concern about falling were taking significantly more antihypertensive medications than those with mild or no concern. After adjusting for baseline characteristics, no associations were evident between BP, medications, and concern about falling. Results were similar in older and younger participants; interactions between BP and age and functional status were not significantly associated with concern about falling. Although concern about falling is common in older adults with hypertension, it was not found to be associated with low BP or use of more antihypertensive medications in baseline data from SPRINT. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

6A.03: THE RELATIONSHIP BETWEEN INTER-ARM SYSTOLIC BLOOD PRESSURE AND CARDIOVASCULAR RISK FACTORS.

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Ma, W; Zhang, B; Yang, Y; Qi, L; Meng, L; Zhang, Y; Huo, Y

2015-06-01

To analyze the relationship between the inter arm blood pressure difference (IASBPD) and other cardiovascular risk factors. To identify what factors are associated with this difference in a general population. The study subjects were 1426 individuals. The BP was measured simultaneously in both arms by VP1000 vascular profiler (Omron Colin, Japan). The inter-arm BP difference was expressed as the absolute difference (|R - L|). The various risk factors, ba-PWV, carotid IMT and plaque were compared between IASBPD more than 10mmHg group and IASBPD less than 10mmHg group. The relationship between IASBPD more than 10mmHg and various cardiovascular risk factors were analyzed by multivariate logistic analysis. Left upper limb systolic blood pressure was higher than the right upper limb, while right upper limb diastolic pressure was higher than the left upper limb. The prevalence of hypertension was higher in IASBPD increasing group than normal group (40.5% vs 22.6%, p blood pressure were also higher in IASBPD increasing group(p blood pressure, BMI and ABI independently, which may partly explain the mechanism that increasing IASBPD is associated with cardiovascular disease.

2014 Hypertension Guideline: Recommendation for a Change in Goal Systolic Blood Pressure

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Handler, Joel

2015-01-01

The 2014 Kaiser Permanente Care Management Institute National Hypertension Guideline was developed to assist primary care physicians and other health care professionals in the outpatient treatment of uncomplicated hypertension in adult men and nonpregnant women aged 18 years and older. The new guideline reflects general acceptance, with minor modifications, of the “Evidence-Based Guideline” report by the panel members appointed to the National Heart, Lung, and Blood Institute 8th Joint National Committee. A major practice change is the recommendation for goal systolic blood pressure less than 150 mmHg in patients aged 60 years and older who are treated for hypertension in the absence of diabetes or chronic kidney disease. This article describes the reasons for, evidence for, and consequences of the change, and is followed by the National Guidelines handout. PMID:26057683

Power loss and right ventricular efficiency in patients after tetralogy of Fallot repair with pulmonary insufficiency: clinical implications.

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Fogel, Mark A; Sundareswaran, Kartik S; de Zelicourt, Diane; Dasi, Lakshmi P; Pawlowski, Tom; Rome, Jack; Yoganathan, Ajit P

2012-06-01

To quantify right ventricular output power and efficiency and correlate these to ventricular function in patients with repaired tetralogy of Fallot. This might aid in determining the optimal timing for pulmonary valve replacement. We reviewed the cardiac catheterization and magnetic resonance imaging data of 13 patients with tetralogy of Fallot (age, 22 ± 17 years). Using pressure and flow measurements in the main pulmonary artery, cardiac output and regurgitation fraction, right ventricular (RV) power output, loss, and efficiency were calculated. The RV function was evaluated using cardiac magnetic resonance imaging. The RV systolic power was 1.08 ± 0.62 W, with 20.3% ± 8.6% power loss owing to 41% ± 14% pulmonary regurgitation (efficiency, 79.7% ± 8.6%; 0.84 ± 0.73 W), resulting in a net cardiac output of 4.24 ± 1.82 L/min. Power loss correlated significantly with the indexed RV end-diastolic and end-systolic volume (R = 0.78, P = .002 and R = 0.69, P = .009, respectively). The normalized RV power output had a significant negative correlation with RV end-diastolic and end-systolic volumes (both R = -0.87, P = .002 and R = -0.68, P = .023, respectively). A rapid decrease occurred in the RV power capacity with an increasing RV volume, with the curve flattening out at an indexed RV end-diastolic and end-systolic volume threshold of 139 mL/m(2) and 75 mL/m(2), respectively. Significant power loss is present in patients with repaired tetralogy of Fallot and pulmonary regurgitation. A rapid decrease in efficiency occurs with increasing RV volume, suggesting that pulmonary valve replacement should be done before the critical value of 139 mL/m(2) and 75 mL/m(2) for the RV end-diastolic and end-systolic volume, respectively, to preserve RV function. Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Non-constrained monitoring of systolic blood pressure on a weighing scale

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Shin, Jae Hyuk; Lee, Kang Moo; Park, Kwang Suk

2009-01-01

In this study, we developed a novel technique for estimating non-constrained and cuffless blood pressure (BP) that was based on electrocardiogram (ECG) and ballistocardiogram (BCG). The BCG was non-invasively measured using a common electronic weighing scale when a subject was standing on it. The ECG was measured using three different methods: on the chest using Ag/AgCl electrodes, on the hands using dry electrodes and on the feet also using dry electrodes. For a BP correlated parameter, a time interval parameter, which was defined as the time difference between the ECG R-peak and BCG J-peak, was employed for evaluating and estimating beat-to-beat BP. Under a BP varying experiment with a Valsalva manoeuvre, the R–J intervals were extracted at every beat cycle and a systolic blood pressure (SBP) estimation equation was established using linear regression analysis for each subject. In the case of feet delivered ECG (F-ECG), an ensemble average technique synchronized at the BCG J-peak point was applied to extract the ECG signal from the feet. The performance of the proposed method was evaluated using Finapres, a non-invasive blood pressure measurement system, as a reference BP signal, and a scatter plot was used to find the regression line between the reference values and estimated BPs. A moving-window averaging technique was applied to remove the high-frequency noise in the R–J intervals and was applied to enhance the accuracy of the SBP estimation. For all individuals, the estimated SBP was similar to the measured SBP with a reliable correlation, which makes the proposed method suitable for use in a home healthcare system to monitor blood pressure on a weighing scale at the same time as measuring weight

Severity of structural and functional right ventricular remodeling depends on training load in an experimental model of endurance exercise.

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Sanz-de la Garza, Maria; Rubies, Cira; Batlle, Montserrat; Bijnens, Bart H; Mont, Lluis; Sitges, Marta; Guasch, Eduard

2017-09-01

Arrhythmogenic right ventricular (RV) remodeling has been reported in response to regular training, but it remains unclear how exercise intensity affects the presence and extent of such remodeling. We aimed to assess the relationship between RV remodeling and exercise load in a long-term endurance training model. Wistar rats were conditioned to run at moderate (MOD; 45 min, 30 cm/s) or intense (INT; 60 min, 60 cm/s) workloads for 16 wk; sedentary rats served as controls. Cardiac remodeling was assessed with standard echocardiographic and tissue Doppler techniques, sensor-tip pressure catheters, and pressure-volume loop analyses. After MOD training, both ventricles similarly dilated (~16%); the RV apical segment deformation, but not the basal segment deformation, was increased [apical strain rate (SR): -2.9 ± 0.5 vs. -3.3 ± 0.6 s -1 , SED vs. MOD]. INT training prompted marked RV dilatation (~26%) but did not further dilate the left ventricle (LV). A reduction in both RV segments' deformation in INT rats (apical SR: -3.3 ± 0.6 vs. -3.0 ± 0.4 s -1 and basal SR: -3.3 ± 0.7 vs. -2.7 ± 0.6 s -1 , MOD vs. INT) led to decreased global contractile function (maximal rate of rise of LV pressure: 2.53 ± 0.15 vs. 2.17 ± 0.116 mmHg/ms, MOD vs. INT). Echocardiography and hemodynamics consistently pointed to impaired RV diastolic function in INT rats. LV systolic and diastolic functions remained unchanged in all groups. In conclusion, we showed a biphasic, unbalanced RV remodeling response with increasing doses of exercise: physiological adaptation after MOD training turns adverse with INT training, involving disproportionate RV dilatation, decreased contractility, and impaired diastolic function. Our findings support the existence of an exercise load threshold beyond which cardiac remodeling becomes maladaptive. NEW & NOTEWORTHY Exercise promotes left ventricular eccentric hypertrophy with no changes in systolic or diastolic function in healthy rats. Conversely, right

Quantitative evaluation of right ventricular overload with thallium-201 myocardial perfusion scintigraphy

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Watanabe, Toshiya; Miyakoda, Hiroyuki; Koike, Yoshihiro; Itatsu, Hidetaka; Kawai, Naoki; Sotobata, Iwao.

1983-01-01

Thallium-201 myocardial perfusion scintigraphy and right-heart catheterization were performed on patients with right ventricular pressure overload (RVPO) or right ventricular volume overload (RVVO). In 18 patients with RVPO, right ventricular systolic pressure correlated significantly both with the RV/LV wall thallium-201 uptake ratios (r=0.54, p<0.02) and the RV wall/background thallium-201 uptake ratios (r=0.70, p<0.01). RV/LV work ratios also significantly correlated with RV/LV wall thallium-201 uptake ratios (r=0.57, p<0.02). In 19 patients with RVVO, Qp/Qs and RV/LV work ratios both significantly correlated with RV/LV wall thallium-201 uptake ratios (r=0.78 and 0.87, respectively; p<0.001 for both) and RV wall/background thallium-201 uptake ratios (r=0.69, p<0.01 for both parameters). Right ventricular systolic pressure also correlated with RV/LV wall thallium-201 uptake ratios (r=0.57, p<0.02). Feasibility of the differentiation between RVPO and RVVO was suggested with use of ''transitional view angle'' and RV/LV diameter ratios obtained from the scintigram. In patients who underwent cardiac surgery, post-operative alleviations of the right ventricular overload were evaluated. There was a significant decrease in RV/LV wall thallium-201 uptake ratios, but no significant decrease in RV wall/background thallium-201 uptake ratios in patients with RVPO. On the other hand, there was a significant decrease both in RV/LV wall thallium-201 uptake ratios and RV wall/background thallium-201 uptake ratios in patients with RVVO. No significant changes were observed between the scintigraphic measurements obtained 1 month and 1 year after the surgery, irrespective of the type of right ventricular overloading. (J.P.N.)

Comparison of stroke work between repaired tetralogy of Fallot and normal right ventricular physiologies.

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Lee, Namheon; Das, Ashish; Banerjee, Rupak K; Gottliebson, William M

2013-01-01

Adult patients who underwent tetralogy of Fallot repair surgery (rTOF) confront life-threatening ailments due to right ventricular (RV) myocardial dysfunction. Pulmonary valve replacement (PVR) needs to be performed to restore the deteriorating RV function. Determination of correct timing to perform PVR in an rTOF patient remains subjective, due to the unavailability of quantifiable clinical diagnostic parameters. The objective of this study is to evaluate the possibility of using RV body surface area (BSA)-indexed stroke work (SW(I)) to quantify RV inefficiency in TOF patients. We hypothesized that RV SW(I) required to push blood to the lungs in rTOF patients is significantly higher than that of normal subjects. Seven patients with rTOF pathophysiology and eight controls with normal RV physiology were registered for this study. Right ventricular volume and pressure were measured using cardiac magnetic resonance imaging and catheterization, respectively. Statistical analysis was performed to quantify the difference in SW(I) between the RV of the rTOF and control groups. Right ventricular SW(I) in rTOF patients (0.176 ± 0.055 J/m(2)) was significantly higher by 93.4% (P = 0.0026) than that of controls (0.091 ± 0.030 J/m(2)). Further, rTOF patients were found to have significantly higher (P < 0.05) BSA normalized RV end-systolic volume, end-systolic pressure, and regurgitation fraction than control subjects. Ejection fraction and peak ejection rate of rTOF patients were significantly lower (P < 0.05) than those of controls. Patients with rTOF pathophysiology had significantly higher RV SW(I) compared with subjects with normal RV physiology. Therefore, RV SW(I) may be useful to quantify RV inefficiency in rTOF patients along with currently used clinical end points such as RV volume, pressure, regurgitation fraction, and ejection fraction.

Does Late Gadolinium Enhancement still have Value? Right Ventricular Internal Mechanical Work, Ea/Emax and Late Gadolinium Enhancement as Prognostic Markers in Patients with Advanced Pulmonary Hypertension via Cardiac MRI.

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Abouelnour, Amr Ei; Doyle, Mark; Thompson, Diane V; Yamrozik, June; Williams, Ronald B; Shah, Moneal B; Soma, Siva Kr; Murali, Srinivas; Benza, Raymond L; Biederman, Robert Ww

2017-01-01

Investigate the impact of Right Ventricular (RV) Internal Work (IW), ratio of arterial to ventricular end-systolic elastance (E a /E max ), and RV Insertion Point (IP) Late Gadolinium Enhancement (LGE) on outcome in Pulmonary Hypertension (PH) patients. LGE is well known to be present within the RVIPs and Inter Ventricular Septum (IVS) in PH patients, but its prognostic role remains complex and potentially overestimated via 2D qualitative relative to the 3D quantitative measures now available. However, E a /E max , a measure of ventricular-arterial coupling and IW, when added to external cardiac work i.e. the P-V loop area as correlates to the heart's energy demands, might fundamentally improve measures of prognosis as they interrogate physiology beyond just the RV. Cardiac Magnetic Resonance Imaging (CMR) of 124 PH patients (age = 60±13, 85F) referred to a large tertiary PH center, was retrospectively examined for RV volumetric and functional indices and RVIP LGE%. Right Heart Catheterizations (RHC) performed within 1±2 months of the CMR were reviewed. E a /E max was derived as RV End-Systolic Volume (ESV/RVSV). IW was estimated as RVESV ×(RV end-systolic pressure-RV diastolic pressure). Patients were followed from date of CMR for up to 5 years for MACE (death, hospitalized RV failure, initiation of parenteral prostacyclin, sustained ventricular arrhythmia or referral for lung transplantation). MACE was high; 48/124 (39%) patients had MACE by 1.6±1.3 years. Neither RVIP nor IVS LGE using visual assessment or even 3D quantization predicted MACE. The strongest predictor of MACE was RVIW (OR=1.00013, pright-sided human myocardial pathologies.

Combination of Glasgow Coma Scale, Age, and Systolic Blood Pressure in Assessing Patients’ Outcomes with Decreased Consciousness

Directory of Open Access Journals (Sweden)

Amir S Madjid

2017-04-01

Full Text Available Glasgow Coma Scale (GCS is commonly used to assess outcomes of patients with loss of consciousness, but it is insufficient in predicting the outcome of some cases. This study aimed to assess the combination of GCS, systolic blood pressure and age to predict the outcome of patients with decreased consciousness. This was a retrospective cohort observational study of 76 loss of consciousness patients that comes into the Emergency Department of Dr. Cipto Mangunkusumo General Hospital in June-August 2014. Data was obtained from the medical records . GCS, systolic blood pressure and age were recorded when patients were admitted to the triage. Outcome was assessed two weeks after admission in the emergency department. Bivariate analysis on the GCS and age showed significant different between patients with poor outcome group with good outcome group (p<0.05 and no significant different of the systolic blood pressure between both groups (p>0.05. Multivariate analysis on the GCS and age showed good probability equation based on the calibration test and discrimination. The combination of Glasgow Coma Scale and age was accurate in assessing the outcomes of patients with loss of consciousness. Keywords. Glasgow Coma Scale, systolic, age, outcomes     Gabungan Glasgow Coma Scale, Umur, dan Tekanan Darah Sistolik Sebagai Penilai Luaran Pasien Penurunan Kesadaran   Abstrak Glasgow Coma Scale (GCS telah menjadi salah satu penilaian yang digunakan untuk menilai luaran pasien penurunan kesadaran, tetapi dinilai masih belum mampu memprediksi luaran yang terjadi. Penelitian ini bertujuan untuk menilai gabungan GCS, tekanan darah sistolik dan umur untuk memprediksi luaran pasien dengan penurunan kesadaran. Penelitian ini merupakan studi observasional kohort retrospektif yang melibatkan 76 pasien dengan penurunan kesadaran yang datang ke IGD RSUPN Dr. Cipto Mangunkusumo selama bulan Juni-Agustus 2014. Data diambil dari rekam medik. GCS, tekanan darah sistolik dan

Right ventricular outflow tract systolic function correlates with exercise capacity in patients with severe right ventricle dilatation after repair of tetralogy of Fallot.

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Luo, Shuhua; Li, Jianhua; Yang, Dan; Zhou, Yaxin; An, Qi; Chen, Yucheng

2017-05-01

The relationship between exercise capacity and right ventricular (RV) components function in repaired tetralogy of Fallot patients with severely dilated right ventricles is poorly understood. The aim of this study was to characterize the exercise capacity and its relationship to RV global and components function in repaired tetralogy of Fallot patients with RV end-diastolic volume index  >150 ml/m 2 , a currently accepted threshold for pulmonary valve replacement. The medical records and results of cardiac magnetic resonance imaging and cardiopulmonary exercise testing of 25 consecutive eligible patients were reviewed. Twenty age- and gender-matched normal subjects were enrolled as cardiac magnetic resonance control. End-diastolic, end-systolic and stroke volumes, and ejection fraction (EF) were determined for the total RV and its components. Of the 25 patients, 44% maintained normal exercise capacity. RV outlet EF was higher ( P  = 0.02) and RV incisions smaller ( P  = 0.04) in patients with normal exercise capacity than those with subnormal exercise capacity. Predicted peak oxygen consumption correlated better with the RV outflow tract EF than with the EF of other components of the RV or the global EF ( r  = 0.59; P  = 0.002). Multivariate analysis showed the RV outflow tract EF to be the only independent predictor of exercise capacity (ß = 0.442; P  = 0.02). Exercise capacity is preserved in some tetralogy of Fallot patients with severe RV dilatation. RV outflow tract EF is independently associated with exercise capacity in such patients, and could be a reliable determinant of intrinsic RV performance. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Traditional systolic blood pressure targets underestimate hypotension-induced secondary brain injury.

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Brenner, Megan; Stein, Deborah M; Hu, Peter F; Aarabi, Bizhan; Sheth, Kevin; Scalea, Thomas M

2012-05-01

Vital signs, particularly blood pressure, are often manipulated to maximize perfusion and optimize recovery from severe traumatic brain injury (sTBI). We investigated the utility of automated continuously recorded vital signs to predict outcomes after sTBI. Sixty patients with head Abbreviated Injury Scale score ≥ 3, age >14 years, "isolated" TBI, and need for intracranial pressure monitoring were prospectively enrolled at a single, large urban tertiary care facility. Outcome was measured by mortality and extended Glasgow Outcome Scale (GOSE) at 12 months. Continuous, automated, digital data were collected every 6 seconds for 72 hours after admission, and 5-minute means of systolic blood pressure (SBP) were recorded. We calculated SBP as pressure × time dose (PTD) to describe the cumulative amplitude and duration of episodes above and below clinical thresholds. The extent and duration of the insults were calculated as percent time (%time), PTD, and PTD per day (PTD/D) of defined thresholds (SBP: 100 bpm and >120 bpm; and SpO(2): GOSE by receiver operator characteristics. Mean age was 33.9 (range, 16-83) years, mean admission Glasgow Coma Scale score 6.4 ± 3, and mean head Abbreviated Injury Scale score 4.2 ± 0.72. The 30-day mortality rate was 13.3%. Of the 45 patients in whom GOSE at 12 months was available, 28 (62%) had good neurologic outcomes (GOSE score >4). Traditional markers of poor outcome (admission SBP, admission Glasgow Coma Scale, and Marshall score) were not different between groups with good or poor outcome. PTD, PTD/D, and %time SBP GOSE (p = 0.02). PTD/D SBP GOSE (p < 0.05). Within the first 48 hours of intensive care unit admission, hypotension was found to be predictive of mortality and functional outcomes at higher thresholds than traditionally defined. Systemic blood pressure targets closer to 120 mm Hg may be more efficacious in minimizing secondary insults and particularly useful in settings without invasive intracranial monitoring

Closure of digital arteries in high vascular tone states as demonstrated by measurement of systolic blood pressure in the fingers

DEFF Research Database (Denmark)

Krähenbühl, B; Nielsen, S L; Lassen, N A

1977-01-01

Finger systolic blood pressure (FSP) was measured indirectly in normal subjects and patients with primary Raynaud phenomenon by applying a thin-walled plastic cuff around the finger and a strain gauge more distally to detect volume changes. Inducing a high vascular tone in one or more fingers by ...

Lack of association between systolic blood pressure and blood viscosity in normotensive healthy subjects.

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Irace, Concetta; Carallo, Claudio; Scavelli, Faustina; Loprete, Antonio; Merante, Valentina; Gnasso, Agostino

2012-01-01

A direct relationship between blood pressure and viscosity has frequently been reported, although clear data are not available. To better understand the relationship between these two variables, we evaluated blood viscosity and blood pressure in a group of healthy subjects without cardiovascular risk factors. Healthy subjects were selected from participants in a campaign of prevention of cardiovascular disease (n = 103). They underwent blood sampling for measurement of plasma and blood viscosity, haematocrit, blood lipids and glucose. The quantity and distribution of body fat was assessed by body mass index and waist/hip ratio, respectively. Systolic blood pressure (SBP) correlated significantly with age (r = 0.222) and waist/hip ratio (r = 0.374). Diastolic blood pressure (DBP) correlated significantly with waist/hip ratio (r = 0.216), haematocrit (r = 0.333) and blood viscosity (r = 0.258). Multiple linear regression analyses demonstrated that the only variable significantly associated with SBP was age, while haematocrit was the only variable significantly associated with DBP. Blood viscosity was closely related to waist/hip ratio. These findings show that SBP, in healthy subjects, is not influenced by haematocrit and blood viscosity. In contrast, DBP is related to the values of haematocrit. Among classical cardiovascular risk factors, waist/hip ratio is closely related to blood viscosity.

The Prognostic Impact of the Evolution of RV Function in Idiopathic DCM.

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Merlo, Marco; Gobbo, Marco; Stolfo, Davide; Losurdo, Pasquale; Ramani, Federica; Barbati, Giulia; Pivetta, Alberto; Di Lenarda, Andrea; Anzini, Marco; Gigli, Marta; Pinamonti, Bruno; Sinagra, Gianfranco

2016-09-01

In this study, the authors analyzed the prognostic role of right ventricular systolic function (RVF) longitudinal trends in a large cohort of patients affected by dilated cardiomyopathy (DCM). RVF is a known prognostic predictor in DCM; however, whether RVF changes over time to better predict the long-term disease progression has not been investigated. From 1993 to 2008, we analyzed 512 patients with DCM (46 years of age [36 to 55 years of age], left ventricular ejection fraction 32% [25% to 41%]) with a potential follow-up of ≥72 months and available data at baseline and at least 1 pre-specified follow-up evaluation (i.e., 6, 24, 48, or 72 months). RV dysfunction was defined as RV fractional area change model, RVF revaluation over time maintained an independent predictive value (hazard ratio: 2.83; 95% CI: 1.57 to 5.11; p = 0.0006). Patients with DCM frequently present RV dysfunction at first evaluation. However, a complete RVF recovery is largely observed early after optimization of medical therapy and predates subsequent left ventricular reverse remodeling. Systematic revaluation of patients including RVF throughout regular follow-up conferred additive long-term prognostic value to the baseline evaluation. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Effect of self-monitoring and medication self-titration on systolic blood pressure in hypertensive patients at high risk of cardiovascular disease: the TASMIN-SR randomized clinical trial.

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McManus, Richard J; Mant, Jonathan; Haque, M Sayeed; Bray, Emma P; Bryan, Stirling; Greenfield, Sheila M; Jones, Miren I; Jowett, Sue; Little, Paul; Penaloza, Cristina; Schwartz, Claire; Shackleford, Helen; Shovelton, Claire; Varghese, Jinu; Williams, Bryan; Hobbs, F D Richard; Gooding, Trevor; Morrey, Ian; Fisher, Crispin; Buckley, David

2014-08-27

Self-monitoring of blood pressure with self-titration of antihypertensives (self-management) results in lower blood pressure in patients with hypertension, but there are no data about patients in high-risk groups. To determine the effect of self-monitoring with self-titration of antihypertensive medication compared with usual care on systolic blood pressure among patients with cardiovascular disease, diabetes, or chronic kidney disease. A primary care, unblinded, randomized clinical trial involving 552 patients who were aged at least 35 years with a history of stroke, coronary heart disease, diabetes, or chronic kidney disease and with baseline blood pressure of at least 130/80 mm Hg being treated at 59 UK primary care practices was conducted between March 2011 and January 2013. Self-monitoring of blood pressure combined with an individualized self-titration algorithm. During the study period, the office visit blood pressure measurement target was 130/80 mm Hg and the home measurement target was 120/75 mm Hg. Control patients received usual care consisting of seeing their health care clinician for routine blood pressure measurement and adjustment of medication if necessary. The primary outcome was the difference in systolic blood pressure between intervention and control groups at the 12-month office visit. Primary outcome data were available from 450 patients (81%). The mean baseline blood pressure was 143.1/80.5 mm Hg in the intervention group and 143.6/79.5 mm Hg in the control group. After 12 months, the mean blood pressure had decreased to 128.2/73.8 mm Hg in the intervention group and to 137.8/76.3 mm Hg in the control group, a difference of 9.2 mm Hg (95% CI, 5.7-12.7) in systolic and 3.4 mm Hg (95% CI, 1.8-5.0) in diastolic blood pressure following correction for baseline blood pressure. Multiple imputation for missing values gave similar results: the mean baseline was 143.5/80.2 mm Hg in the intervention group vs 144.2/79.9 mm Hg in the control group, and

Inter-arm systolic blood pressure differences, relations with future vascular events and mortality in patients with and without manifest vascular disease

NARCIS (Netherlands)

Kranenburg, Guido; Spiering, Wilko; de Jong, Pim A.; Kappelle, L. Jaap; de Borst, Gert Jan; Cramer, Maarten J.; Visseren, Frank L.J.; Aboyans, Victor; Westerink, Jan

2017-01-01

Background Inter-arm systolic blood pressure difference (SBPD) is an easily obtained patient characteristic which relates to vascular disease. We aimed to identify determinants of large inter-arm SBPD and to investigate the relation between inter-arm SBPD and vascular events in patients with and

Recruitment strategies and challenges in a large intervention trial: Systolic Blood Pressure Intervention Trial (SPRINT)

Science.gov (United States)

Ramsey, Thomas M; Snyder, Joni K; Lovato, Laura C; Roumie, Christianne L; Glasser, Steven P; Cosgrove, Nora M; Olney, Christine M; Tang, Rocky H; Johnson, Karen C; Still, Carolyn H; Gren, Lisa H; Childs, Jeffery C; Crago, Osa L; Summerson, John H; Walsh, Sandy M; Perdue, Letitia H; Bankowski, Denise M; Goff, David C

2016-01-01

Background The Systolic Blood Pressure Intervention Trial (SPRINT) is a multicenter, randomized clinical trial of 9,361 participants with hypertension who are ≥ 50 years old. The trial is designed to evaluate the effect of intensive systolic blood pressure control (systolic blood pressure goal recruitment strategies and lessons learned during recruitment of the SPRINT cohort and five targeted participant subgroups: pre-existing cardiovascular disease, pre-existing chronic kidney disease, age ≥ 75 years, women, and minorities. Methods In collaboration with the National Institutes of Health Project Office and SPRINT Coordinating Center, five Clinical Center Networks oversaw clinical site selection, recruitment, and trial activities. Recruitment began November 8, 2010 and ended March 15, 2013 (about 28 months). Various recruitment strategies were used, including mass mailing, brochures, referrals from healthcare providers or friends, posters, newspaper ads, radio ads, and electronic medical record searches. Results Recruitment was scheduled to last 24 months to enroll a target of 9,250 participants; in just over 28 months, the trial enrolled 9,361 participants. The trial screened 14,692 volunteers, with 33% of initial screens originating from the use of mass mailing lists. Screening results show that participants also responded to recruitment efforts through referral by SPRINT staff, healthcare providers, or friends (45%); brochures or posters placed in clinic waiting areas (15%); and television, radio, newspaper, internet ads, or toll-free numbers (8%). The overall recruitment yield (number randomized /number screened) was 64% (9,361 randomized /14,692 screened), 77% for those with cardiovascular disease, 79% for those with chronic kidney disease, 70% for those age ≥ 75 years, 55% for women, and 61% for minorities. As recruitment was observed to lag behind expectations, additional clinics were included and inclusion criteria were broadened, keeping event rates

Long-term impact of systolic blood pressure and glycemia on the development of microalbuminuria in essential hypertension.

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Pascual, Jose Maria; Rodilla, Enrique; Gonzalez, Carmen; Pérez-Hoyos, Santiago; Redon, Josep

2005-06-01

The objective was to assess the temporal impact of factors related to the development of microalbuminuria during the follow-up of young adult normoalbuminurics with high-normal blood pressure or at stage 1 of essential hypertension. Prospective follow-up was conducted on 245 normoalbuminuric hypertensive subjects (mean age 40.9 years; 134 men; blood pressure 139.7/88.6 mm Hg; body mass index 28.5 kg/m2) never treated previously with antihypertensive drugs, with yearly urinary albumin excretion measurements, until the development of microalbuminuria. After enrollment, patients were placed on usual care including nonpharmacological treatment or with an antihypertensive drug regime to achieve a blood pressure of 15 mg per 24-hour systolic blood pressure >139 mm Hg and a positive trend in fasting glucose were observed in the univariate analyses. However, in the multivariate analysis, only the baseline urinary albumin excretion and the trend of fasting glucose were independently related to the risk of developing microalbuminuria. In mild hypertensives, the development of microalbuminuria was linked to insufficient blood pressure control and to a progressive increment of glucose values.

Global Burden of Hypertension and Systolic Blood Pressure of at Least 110 to 115 mm Hg, 1990-2015

DEFF Research Database (Denmark)

Forouzanfar, Mohammad H; Liu, Patrick; Roth, Gregory A

2017-01-01

Importance: Elevated systolic blood (SBP) pressure is a leading global health risk. Quantifying the levels of SBP is important to guide prevention policies and interventions. Objective: To estimate the association between SBP of at least 110 to 115 mm Hg and SBP of 140 mm Hg or higher and the bur......Importance: Elevated systolic blood (SBP) pressure is a leading global health risk. Quantifying the levels of SBP is important to guide prevention policies and interventions. Objective: To estimate the association between SBP of at least 110 to 115 mm Hg and SBP of 140 mm Hg or higher...... and the burden of different causes of death and disability by age and sex for 195 countries and territories, 1990-2015. Design: A comparative risk assessment of health loss related to SBP. Estimated distribution of SBP was based on 844 studies from 154 countries (published 1980-2015) of 8.69 million participants...... in the primary analysis. Main Outcomes and Measures: Mean SBP level, cause-specific deaths, and health burden related to SBP (≥110-115 mm Hg and also ≥140 mm Hg) by age, sex, country, and year. Results: Between 1990-2015, the rate of SBP of at least 110 to 115 mm Hg increased from 73 119 (95% uncertainty...

Increased augmentation index and central systolic arterial pressure are associated with lower school and motor performance in young adolescents.

Science.gov (United States)

Vogrin, Bernarda; Slak Rupnik, Marjan; Mičetić-Turk, Dušanka

2017-12-01

Objective In adults, improper arterial function has been linked to cognitive impairment. The pulse wave velocity (PWV), augmentation index (AIx) and other vascular parameters are useful indicators of arterial health. In our study, we monitored arterial properties, body constitution, school success, and motor skills in young adolescents. We hypothesize that reduced cognitive and motor abilities have a vascular origin in children. Methods We analysed 81 healthy school children aged 11-16 years. Anthropometry central systolic arterial pressure, body mass index (BMI), standard deviation scores (SDS) BMI, general school performance grade, and eight motor tests were assessed. PWV, AIx, and central systolic arterial pressure (SBPao) were measured. Results AIx and SBPao correlated negatively with school performance grades. Extremely high AIx, PWV and SBPao values were observed in 5% of children and these children had average to low school performance. PWV correlated significantly with weight, height, and waist and hip circumference. AIx, PWV, school success, and BMI correlated strongly with certain motor functions. Conclusions Increased AIx and SBPao are associated with lower school and motor performance in children. PWV is influenced by the body's constitution.

Right ventricular longitudinal strain and right ventricular stroke work index in patients with severe heart failure: left ventricular assist device suitability for transplant candidates.

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Cameli, M; Bernazzali, S; Lisi, M; Tsioulpas, C; Croccia, M G; Lisi, G; Maccherini, M; Mondillo, S

2012-09-01

Right ventricular (RV) systolic function has a critical role in determining the clinical outcome and the success of using left ventricular assist devices in patients with refractory heart failure. RV deformation analysis by speckle tracking echocardiography (STE) has recently allowed the analysis of RV longitudinal function. Using cardiac catheterization as the reference standard, this study aimed to explore the correlation between RV longitudinal function by STE and RV stroke work index (RVSWI) among patients referred for cardiac transplantation. Right heart catheterization and transthoracic echo-Doppler were simultaneously performed in 47 patients referred for cardiac transplant assessment due to refractory heart failure (ejection fraction 25.1 ± 4.5%). Thermodilution RV stroke volume and invasive pulmonary pressures were used to obtain RVSWI. RV longitudinal strain (RVLS) by STE was assessed averaging RV free-wall segments (free-wall RVLS). We also calculated. Tricuspid S' and tricuspid annular plane systolic excursion (TAPSE). No significant correlation was observed for TAPSE on tricuspid S' with RV stroke volume (r = 0.14 and r = 0.06, respectively). A close negative correlation between free-wall RVLS and RVSWI was found (r = -0.82; P rights reserved.

Cardiac systolic function in cirrhotic patients’ candidate of liver trans-plantation compared with control group

Directory of Open Access Journals (Sweden)

Roya Sattarzadeh-Badkoubeh

2017-02-01

Full Text Available Background: We assessed different systolic cardiac indices to describe left and right ventricular dysfunction in cirrhotic patients before liver transplantation. Methods: In this case-control study, eighty-one consecutive individuals with the confirmed hepatic cirrhosis and candidate for liver transplantation in the Imam Khomeini Hospital between March 2008 and March 2010 were selected. Thirty-two age and gender cross-matched healthy volunteers were also selected as the control group. A detailed two-dimensional and Doppler echocardiography was obtained in all patients and controls performed by the same operator on the day of admission. Results: Dimensions of both left and right atriums as well as left ventricular end-diastolic volume and basal right ventricular dimension in the cirrhotic group were significantly higher than control group. Left ventricular end-systolic dimensions as well as aortic annulus diameter were not different between the two study groups. Left ventricular outflow tract velocity time integral, isovolumic pre-ejection time, isovolumic relaxation time, stroke volume, left ventricular ejection fraction, IVCT+IVRT+ET, systolic velocity of tricuspid annulus, systolic velocity of basal segment of RV free wall, systolic velocity of basal segment of septal wall, peak strain of septal margin (base, peak strain of septal margin (midpoint, peak strain of lateral margin (midpoint, strain rate of septal margin (base, strain rate of septal margin (midpoint, strain rate of lateral margin (base, strain rate of lateral margin (midpoint, Tei index (left and right ventricles, systolic time interval and tricuspid annular plane systolic excursion were higher in cirrhotic group, significantly, (P< 0.05. Left ventricular ejection time and systolic velocity of mid segment of lateral wall were lower in cirrhotic group, significantly, (P< 0.05. Conclusion: In this study, the effects of liver on heart were volume overload, hyperdynamic state and

Association of Interarm Systolic Blood Pressure Difference with Atherosclerosis and Left Ventricular Hypertrophy

Science.gov (United States)

Su, Ho-Ming; Lin, Tsung-Hsien; Hsu, Po-Chao; Chu, Chun-Yuan; Lee, Wen-Hsien; Chen, Szu-Chia; Lee, Chee-Siong; Voon, Wen-Chol; Lai, Wen-Ter; Sheu, Sheng-Hsiung

2012-01-01

An interarm systolic blood pressure (SBP) difference of 10 mmHg or more have been associated with peripheral artery disease and adverse cardiovascular outcomes. We investigated whether an association exists between this difference and ankle-brachial index (ABI), brachial-ankle pulse wave velocity (baPWV), and echocardiographic parameters. A total of 1120 patients were included in the study. The bilateral arm blood pressures were measured simultaneously by an ABI-form device. The values of ABI and baPWV were also obtained from the same device. Clinical data, ABIdifference ≥10 mmHg were compared and analyzed. We performed two multivariate forward analyses for determining the factors associated with an interarm SBP difference ≥10 mmHg [model 1: significant variables in univariate analysis except left ventricular mass index (LVMI); model 2: significant variables in univariate analysis except ABIdifference ≥10 mmHg. Female, hypertension, and high body mass index were also associated with an interarm SBP difference ≥10 mmHg. Our study demonstrated that ABIdifference of 10 mmHg or more. Detection of an interarm SBP difference may provide a simple method of detecting patients at increased risk of atherosclerosis and left ventricular hypertrophy. PMID:22927905

24-hour central aortic systolic pressure and 24-hour central pulse pressure are related to diabetic complications in type 1 diabetes - a cross-sectional study

DEFF Research Database (Denmark)

Theilade, Simone; Lajer, Maria Stenkil; Hansen, Tine Willum

2013-01-01

BACKGROUND: Non-invasive measurements of 24 hour ambulatory central aortic systolic pressure (24 h-CASP) and central pulse pressure (24 h-CPP) are now feasible. We evaluate the relationship between 24 h central blood pressure and diabetes-related complications in patients with type 1 diabetes.......68) and 3.72 (1.85-7.47) and autonomic dysfunction: 3.25 (1.65-6.41), 1.64 (1.12-2.39) and 2.89 (1.54-5.42). CONCLUSIONS: 24 h-CASP and 24 h-CPP was higher in patients vs. controls and increased with diabetic complications independently of covariates. Furthermore, 24 h-CASP was stronger associated....... METHODS: The study was cross-sectional, including 715 subjects: 86 controls (C), 69 patients with short diabetes duration (diabetes (≥ 10 years) and normoalbuminuria (LN), 163...

Assessment of regional systolic and diastolic myocardial function using tissue Doppler and strain imaging in dogs with dilated cardiomyopathy.

Science.gov (United States)

Chetboul, Valérie; Gouni, Vassiliki; Sampedrano, Carolina Carlos; Tissier, Renaud; Serres, François; Pouchelon, Jean-Louis

2007-01-01

Tissue Doppler Imaging (TDI) or strain (St) imaging could provide sensitive indices for early detection and treatment follow-up of canine dilated cardiomyopathy (DCM). Analysis of TDI and St features in dogs with overt DCM is a prerequisite before using these new criteria in prospective screenings of predisposed families or in clinical trials. Radial and longitudinal right and left myocardial motion, assessed by TDI and St variables, is altered in dogs with DCM. Case records for 26 dogs; 14 with DCM and 12 healthy controls of comparable age and weight were reviewed. A retrospective analysis was conducted of conventional echocardiography, 2-dimensional color TDI, and St imaging data. The DCM group was characterized by decreases in radial and longitudinal systolic velocity gradients of the left ventricular free wall (LVFW), radial and longitudinal absolute values of peak systolic St of the LVFW, and longitudinal systolic right ventricular (RV) velocities (all P canine DCM.

Euglycemic clamp insulin sensitivity and longitudinal systolic blood pressure

DEFF Research Database (Denmark)

Petrie, John R; Malik, Muhammad Omar; Balkau, Beverley

2013-01-01

and Cardiovascular disease (RISC) study, we measured insulin sensitivity (M/I) using the euglycemic clamp technique in 1073 healthy European adults (587 women, 486 men) aged 30 to 60 years followed up 3 years later. Systolic BP (SBP) at baseline was higher in insulin-resistant women (ie, those in the low sex...

Cardiovascular effects of right ventricle-pulmonary artery valved conduit implantation in experimental pulmonic stenosis

International Nuclear Information System (INIS)

Saida, Y.; Tanaka, R.; Fukushima, R.; Hoshi, K.; Hira, S.; Soda, A.; Iizuka, T.; Ishikawa, T.; Nishimura, T.; Yamane, Y.

2009-01-01

Right ventricle (RV)-pulmonary artery (PA) valved conduit (RPVC) implantation decreases RV systolic pressure in pulmonic stenosis (PS) by forming a bypass route between the RV and the PA. The present study evaluates valved conduits derived from canine aortae in a canine model of PS produced by pulmonary artery banding (PAB). Pulmonary stenosis was elicited using PAB in 10 conditioned beagles aged 8 months. Twelve weeks after PAB, the dogs were assigned to one group that did not undergo surgical intervention and another that underwent RPVC using denacol-treated canine aortic valved grafts (PAB+RPVC). Twelve weeks later, the rate of change in the RV-PA systolic pressure gradient was significantly decreased in the PAB+RPVC, compared with the PAB group (60.5+-16.7% vs. 108.9+-22.9%; p0.01). In addition, the end-diastolic RV free wall thickness (RVFWd) was significantly reduced in the PAB+RPVC, compared with the PAB group (8.2+-0.2 vs. 9.4+-0.7 mm; p0.05). Thereafter, regurgitation was not evident beyond the conduit valve and the decrease in RV pressure overload induced by RPVC was confirmed. The present results indicate that RPVC can be performed under a beating heart without cardiopulmonary bypass and adapted to dogs with various types of PS, including 'supra valvular' PS or PS accompanied by dysplasia of the pulmonary valve. Therefore, we consider that this method is useful for treating PS in small animals

Cytoskeletal role in the transition from compensated to decompensated hypertrophy during adult canine left ventricular pressure overloading

Science.gov (United States)

Tagawa, H.; Koide, M.; Sato, H.; Zile, M. R.; Carabello, B. A.; Cooper, G. 4th

1998-01-01

Increased microtubule density causes cardiocyte contractile dysfunction in right ventricular (RV) pressure-overload hypertrophy, and these linked phenotypic and contractile abnormalities persist and progress during the transition to failure. Although more severe in cells from failing than hypertrophied RVs, the mechanical defects are normalized in each case by microtubule depolymerization. To define the role of increased microtubule density in left ventricular (LV) pressure-overload hypertrophy and failure, in a given LV we examined ventricular mechanics, sarcomere mechanics, and free tubulin and microtubule levels in control dogs and in dogs with aortic stenosis both with LV hypertrophy alone and with initially compensated hypertrophy that had progressed to LV muscle failure. In comparing initial values with those at study 8 weeks later, dogs with hypertrophy alone had a very substantial increase in LV mass but preservation of a normal ejection fraction and mean systolic wall stress. Dogs with hypertrophy and associated failure had a substantial but lesser increase in LV mass and a reduction in ejection fraction, as well as a marked increase in mean systolic wall stress. Cardiocyte contractile function was equivalent, and unaffected by microtubule depolymerization, in cells from control LVs and those with compensated hypertrophy. In contrast, cardiocyte contractile function in cells from failing LVs was quite depressed but was normalized by microtubule depolymerization. Microtubules were increased only in failing LVs. These contractile and cytoskeletal changes, when assayed longitudinally in a given dog by biopsy, appeared in failing ventricles only when wall stress began to increase and function began to decrease. Thus, the microtubule-based cardiocyte contractile dysfunction characteristic of pressure-hypertrophied myocardium, originally described in the RV, obtains equally in the LV but is shown here to have a specific association with increased wall stress.

Molecular analysis of Rv0679c and Rv0180c genes of Mycobacterium tuberculosis from clinical isolates of pulmonary tuberculosis

Directory of Open Access Journals (Sweden)

L Rupa

2016-01-01

Full Text Available Context: Two novel proteins/genes Rv0679c and Rv0180c of Mycobacterium tuberculosis (MTB H37Rv were classified as a hypothetical membrane and transmembrane proteins which might have a role in the invasion. Molecular analysis of these genes in human clinical isolates of pulmonary tuberculosis (PTB patients was not well characterised. Aims: To assess the molecular diversity of Rv0679c and Rv0180c genes of MTB from clinical isolates of PTB patients. Settings and Design: DNA from 97 clinical isolates was extracted and subjected to amplification using selective primers by polymerase chain reaction (PCR. The PCR product obtained was sequenced commercially. Patients and Methods: Clinical isolates obtained from tuberculosis patients were investigated for polymorphisms in the Rv0679c and Rv0180c genes by PCR and DNA sequencing. Genomic DNA isolated by cetyltrimethylammonium bromide method was used for amplification of genes. Results: Rv0679c gene was highly conserved in 61 out of 65 clinical isolates assessed for sequence homology with wild-type H37Rv gene and was identical using ClustalW. Fifty-five out of 78 (70.5% clinical isolates assessed for Rv0180c were positive for single nucleotide polymorphism (SNP at 258th position where the nucleotide G was replaced with T (G to T. In clinical isolates of untreated cases, the frequency was 54.5% for SNP at 258th position which is low compared to cases undergoing treatment where the frequency was 73.1%. Conclusions: Molecular analysis of Rv0180c in clinical isolates of PTB assessed in this study was the first report, where an SNP at 258th position G to T was identified within the gene. Rv0679c gene was highly conserved (94%, within Indian clinical isolates as compared to reports from other nations.

Systolic Sac Pressure Index for the Prediction of Persistent Type II Endoleak for 12 Months After Endovascular Abdominal Aortic Aneurysm Repair

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Ikoma, Akira, E-mail: yfb04322@nifty.com; Nakai, Motoki, E-mail: momonga@wakayama-med.ac.jp; Sato, Morio, E-mail: morisato@wakayama-med.ac.jp; Sato, Hirotatsu, E-mail: kuppa1220@yahoo.co.jp; Minamiguchi, Hiroki, E-mail: hiromina4@hotmail.com; Sonomura, Tetsuo, E-mail: sonomura@wakayama-med.ac.jp [Wakayama Medical University, Departments of Radiology (Japan); Nishimura, Yoshiharu, E-mail: nishim-y@wakayama-med.ac.jp; Okamura, Yoshitaka, E-mail: y-ok@wakayama-med.ac.jp [Wakayama Medical University, Thoracic and Cardiovascular Surgery (Japan)

2016-04-15

PurposeTo assess the relationship between the systolic sac pressure index (SPI) and the presence of endoleaks 12 months after endovascular abdominal aortic aneurysm repair (EVAR).Materials and MethodsWe performed a single-center prospective trial of consecutively treated patients. SPI (calculated as systolic sac pressure/systolic aortic pressure) was measured by catheterization immediately after EVAR. Contrast-enhanced computed tomography was scheduled 12 months after EVAR to detect possible endoleaks.ResultsData were available for 34 patients who underwent EVAR for an AAA. Persisting type II endoleak was found in 8 patients (endoleak-positive group) but not in the other 26 patients (endoleak-negative group). The mean ± standard deviation SPI was significantly greater in the endoleak-positive group than in the endoleak-negative group (0.692 ± 0.048 vs. 0.505 ± 0.081, respectively; P = .001). Receiver-operating characteristic curve analysis revealed that an SPI of 0.638 was the optimum cutoff value for predicting a persistent endoleak at 12 months with high accuracy (0.971; 33/34), sensitivity (1.00), and specificity (0.962) values. The mean change in AAA diameter was −4.28 ± 5.03 mm and 2.22 ± 4.54 mm in patients with SPI of <0.638 or ≥0.638, respectively (P = .002).ConclusionPatients with an SPI of ≥0.638 immediately after EVAR were more likely to have a persistent type II endoleak at 12 months with an accuracy of 0.971, and showed increases in aneurysm sac diameter compared with patients with an SPI of <0.638.

Non-invasive aortic systolic pressure and pulse wave velocity estimation in a primary care setting: An in silico study.

Science.gov (United States)

Guala, Andrea; Camporeale, Carlo; Ridolfi, Luca; Mesin, Luca

2017-04-01

Everyday clinical cardiovascular evaluation is still largely based on brachial systolic and diastolic pressures. However, several clinical studies have demonstrated the higher diagnostic capacities of the aortic pressure, as well as the need to assess the aortic mechanical properties (e.g., by measuring the aortic pulse wave velocity). In order to fill this gap, we propose to exploit a set of easy-to-obtain physical characteristics to estimate the aortic pressure and pulse wave velocity. To this aim, a large population of virtual subjects is created by a validated mathematical model of the cardiovascular system. Quadratic regressive models are then fitted and statistically selected in order to obtain reliable estimations of the aortic pressure and pulse wave velocity starting from the knowledge of the subject age, height, weight, brachial pressure, photoplethysmographic measures and either electrocardiogram or phonocardiogram. The results are very encouraging and foster clinical studies aiming to apply a similar technique to a real population. Copyright © 2017 IPEM. Published by Elsevier Ltd. All rights reserved.

Predictors of high central blood pressure in young with isolated systolic hypertension

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Radchenko GD

2016-08-01

Full Text Available G D Radchenko, O O Torbas, Yu M Sirenko State Institute National Scientific Center, M.D. Strazhesko Institute of Cardiology, National Academy of Medical Science, Kyiv, Ukraine Objective: According to the European Society of Cardiology/European Society of Hypertension 2013 guidelines, evaluation of aortic blood pressure (BP is needed in young with isolated systolic hypertension (ISH, but using special devices is not common, especially in Ukraine, where only a few centers have these devices. The purpose of our study was to identify the simple clinical predictors for differentiation (with or without elevated aortic systolic BP [SBP] of the young with ISH without the need for further extensive work-up. Patients and methods: The study included 44 young men (mean age: 32.2±1.3 years with office SBP ≥140 mmHg and office diastolic BP (DBP <90 mmHg (average: 153.4±2.1 mmHg and 83.4±1.7 mmHg, respectively. The following procedures were performed in all the subjects: body weight and height evaluation; measurement of office SBP, DBP, and heart rate; ambulatory BP monitoring; measurement of pulse wave velocity in arteries of elastic and muscle types and central SBP (cSBP; biochemical blood tests; electrocardiography; echocardiography; and carotid ultrasound investigations. Step-by-step multifactor regression analyses were used for finding the predictors of high cSBP. Results: Depending on the cSBP level, all the patients were divided into two groups: first group (n=17, subjects with normal cSBP, and second group (n=27, subjects with elevated cSBP. Patients in the second group were significantly older, with less height and higher body mass index; they had significantly higher levels of office SBP and DBP. Characteristics of target organ damage were within normal limits in both groups and did not differ significantly. Only pulse wave velocity in arteries of elastic type was significantly higher in the second group. The independent predictors of

EMTP-RV at a glance

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Mahseredjian, J.; Dennetiere, S. [IREQ Headquarters, PQ (Canada); Saad, O.; Khodabakhchian, B. [TransEnergie Technologies, PQ (Canada)

2004-10-01

A new restructured version of an electromagnetic transient program, EMTP-RV, which is a combination of the well-known EMTP and a powerful graphical interface EMTPWorks, is described. EMTP-RV provides a higher level of capabilities in the simulation of large scale electrical networks, making it possible to rapidly design, simulate and view large and complex systems, without the usual large expenditure of engineering and development time, and at the same time allowing more detailed studies on the complex phenomena of power system transients. EMTP-RV has a completely new control system solver, an optional Newton method for finding the simultaneous solution of all control system blocks, and a complex matrix-based steady-state solution, used primarily in automatic initialization of state-variables. The article also describes the highly efficient, intuitive and user-friendly graphical user interface EMTPWorks, which has an open architecture for maximized user configurability from basic user-defined model assemblies to more advanced script-based programming. The EMTP-RV package also includes an efficient data acquisition and processing software, named ScopeView and another visualization function called MPLOT. ScopeView offers multi-page and multi-column capabilities, an advanced built-in function editor, and is especially well adapted for the simultaneous viewing and mathematical post-processing of EMTP-RV. MPLOT, a compiled version of a set of m-files, is well suited for waveform viewing and statistical analysis. A one-week seminar and computer workshop on different aspects of transient system studies and analysis with EMTP-RV is provided twice a year by TransEnergie Technologies. 1 fig.

Echocardiographic estimation of right ventricular stroke work in children with pulmonary arterial hypertension: comparison with invasive measurements.

Science.gov (United States)

Di Maria, Michael V; Burkett, Dale A; Younoszai, Adel K; Landeck, Bruce F; Mertens, Luc; Ivy, D Dunbar; Friedberg, Mark K; Hunter, Kendall S

2015-11-01

Right ventricular (RV) failure is a key determinant of mortality in children with pulmonary arterial hypertension (PAH). RV stroke work (RVSW) can be estimated as the product of RV systolic pressure and stroke volume. The authors have shown that RVSW predicts adverse outcomes in this population when derived from hemodynamic data; noninvasive assessment of RVSW may be advantageous but has not been assessed. There are few data validating noninvasive versus invasive measurements in children with PAH. The aim of this study was to compare echocardiographically derived RVSW with RVSW determined from hemodynamic data. This was a retrospective study, including subjects with idiopathic PAH and minor or repaired congenital heart disease. Forty-nine subjects were included, in whom cardiac catheterization and echocardiography were performed within 1 month. Fourteen additional patients were included in a separate cohort, in whom catheterization and echocardiography were performed simultaneously. Catheterization-derived RVSW was calculated as RV systolic pressure × (cardiac output/heart rate). Echocardiographically derived RVSW was calculated as 4 × (peak tricuspid regurgitant jet velocity)(2) × (pulmonary valve area × velocity-time integral). Statistics included the intraclass correlation coefficient and Bland-Altman analysis. Echocardiographically derived RVSW was linearly correlated with invasively derived RVSW (r = 0.74, P work was related to indexed pulmonary vascular resistance (r = 0.43, P = .002), tricuspid annular plane systolic excursion (r = 0.41, P = .004), and RV wall thickness (r = 0.62, P work, a potential novel index of RV function, can be estimated noninvasively and is related to pulmonary hemodynamics and other indices of RV performance. Copyright © 2015 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

Heart Rate and Systolic Blood Pressure Variability on Recently Diagnosed Diabetics

Directory of Open Access Journals (Sweden)

Anaclara Michel-Chávez

2015-01-01

Full Text Available Background: Diabetes affects approximately 250 million people in the world. Cardiovascular autonomic neuropathy is a common complication of diabetes that leads to severe postural hypotension, exercise intolerance, and increased incidence of silent myocardial infarction. Objective: To determine the variability of heart rate (HR and systolic blood pressure (SBP in recently diagnosed diabetic patients. Methods: The study included 30 patients with a diagnosis of type 2 diabetes of less than 2 years and 30 healthy controls. We used a Finapres® device to measure during five minutes beat-to-beat HR and blood pressure in three experimental conditions: supine position, standing position, and rhythmic breathing at 0.1 Hz. The results were analyzed in the time and frequency domains. Results: In the HR analysis, statistically significant differences were found in the time domain, specifically on short-term values such as standard deviation of NN intervals (SDNN, root mean square of successive differences (RMSSD, and number of pairs of successive NNs that differ by more than 50 ms (pNN50. In the BP analysis, there were no significant differences, but there was a sympathetic dominance in all three conditions. The baroreflex sensitivity (BRS decreased in patients with early diabetes compared with healthy subjects during the standing maneuver. Conclusions: There is a decrease in HR variability in patients with early type 2 diabetes. No changes were observed in the BP analysis in the supine position, but there were changes in BRS with the standing maneuver, probably due to sympathetic hyperactivity.

Kohtujurist Ivo Raudjärv peab etteheiteid maksuametile põhjendatuiks / Ivo Raudjärv ; interv. Edith Kiilmaa

Index Scriptorium Estoniae

Raudjärv, Ivo, 1976-

2003-01-01

Maksumaksja intervjuu juristibüroo Raudjärv & Ko UÜ juhataja Ivo Raudjärvega. Kommentaarid: Lasse Lehis (TÜ finantsõiguse dotsent, Riigikohtu halduskolleegiumi nõunik) "Ivo Raudjärv - asendamatu asjatundja", Aivar Pau (Maksuameti pressiesindaja) "Maksuameti statistika põhineb jõustunud kohtulahenditel", Jüri Allikalt (Jüri Allikaltþi õigusbüroo jurist-maksukonsultant) "Analüütiline Ivo Raudjärv". Lisatud Ivo Raudjärve CV

Right Ventricular Volumes and Systolic Function by Cardiac Magnetic Resonance and the Impact of Sex, Age, and Obesity in a Longitudinally Followed Cohort Free of Pulmonary and Cardiovascular Disease: The Framingham Heart Study.

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Foppa, Murilo; Arora, Garima; Gona, Philimon; Ashrafi, Arman; Salton, Carol J; Yeon, Susan B; Blease, Susan J; Levy, Daniel; O'Donnell, Christopher J; Manning, Warren J; Chuang, Michael L

2016-03-01

Cardiac magnetic resonance is uniquely well suited for noninvasive imaging of the right ventricle. We sought to define normal cardiac magnetic resonance reference values and to identify the main determinants of right ventricular (RV) volumes and systolic function using a modern imaging sequence in a community-dwelling, longitudinally followed cohort free of clinical cardiovascular and pulmonary disease. The Framingham Heart Study Offspring cohort has been followed since 1971. We scanned 1794 Offspring cohort members using steady-state free precession cardiac magnetic resonance and identified a reference group of 1336 adults (64±9 years, 576 men) free of prevalent cardiovascular and pulmonary disease. RV trabeculations and papillary muscles were considered cavity volume. Men had greater RV volumes and cardiac output before and after indexation to body size (all Pheart rate account for most of the variability in RV volumes and function in this community-dwelling population. We report sex-specific normative values for RV measurements among principally middle-aged and older adults. RV ejection fraction is greater in women. RV volumes increase with body size, are greater in men, and are smaller in older people. Body surface area seems to be appropriate for indexation of cardiac magnetic resonance-derived RV volumes. © 2016 American Heart Association, Inc.

Observation of the pulse oximeter trace to estimate systolic blood ...

African Journals Online (AJOL)

Background: The estimation of systolic blood pressure by disappearance and reappearance of the pulse oximeter trace during cuff inflation and deflation was compared with non-invasive blood pressure (NIBP) measurement, across the range of body mass index (BMI), during spinal anaesthesia for Caesarean section.

The Relationship Between the Metabolic Syndrome and Systolic Inter-Arm Systolic Blood Pressure Difference in Korean Adults.

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Yoon, Hyun; Choi, Seong Woo; Park, Jong; Ryu, So Yeon; Han, Mi Ah; Kim, Gwang Seok; Kim, Sung Gil; Oh, Hye Jong; Choi, Cheol Won

2015-10-01

The present study was conducted to assess the relationship between metabolic syndrome and systolic inter-arm blood pressure difference (sIAD) in Korean adults. This study included 410 adults (235 males, 175 females) who were over 30 years old and had undergone a health check from July to December in 2013. The incidence of high sIAD and metabolic syndrome were 23.4% and 23.2%, respectively. Key study results were as follows: First, the sIAD levels increased significantly with an increase in metabolic syndrome score (p<0.001), shown by sIAD levels after adjusted the variables that affect sIAD levels (age, gender, smoking, drinking, exercising, total cholesterol, and body mass index). These were 4.6±0.7 mmHg for metabolic syndrome score (MSS) 0; 5.8±0.5 mmHg for MSS 1; 6.2±0.6 mmHg for MSS 2, 9.2±0.8 mmHg for MSS 3; and 9.9±1.2 mmHg for MSS ≥4 (p<0.001). Second, the sIAD level of the metabolic syndrome group (9.3±0.7 mmHg) was significantly higher (p<0.001) than for the nonmetabolic syndrome group (5.7±0.3 mmHg). In conclusion, metabolic syndrome and an increased number of its components are associated with the sIAD levels in Korean adults.

A man with multiple cardiac masses.

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Indrabhinduwat, Manasawee; Arciniegas Calle, Maria C; Colgan, Joseph P; Villarraga, Benoy N

2018-06-12

A 37-year-old male presented with cough, dyspnea, significant weight loss (45 pounds) and subacute fever for the past two months. Physical examination revealed inspiratory and expiratory wheezing bilaterally. A normal S1, S2 and a 3/6 systolic ejection murmur at the left upper parasternal border with respiratory variation were found during cardiac auscultation. Kidney and bone marrow biopsy reported a high grade B cell lymphoma. Echocardiography and cardiac CT findings consisted of multiple intracardiac masses affecting the right ventricular (RV) outflow track, RV apex, medial portion of the right atrium and posterior left atrium, as well as mild impairment of the RV systolic function. The masses in the RV outflow track caused partial obstruction (Pulmonary Valve peak velocity 2.3 m/s) with a RV systolic pressure of 43 mmHg. The infiltrative mass in the interatrial septum extended into both the right and left atrial cavities. The right superior pulmonary vein was occluded. This patient was treated with aggressive chemotherapy and had a good clinical response that resulted in mass size reduction after the first course of chemotherapy. Multimodality imaging techniques such as echocardiography, cardiac CT and PET scan can provide complementary information to better evaluate, stage and manage these patients. © 2018 The authors.

Interarm systolic blood pressure difference is associated with myocardial injury after noncardiac surgery.

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Belen, Erdal; Ozal, Ender; Bayyigit, Akif; Gunaydın, Senay; Helvacı, Aysen

Myocardial injury after non-cardiac surgery (MINS) is closely related to increased cardiovascular mortality. To evaluate the relationship between MINS and interarm systolic blood pressure difference (IASBPD), which has previously been shown to correlate with the frequency of cardiovascular events and arterial arteriosclerotic processes. This observational, single-centre cohort study included 240 consecutive noncardiac surgery patients aged ≥ 45 years. Simultaneous blood pressure recordings were taken preoperatively and IASBPD was calculated. Patients' electrocardiography recordings and high sensitivity cardiac troponin T (hscTnT) levels were obtained for a period of three days postoperatively. Postoperatively, 27 (11.3%) patients were found to have MINS when hscTnT ≥ 14 ng/L was taken as a cut-off value. IASBPD > 10 mm Hg was found in 44 (18.3%) patients. When IASBPD was accepted to be a continuous variable, there was a higher IASBPD value in the MINS group (9.4 ± 5.0 vs. 4.5 ± 3.8, p 10 mm Hg and those not, exaggerate IASBPD was found to be more frequent in patients developing MINS (16 [59.3%] vs. 28 [13.1%], respectively, p 10 mm Hg to be independently associated with the development of MINS (OR: 30.82; CI: 9.14-103.98; p AUC = 0.79; 95% CI 0.71-0.87). Increased IASBPD is closely related to development of MINS. The preoperative measurement of blood pressure from both arms may be an important and easy to use clinical tool in determining cardiovascular risk.

Interarm differences in systolic blood pressure and mortality among US army veterans

DEFF Research Database (Denmark)

White, James; Mortensen, Laust Hvas; Kivimäki, Mika

2014-01-01

BACKGROUND: Differences between the arms in systolic blood pressure (SBP) of ≥10 mmHg have been associated with an increased risk of mortality in patients with hypertensive and chronic renal disease. For the first time, we examined these relationships in a non-clinical population. DESIGN: Cohort...... an interarm difference of ≥10 and 2.4% of ≥15 mmHg. A 15-year follow-up period gave rise to 246 deaths (64 from cardiovascular disease, CVD). Interarm differences of ≥10 mmHg were associated with an elevated risk of all-cause mortality (hazard ratio, HR, 1.49, 95% confidence interval, CI, 1.04-2.14) and CVD...... mortality (HR 1.93, 95% CI 1.01-3.69). After adjusting for SBP, DBP, lipids, fasting glucose, and erythrocyte sedimentation rate, associations between interarm differences of ≥10 mmHg and all-cause mortality (HR 1.35, 95% CI 0.94-1.95) and CVD mortality (1.62, 95% CI 0.84-3.14) were significantly attenuated...

Role of electrocardiographic changes in discriminating acute or chronic right ventricular pressure overload.

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Can, Mehmet Mustafa; Özveren, Olcay; Biteker, Murat; Şengül, Cihan; Uz, Ömer; Işılak, Zafer; Kırılmaz, Ata

2013-06-01

Pulmonary embolism (PE) and severe pulmonary stenosis (PS) are two distinct conditions accompanied by increased pressure load of the right ventricle (RV). Despite major advances in our understanding of the mechanisms of RV adaptation to the increased pressure, substantial gaps in our knowledge remain unsettled. One of much less known aspect of pressure overload of RV is its impact on electrocardiographic (ECG) changes. In this study, we aimed to study whether acute and chronic RV overload are accompanied by different ECG patterns. Thirty-eight patients with PE underwent ECG monitoring were compared with 20 matched patients with PS in this observational retrospective study. ECG abnormalities suggestive of RV overload were recorded and analyzed in both groups. Logistic regression analysis was used to define the predictors of chronic RV overload. Among the ECG changes studied, premature atrial contraction (OR-12.2, 95% CI, 1.3-107, p=0.008), right axis deviation (OR-20.4, 95% CI 4.2-98, poverload. Our data indicate that the ECG changes that attributed to the acute RV pressure loading states may be more prevalent in chronic RV overload as compared with acute RV overload.

Tricuspid annular plane systolic excursion in the assessment of right ventricular function in children and adolescents after repair of tetralogy of Fallot.

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Mercer-Rosa, Laura; Parnell, Aimee; Forfia, Paul R; Yang, Wei; Goldmuntz, Elizabeth; Kawut, Steven M

2013-11-01

Assessing right ventricular (RV) performance is essential for patients with tetralogy of Fallot (TOF). The aim of this study was to investigate the reliability and validity of tricuspid annular plane systolic excursion (TAPSE) against cardiac magnetic resonance imaging measures and cardiopulmonary exercise testing. A retrospective study was performed in 125 outpatients with repaired TOF with available protocol-driven echocardiography, cardiac magnetic resonance imaging, and exercise stress testing obtained as part of a cross-sectional study. TAPSE was measured on the two-dimensional apical four-chamber view on echocardiography by two readers. Multivariate linear regression was used to examine the association between TAPSE and measures of RV function and exercise capacity. The mean age was 12.6 ± 3.3 years, 41 patients (33%) were female, and 104 (83%) were white. TAPSE averaged 1.6 ± 0.37 cm, with an interreader intraclass correlation coefficient of 0.78 (n = 18). TAPSE was significantly associated with cardiac magnetic resonance-based RV stroke volume after adjustment for gender and body surface area (β = 13.8; 95% confidence interval, 2.25-25.30; P = .02). TAPSE was not associated with cardiac magnetic resonance-based RV ejection fraction (P = .77). On exercise testing, TAPSE was not associated with peak oxygen consumption, percentage of predicted oxygen consumption, oxygen pulse, or the ventilatory equivalent for carbon dioxide in patients with maximal exercise stress testing (n = 73 [58%]). TAPSE is reproducibly measured by echocardiography in patients with TOF. It is not associated with RV ejection fraction or exercise performance, and its association with RV stroke volume may be confounded by body size. On the basis of these results, TAPSE is not representative of global RV performance in patients with TOF. Copyright © 2013 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.

Effects of Sacubitril/Valsartan Versus Olmesartan on Central Hemodynamics in the Elderly With Systolic Hypertension: The PARAMETER Study.

Science.gov (United States)

Williams, Bryan; Cockcroft, John R; Kario, Kazuomi; Zappe, Dion H; Brunel, Patrick C; Wang, Qian; Guo, Weinong

2017-03-01

Effective treatment of systolic hypertension in elderly patients remains a major therapeutic challenge. A multicenter, double-blind, randomized controlled trial with sacubitril/valsartan (LCZ696), a first-in-class angiotensin receptor neprilysin inhibitor, was conducted to determine its effects versus olmesartan (angiotensin receptor blocker) on central aortic pressures, in elderly patients (aged ≥60 years) with systolic hypertension and pulse pressure >60 mm Hg, indicative of arterial stiffness. Patients (n=454; mean age, 67.7 years; mean seated systolic blood pressure, 158.6 mm Hg; mean seated pulse pressure, 69.7 mm Hg) were randomized to receive once-daily sacubitril/valsartan 200 mg or olmesartan 20 mg, force titrated to double the initial doses after 4 weeks, before primary assessment at 12 weeks. The study extended double-blind treatment for 12 to 52 weeks, during which amlodipine (2.5-5 mg) and subsequently hydrochlorothiazide (6.25-25 mg) were added-on for patients not achieving blood pressure target (secondary assessments at week 12 (central aortic pulse pressure, -2.4 mm Hg, P blood pressure and central aortic systolic pressure, -4.1 mm Hg and -3.6 mm Hg, respectively, both P blood pressure parameters were similar between treatments ( P hypertension and stiff arteries. © 2017 American Heart Association, Inc.

Mozart, but not the Beatles, reduces systolic blood pressure in patients with myocardial infarction.

Science.gov (United States)

Gruhlke, Luiza Carolina; Patrício, Marcelo Coelho; Moreira, Daniel Medeiros

2015-12-01

Music reduces systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) in various clinical situations, but it is unclear whether these changes occur in post-infarction patients. The aim is to evaluate the effects of music on patients with acute myocardial infarction (MI). We evaluated patients with MI and we measured SBP, DBP, HR and double product (DP) two times before the intervention and one time every fifteen minutes with an ambulatory blood pressure monitor. We divided the patients into 3 groups: a group listening to music by Mozart; another listening to a Beatles collection and a third one listening to the radio news. Outcomes were the change in mean SBP, DBP, HR and DP with intervention. We enrolled 60 patients (20 in each group). SBP was significantly reduced in the Mozart group (variation of –7.2 ± 8.5 mmHg) compared to the Beatles group (–1.3 ± 6.2 mmHg) (P = 0.021) and the radio news group (0.6 ± 8.7 mmHg) (P = 0.003). DP was significantly reduced in the Mozart group compared with the News group (–668.5 ± 773.2 vs 31.6 ± 722.1 mmHg) (P = 0.006). There were no differences in DBP and HR. Patients with MI who listened Mozart had a reduction in SBP and DP compared to those who listened to the Beatles or the news.

Melodic algorithms for pulse oximetry to allow audible discrimination of abnormal systolic blood pressures.

Science.gov (United States)

Chima, Ranjit S; Ortega, Rafael; Connor, Christopher W

2014-12-01

An anesthesiologist must remain vigilant of the patient's clinical status, incorporating many independent physiological measurements. Oxygen saturation and heart rate are represented by continuous audible tones generated by the pulse oximeter, a mandated monitoring device. Other important clinical parameters--notably blood pressure--lack any audible representation beyond arbitrarily-configured threshold alarms. Attempts to introduce further continuous audible tones have apparently foundered; the complexity and interaction of these tones have exceeded the ability of clinicians to interpret them. Instead, we manipulate the tonal and rhythmic structure of the accepted pulse oximeter tone pattern melodically. Three melodic algorithms were developed to apply tonal and rhythmic variations to the continuous pulse oximeter tone, dependent on the systolic blood pressure. The algorithms distort the original audible pattern minimally, to facilitate comprehension of both the underlying pattern and the applied variations. A panel of anesthesia practitioners (attending anesthesiologists, residents and nurse anesthetists) assessed these algorithms in characterizing perturbations in cardiopulmonary status. Twelve scenarios, incorporating combinations of oxygen desaturation, bradycardia, tachycardia, hypotension and hypertension, were tested. A rhythmic variation in which additional auditory information was conveyed only at halftime intervals, with every other "beat" of the pulse oximeter, was strongly favored. The respondents also strongly favored the use of musical chords over single tones. Given three algorithms of tones embedded in the pulse oximeter signal, anesthesiologists preferred a melodic tone to signal a significant change in blood pressure.

Effect of tender coconut water on systolic and diastolic blood pressure in prehypertensive women

Directory of Open Access Journals (Sweden)

Farapti Farapti

2014-02-01

. Dietary intakes of high potassium will decrease blood pressure (BP. Tender coconut water (TCW is a typical drink high in potassium. This study aimed to investigate the effect of TCW on BP in female teachers and employees prehypertension. Methods: The research was a parallel single blind randomized clinical trial. A total of 32 female prehypertension subjects aged 25-44 years. The subjects were selected using certain criteria and randomly allocated to one of two groups using block randomized, 16 subjects each. The treatment group received TCW 300 ml twice daily for 14 days and nutritional counseling, and the control group received water 300 ml twice daily for 14 days and nutritional counseling. Assessment of BP was done on day 0, day 8, and day 15. Statistical analysis were done using t-test and Mann-Whitney test. Results: Mean dietary intakes of potassium were 1420.28±405.54 mg/day or 30.22±8.63% compared to Recommended Dietary Allowance (RDA. During treatment period, potassium intake increased significantly in the treatment group. There were decreased BP in both groups, which were greater in the treatment group, but not statistically significant different (P > 0.05. The mean decrease of systolic BP was significant in treatment group (P = 0.031, meanwhile the mean decrease of diastolic BP was not significant (P=0.134. Conclusion: Tender coconut water 300 ml twice daily for 14 consecutive days has tendency to decrease systolic BP, but not diastolic blood pressure. (Health Science Indones 2013;2: 64-8Key words: coconut water, systolic and diastolic blood pressure

Higher ambulatory systolic blood pressure independently associated with enlarged perivascular spaces in basal ganglia.

Science.gov (United States)

Yang, Shuna; Yuan, Junliang; Zhang, Xiaoyu; Fan, Huimin; Li, Yue; Yin, Jiangmei; Hu, Wenli

2017-09-01

Enlarged perivascular spaces (EPVS) have been identified as a marker of cerebral small vessel diseases (CSVD). Ambulatory blood pressure (ABP) is the strongest predictor of hypertension-related brain damage. However, the relationship between ABP levels and EPVS is unclear. This study aimed to investigate the association between ABP levels and EPVS by 24-hour ambulatory blood pressure monitoring (ABPM). We prospectively recruited inpatients for physical examinations in our hospital from May 2013 to Jun 2016. 24-hour ABPM data and cranial magnetic resonance imaging information were collected. EPVS in basal ganglia (BG) and centrum semiovale (CSO) were identified and classified into three categories by the severity. White matter hyperintensities were scored by Fazekas scale. Spearman correlation analysis and multiple logistic regression analysis were used to determine the relationship between ABP levels and EPVS. A total of 573 subjects were enrolled in this study. 24-hour, day and night systolic blood pressure (SBP) levels were positively related to higher numbers of EPVS in BG (24-hour SBP: r = 0.23, p blood pressure (DBP) levels increased with an increasing degree of EPVS in CSO (p = 0.04 and 0.049, respectively). But the association disappeared after adjusting for confounders. Spearman correlation analysis indicated that ABP levels were not associated with higher numbers of EPVS in CSO (p > 0.05). DBP levels were not independently associated with the severity of EPVS in BG and CSO. Higher SBP levels were independently associated with EPVS in BG, but not in CSO, which supported EPVS in BG to be a marker of CSVD. Pathogenesis of EPVS in BG and CSO might be different.

Slow loaded breathing training improves blood pressure, lung capacity and arm exercise endurance for older people with treated and stable isolated systolic hypertension.

Science.gov (United States)

Ublosakka-Jones, Chulee; Tongdee, Phailin; Pachirat, Orathai; Jones, David A

2018-03-28

Hypertension and reduced lung function are important features of aging. Slow loaded breathing training reduces resting blood pressure and the question is whether this can also improve lung function. Thirty-two people (67 ± 5 years, 16 male) with controlled isolated systolic hypertension undertook an eight weeks randomised controlled training trial with an inspiratory load of 25% maximum inspiratory pressure (MIP) at 6 breaths per minute (slow loaded breathing; SLB) or deep breathing control (CON). Outcome measures were resting blood pressure (BP) and heart rate; MIP; lung capacity; chest and abdominal expansion; arm cranking exercise endurance at 50% heart rate reserve. Home based measurement of resting systolic BP decreased by 20 mm Hg (15 to 25) (Mean and 95%CI) for SLB and by 5 mm Hg (1 to 7) for CON. Heart rate and diastolic BP also decreased significantly for SLB but not CON. MIP increased by 15.8 cm H 2 O (11.8 to 19.8) and slow vital capacity by 0.21 L (0.15 to 0.27) for SLB but not for CON. Chest and abdominal expansion increased by 2.3 cm (2.05 to 2.55) and 2.5 cm (2.15 to 2.85), respectively for SLB and by 0.5 cm (0.26 to 0.74) and 1.7 cm (1.32 to 2.08) for CON. Arm exercise time increased by 4.9 min (3.65 to 5.15) for SLB with no significant change for CON. Slow inspiratory muscle training is not only effective in reducing resting BP, even in older people with well controlled isolated systolic hypertension but also increases inspiratory muscle strength, lung capacity and arm exercise duration. Copyright © 2018. Published by Elsevier Inc.

Intraoperative Transesophageal Echocardiography and Right Ventricular Failure After Left Ventricular Assist Device Implantation.

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Silverton, Natalie A; Patel, Ravi; Zimmerman, Josh; Ma, Jianing; Stoddard, Greg; Selzman, Craig; Morrissey, Candice K

2018-02-15

To determine whether intraoperative measures of right ventricular (RV) function using transesophageal echocardiography are associated with subsequent RV failure after left ventricular assist device (LVAD) implantation. Retrospective, nonrandomized, observational study. Single tertiary-level, university-affiliated hospital. The study comprised 100 patients with systolic heart failure undergoing elective LVAD implantation. Transesophageal echocardiographic images before and after cardiopulmonary bypass were analyzed to quantify RV function using tricuspid annular plane systolic excursion (TAPSE), tricuspid annular systolic velocity (S'), fractional area change (FAC), RV global longitudinal strain, and RV free wall strain. A chart review was performed to determine which patients subsequently developed RV failure (right ventricular assist device placement or prolonged inotrope requirement ≥14 days). Nineteen patients (19%) subsequently developed RV failure. Postbypass FAC was the only measure of RV function that distinguished between the RV failure and non-RV failure groups (21.2% v 26.5%; p = 0.04). The sensitivity, specificity, and area under the curve of an abnormal RV FAC (failure after LVAD implantation were 84%, 20%, and 0.52, respectively. No other intraoperative measure of RV function was associated with subsequent RV failure. RV failure increased ventilator time, intensive care unit and hospital length of stay, and mortality. Intraoperative measures of RV function such as tricuspid annular plane systolic excursion, tricuspid annular systolic velocity, and RV strain were not associated with RV failure after LVAD implantation. Decreased postbypass FAC was significantly associated with RV failure but showed poor discrimination. Copyright © 2018 Elsevier Inc. All rights reserved.

Ongoing right ventricular hemodynamics in heart failure: clinical value of measurements derived from an implantable monitoring system.

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Adamson, Philip B; Magalski, Anthony; Braunschweig, Frieder; Böhm, Michael; Reynolds, Dwight; Steinhaus, David; Luby, Allyson; Linde, Cecilia; Ryden, Lars; Cremers, Bodo; Takle, Teri; Bennett, Tom

2003-02-19

This study examined the characteristics of continuously measured right ventricular (RV) hemodynamic information derived from an implantable hemodynamic monitor (IHM) in heart failure patients. Hemodynamic monitoring might improve the day-to-day management of patients with chronic heart failure (CHF). Little is known about the characteristics of long-term hemodynamic information in patients with CHF or how such information relates to meaningful clinical events. Thirty-two patients with CHF received a permanent RV IHM system similar to a single-lead pacemaker. Right ventricular systolic and diastolic pressures, heart rate, and pressure derivatives were continuously measured for nine months without using the data for clinical decision-making or management of patients. Data were then made available to clinical providers, and the patients were followed up for 17 months. Pressure characteristics during optimal volume, clinically determined volume-overload exacerbations, and volume depletion events were examined. The effect of IHM on hospitalizations was examined using the patients' historical controls. Long-term RV pressure measurements had either marked variability or minimal time-related changes. During 36 volume-overload events, RV systolic pressures increased by 25 +/- 4% (p < 0.05) and heart rate increased by 11 +/- 2% (p < 0.05). Pressure increases occurred in 9 of 12 events 4 +/- 2 days before the exacerbations requiring hospitalization. Hospitalizations before using IHM data for clinical management averaged 1.08 per patient year and decreased to 0.47 per patient-year (57% reduction, p < 0.01) after hemodynamic data were used. Long-term ambulatory pressure measurements from an IHM may be helpful in guiding day-to-day clinical management, with a potentially favorable impact on CHF hospitalizations.

The Norwood procedure: in favor of the RV-PA conduit.

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Barron, David J

2013-01-01

Evolution of the Norwood procedure has culminated in there currently being three treatment strategies available for initial management: the 'classical' Norwood (utilizing a Blalock-Taussig shunt), the Norwood with right-ventricle to pulmonary artery (RV-PA) conduit, and the 'hybrid' Norwood procedure utilizing bilateral pulmonary artery banding and ductal stenting. Each variant has its potential advantages and disadvantages, and this paper looks to examine the evidence in favor of each strategy, with emphasis on the supportive data for the RV-PA conduit. The 'classical' procedure has the benefit of the greatest accumulated surgical experience and avoids any incision into the ventricle. However, the diastolic run-off of the Blalock-Taussig shunt can cause hemodynamic instability and unpredictable coronary steal phenomenon. The RV-PA conduit has the advantage of maintaining diastolic pressure with a more stable postoperative course, but at the cost of a ventriculotomy that may have detrimental long-term sequelae. The 'hybrid' procedure has the advantage of avoiding cardiopulmonary bypass, but does not always secure coronary blood flow and has a high inter-stage morbidity and reintervention rate. The evidence shows that each technique may have its place in future management, and that treatment algorithms could emerge that direct the choice of procedure for specific patient groups. Copyright © 2013 Elsevier Inc. All rights reserved.

Analysis on Dynamic Transmission Accuracy for RV Reducer

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Zhang Fengshou

2017-01-01

Full Text Available By taking rotate vector (RV reducer as the research object, the factors affecting the transmission accuracy are studied, including the machining errors of the main parts, assembly errors, clearance, micro-displacement, gear mesh stiffness and damping, bearing stiffness. Based on Newton second law, the transmission error mathematical model of RV reducer is set up. Then, the RV reducer transmission error curve is achieved by solving the mathematical model using the Runge-Kutta methods under the combined action of various error factors. Through the analysis of RV reducer transmission test, it can be found that there are similar variation trend and frequency components compared the theoretical research and experimental result. The presented method is useful to the research on dynamic transmission accuracy of RV reducer, and also applies to research the transmission accuracy of other cycloid drive systems.

Right Ventricular Hemodynamics in Patients with Pulmonary Hypertension

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Browning, James; Fenster, Brett; Hertzberg, Jean; Schroeder, Joyce

2012-11-01

Recent advances in cardiac magnetic resonance imaging (CMR) have allowed for characterization of blood flow in the right ventricle (RV), including calculation of vorticity and circulation, and qualitative visual assessment of coherent flow patterns. In this study, we investigate qualitative and quantitative differences in right ventricular hemodynamics between subjects with pulmonary hypertension (PH) and normal controls. Fifteen (15) PH subjects and 10 age-matched controls underwent same day 3D time resolved CMR and echocardiography. Echocardiography was used to determine right ventricular diastolic function as well as pulmonary artery systolic pressure (PASP). Velocity vectors, vorticity vectors, and streamlines in the RV were visualized in Paraview and total RV Early (E) and Atrial (A) wave diastolic vorticity was quantified. Visualizations of blood flow in the RV are presented for PH and normal subjects. The hypothesis that PH subjects exhibit different RV vorticity levels than normals during diastole is tested and the relationship between RV vorticity and PASP is explored. The mechanics of RV vortex formation are discussed within the context of pulmonary arterial pressure and right ventricular diastolic function coincident with PH.

Tricuspid Annular Plane Systolic Excursion (TAPSE in a Patient with Pulmonary Emboli

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Nicole Zawada

2018-01-01

Full Text Available History of present illness: A 60-year-old male with a history of pulmonary emboli (PE presented to the emergency department with exertional shortness of breath following a ten-hour flight. The patient admitted to recently stopping his previously prescribed rivaroxaban. His electrocardiogram (ECG showed findings consistent with a S1Q3T3 pattern. Point-of-care ultrasound (POCUS was performed using the curvilinear probe, which revealed a thrombus in the inferior vena cava (IVC. POCUS using the phased array probe demonstrated an abnormal tricuspid annular plane systolic excursion (TAPSE and a significantly dilated right ventricle (RV. Computed tomography angiogram (CTA showed evidence of acute emboli within the right and left distal main pulmonary arteries, left lobar, and left proximal segmental artery. Additionally, a thrombus was visualized in the left distal subhepatic IVC. The patient was admitted to telemetry for anticoagulation and monitoring. Right heart catheterization revealed a significantly elevated pulmonary artery pressure of 95/27. Significant findings: Video 1 and Image 1 show a thrombus in the patient’s IVC. Video 2 and Images 2-3 demonstrate a positive TAPSE of less than 17mm (blue arrow length with a significantly dilated RV, indicating abnormal excursion of the tricuspid annulus and right ventricular dysfunction. Discussion: Pulmonary embolism is the third leading cause of death from cardiovascular disease following myocardial infarction and stroke.1 Approximately half of all PEs are diagnosed in the emergency department2 and early detection and treatment have been shown to improve outcomes and survival.3 Pulmonary emboli can present with a wide range of symptoms including dyspnea, chest pain, shock, or sustained hypotension, and can even be asymptomatic, making it a potentially challenging diagnosis.4 Studies show a high specificity of over 80% but low sensitivity of lower than 60%, for echocardiography in the diagnosis of PE

2D speckle tracking echocardiography of the right ventricle free wall in SCUBA divers after single open sea dive.

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Susilovic-Grabovac, Zora; Obad, Ante; Duplančić, Darko; Banić, Ivana; Brusoni, Denise; Agostoni, Piergiuseppe; Vuković, Ivica; Dujic, Zeljko; Bakovic, Darija

2018-03-01

The presence of circulating gas bubbles and their influence on pulmonary and right heart hemodynamics was reported after uncomplicated self-contained underwater breathing apparatus (SCUBA) dive(s). Improvements in cardiac imaging have recently focused great attention on the right ventricle (RV). The aim of our study was to evaluate possible effects of a single air SCUBA dive on RV function using 2D speckle tracking echocardiography in healthy divers after single open sea dive to 18 meters of seawater, followed by bottom stay of 47 minutes with a direct ascent to the surface. Twelve experienced male divers (age 39.5 ± 10.5 years) participated in the study. Echocardiographic assessment of the right ventricular function (free wall 2 D strain, tricuspid annular planes systolic excursion [TAPSE], lateral tricuspid annular peak systolic velocity [RV s`] and fractional area change [FAC]) was performed directly prior to and 30, 60, 90 and 120 minutes after surfacing. Two-dimensional strain of all three segments of free right ventricular wall showed a significant increase in longitudinal shortening in post-dive period for maximally 26% (basal), 15.4% (mid) and 16.3% (apical) as well as TAPSE (11.6%), RV FAC (19.2%), RV S` (12.7%) suggesting a rise in systolic function of right heart. Mean pulmonary arterial pressure (mean PAP) increased post-dive from 13.3 mmHg to maximally 23.5 mmHg (P = .002), indicating increased RV afterload. Our results demonstrated that single dive with significant bubble load lead to increase in systolic function and longitudinal strain of the right heart in parallel with increase in mean PAP. © 2017 John Wiley & Sons Australia, Ltd.

The development of remote controlled linear guide and mast vertical guide of repair robot for RV head CRDM nozzle region in NPP

International Nuclear Information System (INIS)

Kim, Seung Ho; Seo, Yong Chil; Shin, Ho Cheol; Lee, Sung Uk; Jung, Kyung Min

2006-11-01

Reactor vessel which is core instrument in NPP must maintains integrity in the high temperature, high pressure and high radiation environment. Therefore RV must be inspected periodically. If there is defect, the RV must be repaired. A remote controlled linear guide and a vertical guide were developed for a welding repair robot of the RV head CRDM nozzle region. During inspection/maintenance, the RV head is placed RV head storage which is a double circled concrete structure. A linear guide was developed to provide a linear motion to the repair robot, which locates the robot under the RV head. The linear guide also provides a strong support to the robot not to overturn when the robot repairs the RV head. The robot needs lifting about 2m to reach the CRDM nozzle, therefore a vertical guide was developed. For easy traveling, the linear guide is designed 4 parts and the vertical guide is designed 3 parts. A control system was developed to remotely control the guide system which is composed of a connecter box, cables, control box, a computer and a control program. A monitoring system was developed to monitor operation of the guide system

The development of remote controlled linear guide and mast vertical guide of repair robot for RV head CRDM nozzle region in NPP

Energy Technology Data Exchange (ETDEWEB)

Kim, Seung Ho; Seo, Yong Chil; Shin, Ho Cheol; Lee, Sung Uk; Jung, Kyung Min

2006-11-15

Reactor vessel which is core instrument in NPP must maintains integrity in the high temperature, high pressure and high radiation environment. Therefore RV must be inspected periodically. If there is defect, the RV must be repaired. A remote controlled linear guide and a vertical guide were developed for a welding repair robot of the RV head CRDM nozzle region. During inspection/maintenance, the RV head is placed RV head storage which is a double circled concrete structure. A linear guide was developed to provide a linear motion to the repair robot, which locates the robot under the RV head. The linear guide also provides a strong support to the robot not to overturn when the robot repairs the RV head. The robot needs lifting about 2m to reach the CRDM nozzle, therefore a vertical guide was developed. For easy traveling, the linear guide is designed 4 parts and the vertical guide is designed 3 parts. A control system was developed to remotely control the guide system which is composed of a connecter box, cables, control box, a computer and a control program. A monitoring system was developed to monitor operation of the guide system.

Interankle systolic blood pressure difference and renal outcomes in patients with chronic kidney disease.

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Chen, Szu-Chia; Tsai, Yi-Chun; Huang, Jiun-Chi; Lee, Su-Chu; Chang, Jer-Ming; Hwang, Shang-Jyh; Chen, Hung-Chun

2016-05-01

Interankle blood pressure (BP) difference has been associated with peripheral artery disease and adverse cardiovascular outcomes. However, the relationship between interankle BP difference and renal outcomes in chronic kidney disease (CKD) has never been evaluated. The purpose of this study was to determine whether interankle BP difference is associated with the rate of renal function decline and progression to renal end points in patients with stage 3-5 CKD. We enrolled 144 patients with CKD from one regional hospital. The BP in four limbs was simultaneously measured using an ABI-form device. The decline in renal function was evaluated using an estimated glomerular filtration rate (eGFR) slope. Rapid renal progression was defined as an eGFR slope < -3 mL/min per 1.73 m(2) per year. The renal end points were defined as ≥ 25% decline in eGFR or commencement of dialysis during the follow-up period. During a mean follow-up period of 3.1 years, 90 patients (62.5%) reached renal end points. Multivariate analysis showed that an increased interankle systolic BP difference (per 5 mmHg) was associated with a worse eGFR slope (regression β, -0.292; 95% confidence interval [CI], -0.482 to -0.102; P = 0.003), rapid renal progression (odds ratio, 1.189; 95% CI, 1.015-1.394; P = 0.032), and an increased risk of progression to renal end points (hazard ratio, 1.126; 95% CI, 1.052-1.204, P = 0.001). Interankle systolic BP difference was associated with rapid renal progression and progression to renal end points in patients with stage 3-5 CKD in our study. © 2015 Asian Pacific Society of Nephrology.

Retinopathy of Prematurity Is Associated with Increased Systolic Blood Pressure in Adults Who Were Born Preterm.

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Kistner, Anna; Jacobson, Lena; Östergren, Jan; Hellström, Ann

2017-01-01

Adults born preterm are at risk of developing cardiovascular morbidities. The aim of this study was to evaluate the relationship between retinopathy of prematurity (ROP) and blood pressure (BP) and salivary cortisol levels during adulthood. Sixty-nine subjects (mean age 22.6 years) were included. Subjects were adults who were: (a) ex-preterm infants with severe ROP (n = 22), born at gestational age (GA) <30 weeks with a birth weight (BW) <1,000 g, (b) ex-preterm infants with no/mild ROP (n = 21), born at GA <28 weeks with a BW <1,000 g, or (c) full-term controls (n = 26). Anthropometric data, office BP, ambulatory BP, and morning and evening salivary cortisol were analyzed. As adults, ex-preterm infants with severe ROP had on average 7.4 mm Hg higher systolic office BP than those with no/mild ROP (p = 0.019) and controls (p = 0.007). A high cortisol level, tall height, and severe ROP were independent predictors of higher ambulatory systolic BP during adulthood in forward stepwise regression analysis, independent of GA. Our results indicate that preterm infants with severe abnormal retinal vascular development during the neonatal period may be at an increased risk for increased BP during adulthood. We found no differences between those with no/mild ROP as infants and controls with regard to BP data. © 2017 The Author(s) Published by S. Karger AG, Basel.

How well can blood pressure be controlled? Progress report on the Systolic Hypertension in Europe Follow-Up Study (Syst-Eur 2

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Sarti Cinzia

2001-10-01

Full Text Available Abstract Background The randomised, double-blind, placebo-controlled Systolic Hypertension in Europe trial (Syst-Eur 1 proved that blood pressure (BP lowering therapy starting with nitrendipine reduces the risk of cardiovascular complications in elderly patients with isolated systolic hypertension. In an attempt to confirm the safety of long-term antihypertensive therapy based on a dihydropyridine, the Syst-Eur patients remained in open follow-up after the end of Syst-Eur 1. This paper presents the second progress report of this follow-up study (Syst-Eur 2. It describes BP control and adherence to study medications. Methods After the end of Syst-Eur 1 all patients, treated either actively or with placebo, were invited either to continue or to start antihypertensive treatment with the same drugs as previously used in the active treatment arm. In order to reach the target BP (sitting SBP Results Of the 3787 eligible patients, 3516 (93% entered Syst-Eur 2. At the last available visit, 72% of the patients were taking nitrendipine. SBP/DBP at entry in Syst-Eur 2 averaged 160/83 mmHg in the former placebo group and 151/80 mmHg in the former active-treatment group. At the last follow-up visit SBP/DBP in the patients previously randomised to placebo or active treatment had decreased by 16/5 mmHg and 7/5 mmHg, respectively. The target BP was reached by 74% of the patients. Conclusion Substantial reductions in systolic BP may be achieved in older patients with isolated systolic hypertension with a treatment strategy starting with the dihydropyridine calcium-channel blocker, nitrendipine, with the possible addition of enalapril and/or hydrochlorothiazide.

Chemical Compositions of RV Tauri Stars and Related Objects

Science.gov (United States)

Rao, S. S.; Giridhar, S.

2014-04-01

We have undertaken a comprehensive abundance analysis for a sample of relatively unexplored RV Tauri and RV Tauri like stars to further our understanding of post-Asymptotic Giant Branch (post-AGB) evolution. From our study based on high resolution spectra and a grid of model atmospheres, we find indications of mild s-processing for V820 Cen and IRAS 06165+3158. On the other hand, SU Gem and BT Lac exhibit the effects of mild dust-gas winnowing. We have also compiled the existing abundance data on RV Tauri objects and find that a large fraction of them are afflicted by dust-gas winnowing and aided by the present work, we find a small group of two RV Tauris showing mild s-process enhancement in our Galaxy. With two out of three reported s-process enhanced objects belonging to RV Tauri spectroscopic class C, these intrinsically metal-poor objects appear to be promising candidates to analyse the possible s-processing in RV Tauri stars.

Crucial role of rho-kinase in pressure overload-induced right ventricular hypertrophy and dysfunction in mice.

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Ikeda, Shohei; Satoh, Kimio; Kikuchi, Nobuhiro; Miyata, Satoshi; Suzuki, Kota; Omura, Junichi; Shimizu, Toru; Kobayashi, Kenta; Kobayashi, Kazuto; Fukumoto, Yoshihiro; Sakata, Yasuhiko; Shimokawa, Hiroaki

2014-06-01

Right ventricular (RV) failure is the leading cause of death in various cardiopulmonary diseases, including pulmonary hypertension. It is generally considered that the RV is vulnerable to pressure overload as compared with the left ventricle (LV). However, as compared with LV failure, the molecular mechanisms of RV failure are poorly understood, and hence therapeutic targets of the disorder remain to be elucidated. Thus, we aimed to identify molecular therapeutic targets for RV failure in a mouse model of pressure overload. To induce pressure overload to respective ventricles, we performed pulmonary artery constriction or transverse aortic constriction in mice. We first performed microarray analysis and found that the molecules related to RhoA/Rho-kinase and integrin pathways were significantly upregulated in the RV with pulmonary artery constriction compared with the LV with transverse aortic constriction. Then, we examined the responses of both ventricles to chronic pressure overload in vivo. We demonstrated that compared with transverse aortic constriction, pulmonary artery constriction caused greater extents of mortality, Rho-kinase expression (especially ROCK2 isoform), and oxidative stress in pressure-overloaded RV, reflecting the weakness of the RV in response to pressure overload. Furthermore, mice with myocardial-specific overexpression of dominant-negative Rho-kinase showed resistance to pressure overload-induced hypertrophy and dysfunction associated with reduced oxidative stress. Finally, dominant-negative Rho-kinase mice showed a significantly improved long-term survival in both pulmonary artery constriction and transverse aortic constriction as compared with littermate controls. These results indicate that the Rho-kinase pathway plays a crucial role in RV hypertrophy and dysfunction, suggesting that the pathway is a novel therapeutic target of RV failure in humans. © 2014 American Heart Association, Inc.

Measuring systolic ankle and toe pressure using the strain gauge technique--a comparison study between mercury and indium-gallium strain gauges

DEFF Research Database (Denmark)

Broholm, Rikke; Wiinberg, Niels; Simonsen, Lene

2014-01-01

BACKGROUND: Measurement of the ankle and toe pressures are often performed using a plethysmograph, compression cuffs and a strain gauge. Usually, the strain gauge contains mercury but other alternatives exist. From 2014, the mercury-containing strain gauge will no longer be available in the Europ......BACKGROUND: Measurement of the ankle and toe pressures are often performed using a plethysmograph, compression cuffs and a strain gauge. Usually, the strain gauge contains mercury but other alternatives exist. From 2014, the mercury-containing strain gauge will no longer be available...... in the European Union. The aim of this study was to compare an indium-gallium strain gauge to the established mercury-containing strain gauge. METHODS: Consecutive patients referred to the Department of Clinical Physiology and Nuclear Medicine at Bispebjerg and Frederiksberg Hospitals for measurements of systolic...... ankle and toe pressures volunteered for the study. Ankle and toe pressures were measured twice with the mercury and the indium-gallium strain gauge in random order. Comparison of the correlation between the mean pressure using the mercury and the indium-gallium device and the difference between the two...

Acute Effects of Positive Airway Pressure on Functional Mitral Regurgitation in Patients with Systolic Heart Failure

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Takao Kato

2017-11-01

Full Text Available Background: Acute effects of positive airway pressure (PAP [including continuous PAP (CPAP and adaptive servo-ventilation, an advanced form of bi-level PAP] on functional mitral regurgitation (fMR in patients with heart failure (HF with left ventricular (LV systolic dysfunction remain unclear. Thus, whether PAP therapy reduces fMR in such patients with HF was investigated.Methods and Results: Twenty patients with HF and LV systolic dysfunction defined as LV ejection fraction (LVEF <50% (14 men; mean LVEF, 35.0 ± 11.5% with fMR underwent echocardiography during 10-min CPAP (4 and 8 cm H2O and adaptive servo-ventilation. For fMR assessment, MR jet area fraction, defined as the ratio of MR jet on color Doppler to the left atrial area, was measured. The forward stroke volume (SV index (fSVI was calculated from the time-velocity integral, cross-sectional area of the aortic annulus, and body surface area. fMR significantly reduced on CPAP at 8 cm H2O (0.30 ± 0.12 and adaptive servo-ventilation (0.29 ± 0.12, compared with the baseline phase (0.37 ± 0.12 and CPAP at 4 cm H2O (0.34 ± 0.12 (P < 0.001. The fSVI did not change in any of the PAP sessions (P = 0.888. However, significant differences in fSVI responses to PAP were found between sexes (P for interaction, 0.006, with a significant reduction in fSVI in women (P = 0.041 and between patients with baseline fSVI ≥ and < the median value (27.8 ml/m2, P for interaction, 0.018, with a significant fSVI reduction in patients with high baseline fSVI (P = 0.028. In addition, significant differences were found in fSVI responses to PAP between patients with LV end-systolic volume (LVESV index ≥ and < the median value (62.0 ml/m2, P for interaction, 0.034, with a significant fSVI increase in patients with a high LVESV index (P = 0.023.Conclusion: In patients with HF, LV systolic dysfunction, and fMR, PAP can alleviate fMR without any overall changes in forward SV. However, MR alleviation due to PAP

Ventricular Geometry From Non-contrast Non-ECG-gated CT Scans: An Imaging Marker of Cardiopulmonary Disease in Smokers.

Science.gov (United States)

Rahaghi, Farbod N; Vegas-Sanchez-Ferrero, Gonzalo; Minhas, Jasleen K; Come, Carolyn E; De La Bruere, Isaac; Wells, James M; González, Germán; Bhatt, Surya P; Fenster, Brett E; Diaz, Alejandro A; Kohli, Puja; Ross, James C; Lynch, David A; Dransfield, Mark T; Bowler, Russel P; Ledesma-Carbayo, Maria J; San José Estépar, Raúl; Washko, George R

2017-05-01

Imaging-based assessment of cardiovascular structure and function provides clinically relevant information in smokers. Non-cardiac-gated thoracic computed tomographic (CT) scanning is increasingly leveraged for clinical care and lung cancer screening. We sought to determine if more comprehensive measures of ventricular geometry could be obtained from CT using an atlas-based surface model of the heart. Subcohorts of 24 subjects with cardiac magnetic resonance imaging (MRI) and 262 subjects with echocardiography were identified from COPDGene, a longitudinal observational study of smokers. A surface model of the heart was manually initialized, and then automatically optimized to fit the epicardium for each CT. Estimates of right and left ventricular (RV and LV) volume and free-wall curvature were then calculated and compared to structural and functional metrics obtained from MRI and echocardiograms. CT measures of RV dimension and curvature correlated with similar measures obtained using MRI. RV and LV volume obtained from CT inversely correlated with echocardiogram-based estimates of RV systolic pressure using tricuspid regurgitation jet velocity and LV ejection fraction respectively. Patients with evidence of RV or LV dysfunction on echocardiogram had larger RV and LV dimensions on CT. Logistic regression models based on demographics and ventricular measures from CT had an area under the curve of >0.7 for the prediction of elevated right ventricular systolic pressure and ventricular failure. These data suggest that non-cardiac-gated, non-contrast-enhanced thoracic CT scanning may provide insight into cardiac structure and function in smokers. Copyright © 2017. Published by Elsevier Inc.

The effect of comorbidity on glycemic control and systolic blood pressure in type 2 diabetes: a cohort study with 5 year follow-up in primary care.

NARCIS (Netherlands)

Luijks, H.; Biermans, M.; Bor, H.; Weel, C. van; Lagro-Janssen, T.; Grauw, W. de; Schermer, T.

2017-01-01

Aims: To explore the longitudinal effect of chronic comorbid diseases on glycemic control (HbA1C) and systolic blood pressure (SBP) in type 2 diabetes patients. Methods: In a representative primary care cohort of patients with newly diagnosed type 2 diabetes in The Netherlands (n = 610), we tested

Hyperglycemia and nocturnal systolic blood pressure are associatedwith left ventricular hypertrophy and diastolic dysfunction in hypertensive diabetic patients

Directory of Open Access Journals (Sweden)

Felício João S

2006-09-01

Full Text Available Abstract Background The aim of this study was to determine if hypertensive type 2 diabetic patients, when compared to patients with essential hypertension have an increased left ventricular mass index (LVMI and a worse diastolic function, and if this fact would be related to 24-h pressoric levels changes. Methods Ninety-one hypertensive patients with type 2 diabetes mellitus (DM (group-1 [G1], 59 essential hypertensive patients (group-2 [G2] and 26 healthy controls (group-3 [G3] were submitted to 24-h Ambulatory Blood Pressure Monitoring (ABPM and echocardiography (ECHO with Doppler. We calculated an average of fasting blood glucose (AFBG values of G1 from the previous 4.2 years and a glycemic control index (GCI (percentual of FBG above 200 mg/dl. Results G1 and G2 did not differ on average of diurnal systolic and diastolic BP. However, G1 presented worse diastolic function and a higher average of nocturnal systolic BP (NSBP and LVMI (NSBP = 132 ± 18 vs 124 ± 14 mmHg; P 2; P 165 mg/dl showed an additional risk of LVH (P Conclusion This study suggests that hyperglycemia and higher NSBP levels should be responsible for an increased prevalence of LVH in hypertensive patients with Type 2 DM.

Admission Systolic Blood Pressure Predicts the Number of Blood Pressure Medications at Discharge in Patients With Primary Intracerebral Hemorrhage.

Science.gov (United States)

Khawaja, Ayaz M; Shiue, Harn; Boehme, Amelia K; Albright, Karen C; Venkatraman, Anand; Kumar, Gyanendra; Lyerly, Michael J; Hays-Shapshak, Angela; Mirza, Maira; Gropen, Toby I; Harrigan, Mark R

2018-03-01

Control of systolic blood pressure (SBP) after primary intracerebral hemorrhage improves outcomes. Factors determining the number of blood pressure medications (BPM) required for goal SBP<160 mm Hg at discharge are unknown. We hypothesized that higher admission-SBPs require a greater number of BPM for goal discharge-SBP<160 mm Hg, and investigated factors influencing this goal. We conducted a retrospective review of 288 patients who presented with primary intracerebral hemorrhage. Admission-SBP was obtained. Primary outcome was the number of BPM at discharge. Comparison was made between patients presenting with and without a history of hypertension, and patients discharged on <3 and ≥3 BPM. Patients with hypertension history had a higher median admission-SBP compared with those without (180 vs. 157 mm Hg, P=0.0001). In total, 133 of 288 (46.2%) patients were discharged on <3 BPM; 155/288 (53.8%) were discharged on ≥3 BPM. Hypertension history (P<0.0001) and admission-SBP (P<0.0001) predicted the number of BPM at discharge. In patients without hypertension history, every 10 mm Hg increase in SBP resulted in an absolute increase of 0.5 BPM at discharge (P=0.0011), whereas in those with hypertension, the absolute increase was 1.3 BPM (P=0.0012). In comparison with patients discharged on <3 BPM, patients discharged on ≥3 BPM were more likely to have a higher median admission-SBP, be younger in age, belong to the African-American race, have a history of diabetes, have higher median admission-National Institutes of Health Stroke Scale and modified Rankin Scale of 4 to 5 at discharge. An understanding of the factors influencing BPM at discharge may help clinicians better optimize blood pressure control both before and after discharge.

Effects of garlic on blood pressure in patients with and without systolic hypertension: a meta-analysis.

Science.gov (United States)

Reinhart, Kurt M; Coleman, Craig I; Teevan, Colleen; Vachhani, Payal; White, C Michael

2008-12-01

Garlic has been suggested to lower blood pressure; however, studies evaluating this parameter have provided conflicting results. To examine the effect of garlic on blood pressure in patients with and without elevated systolic blood pressure (SPB) through meta-analyses of randomized controlled trials. A systematic search of MEDLINE, CINAHL, and the Cochrane Central Register of Controlled Trials was conducted to identify randomized controlled trials in humans evaluating garlic's effect on blood pressure. All databases were searched from their inception through June 26, 2008, using the key words garlic, Allium sativum, and allicin. A manual search of published literature was used to identify additional relevant studies. To be included in the analysis, studies must have been written in English or German and reported endpoints of SBP or diastolic blood pressure (DBP). Studies whose population had a mean baseline SBP greater than 140 mm Hg were evaluated separately from those whose population had lower baseline blood pressures. Garlic's effect on SBP and DBP was treated as a continuous variable and weighted mean differences were calculated using a random-effects model. Ten trials were included in the analysis; 3 of these had patients with elevated SBP. Garlic reduced SBP by 16.3 mm Hg (95% CI 6.2 to 26.5) and DBP by 9.3 mm Hg (95% CI 5.3 to 13.3) compared with placebo in patients with elevated SBP. However, the use of garlic did not reduce SBP or DBP in patients without elevated SBP. There was only a minor degree of heterogeneity in the analyses and publication bias did not appear to influence the results. This meta-analysis suggests that garlic is associated with blood pressure reductions in patients with an elevated SBP although not in those without elevated SBP. Future research should focus on the impact of garlic on clinical events and the assessment of the long-term risk of harm.

Quantitative estimation of the right ventricular overloading by thallium-201 myocardial scintigraphy

International Nuclear Information System (INIS)

Owada, Kenji; Machii, Kazuo; Tsukahara, Yasunori

1982-01-01

Thallium-201 myocardial scintigraphy was performed on 55 patients with various types of right ventricular overloading. The right ventricular (RV) free wall was visualized in 39 out of the 55 patients (71%). The mean values of right ventricular systolic pressure (RVSP) and pulmonary artery mean pressure (PAMP) in the visualized cases (uptakers) were 54.6 +- 24.1 and 30.5 +- 15.3 mmHg, respectively. These values were significantly higher than those of the non-visualized cases (non-uptakers). There were 12 RVSP-''normotensive'' uptakers and 15 PAMP-''normotensive'' uptakers. The RV free wall images were classified into three types according to their morphological features. Type I was predominantly seen in cases of RV pressure overloading, type II in RV volume overloading and type III in combined ventricular overloading. RVSP in the type III group was significantly higher than that in other two groups. The radioactivity ratio in RV free wall and interventricular septum (IVS), the RV/IVS uptake ratio was calculated using left anterior oblique (LAO) view images. The RV/IVS uptake ratio closely correlated with RVSP and PAMP (r = 0.88 and 0.82, respectively). In each group of RV free wall image, there were also close correlations between the RV/IVS uptake ratio and both RVSP and PAMP. Our results indicate that the RV/IVS uptake ratio can be used as a parameter for the semi-quantitative estimation of right ventricular overloading. (author)

Hypertrophic response to hemodynamic overload: role of load vs. renin-angiotensin system activation

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Koide, M.; Carabello, B. A.; Conrad, C. C.; Buckley, J. M.; DeFreyte, G.; Barnes, M.; Tomanek, R. J.; Wei, C. C.; Dell'Italia, L. J.; Cooper, G. 4th;

Hyperbolic isometries of systolic complexes

DEFF Research Database (Denmark)

Prytula, Tomasz Pawel

The main topics of this thesis are the geometric features of systolic complexesarising from the actions of hyperbolic isometries. The thesis consists ofan introduction followed by two articles.Given a hyperbolic isometry h of a systolic complex X, our central theme isto study the minimal displace......The main topics of this thesis are the geometric features of systolic complexesarising from the actions of hyperbolic isometries. The thesis consists ofan introduction followed by two articles.Given a hyperbolic isometry h of a systolic complex X, our central theme isto study the minimal...... algebraic-topological features of systolic groups. In addition, we provide newexamples of systolic groups.In the first article we show that the minimal displacement set of a hyperbolicisometry of a systolic complex is quasi-isometric to the product of a tree andthe real line. We use this theorem...

Tilting-induced decrease in systolic blood pressure in bedridden hypertensive elderly inpatients: effects of azelnidipine.

Science.gov (United States)

Morimoto, Shigeto; Takahashi, Takashi; Okaishi, Kohya; Nakahashi, Takeshi; Nomura, Kohji; Kanda, Tsugiyasu; Okuro, Masashi; Murai, Hiroshi; Nishino, Tomoichi; Matsumoto, Masayuki

2006-12-01

The object of this study was to examine blood pressure (BP) variability due to postural change in elderly hypertensive patients. The subjects studied were 154 elderly inpatients in a hospital for the elderly (48 male and 106 female; median age: 82 years), consisting of age- and sex-matched bedridden (n=39) and non-bedridden (n=39) normotensive controls and bedridden (n=38) and non-bedridden (n=38) hypertensive patients. BP and pulse rate (PR) were measured in the supine position, then again after a 2-min, 45 deg head-up tilt with the legs horizontal. The decrease in systolic BP (SBP) on tilting in the bedridden hypertensive group (median: -10 mmHg; range: -32 to 9 mmHg) was significantly (pbedridden hypertensive group. Our findings indicate that tilt-induced decrease in SBP is a rather common phenomenon in bedridden elderly hypertensive patients, and that treatment with azelnidipine attenuates tilt-induced decrease in SBP, probably through an improvement of baroreceptor sensitivity.

Hemodynamic variables during exercise in childhood and resting systolic blood pressure levels 6 years later in adolescence: the European Youth Heart Study

DEFF Research Database (Denmark)

Grøntved, Anders; Andresen, Brage Storstein; Møller, N C

2011-01-01

of Danish children followed longitudinally for 6 years. The study comprised 226 children randomly sampled at age 9, who had their blood pressure and HR measured during ergometer exercise to exhaustion and was reassessed in adolescence. SBP and RPP during exercise in stage two of the test were positively......The aim of this study was to analyze whether systolic blood pressure (SBP), heart rate (HR) and rate pressure product (RPP) during exercise in childhood can predict resting SBP levels in adolescence independent of resting SBP and conventional cardiovascular risk factors. We studied this in a sample...... remained significant (P=0.059 and P=0.012, respectively). No significant independent associations were observed for HR during exercise, but associations were in the same direction. Our results supports that measuring SBP and RPP, during a standard acute ergometer exercise test in children, improves...

A Calibrated Method of Massage Therapy Decreases Systolic Blood Pressure Concomitant With Changes in Heart Rate Variability in Male Rats.

Science.gov (United States)

Spurgin, Kurt A; Kaprelian, Anthony; Gutierrez, Roberto; Jha, Vidyasagar; Wilson, Christopher G; Dobyns, Abigail; Xu, Karen H; Curras-Collazo, Margarita C

2017-02-01

The purpose of this study was to develop a method for applying calibrated manual massage pressures by using commonly available, inexpensive sphygmomanometer parts and validate the use of this approach as a quantitative method of applying massage therapy to rodents. Massage pressures were monitored by using a modified neonatal blood pressure (BP) cuff attached to an aneroid gauge. Lightly anesthetized rats were stroked on the ventral abdomen for 5 minutes at pressures of 20 mm Hg and 40 mm Hg. Blood pressure was monitored noninvasively for 20 minutes following massage therapy at 5-minute intervals. Interexaminer reliability was assessed by applying 20 mm Hg and 40 mm Hg pressures to a digital scale in the presence or absence of the pressure gauge. With the use of this method, we observed good interexaminer reliability, with intraclass coefficients of 0.989 versus 0.624 in blinded controls. In Long-Evans rats, systolic BP dropped by an average of 9.86% ± 0.27% following application of 40 mm Hg massage pressure. Similar effects were seen following 20 mm Hg pressure (6.52% ± 1.7%), although latency to effect was greater than at 40 mm Hg. Sprague-Dawley rats behaved similarly to Long-Evans rats. Low-frequency/high-frequency ratio, a widely-used index of autonomic tone in cardiovascular regulation, showed a significant increase within 5 minutes after 40 mm Hg massage pressure was applied. The calibrated massage method was shown to be a reproducible method for applying massage pressures in rodents and lowering BP. Copyright © 2016. Published by Elsevier Inc.

Lower Protein-to-Carbohydrate Ratio in Maternal Diet is Associated with Higher Childhood Systolic Blood Pressure up to Age Four Years

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Michelle L. Blumfield

2015-04-01

Full Text Available The prenatal environment can influence development of offspring blood pressure (BP, which tracks into adulthood. This prospective longitudinal study investigated whether maternal pregnancy dietary intake is associated with the development of child BP up to age four years. Data are from 129 mother-child dyads enrolled in the Women and Their Children’s Health study. Maternal diet was assessed using a validated 74-item food frequency questionnaire at 18 to 24 weeks and 36 to 40 weeks, with a reference period of the previous three months. Child systolic and diastolic BP were measured at 3, 6, 9, 12, 24, 36 and 48 months, using an automated BP monitor. Using mixed-model regression analyses adjusted for childhood growth indices, pregnancy intakes of percentage of energy (E% polyunsaturated fat (β coefficient 0.73; 95% CI 0.003, 1.45; p = 0.045, E% omega-6 fatty acids (β coefficient 0.89; 95% CI 0.09, 1.69; p = 0.03 and protein-to-carbohydrate (P:C ratio (β coefficient −14.14; 95% CI −27.68, −0.60; p = 0.04 were associated with child systolic BP trajectory up to 4 years. Child systolic BP was greatest at low proportions of dietary protein (<16% of energy and high carbohydrate (>40% of energy intakes. There may be an ideal maternal macronutrient ratio associated with optimal infant BP. Maternal diet, which is potentially modifiable, may play an important role in influencing offspring risk of future hypertension.

Forward coronary flow normally seen in systole is the result of both forward and concealed back flow

NARCIS (Netherlands)

Spaan, J. A.; Breuls, N. P.; Laird, J. D.

1981-01-01

Normally systolic coronary blood flow is almost entirely forward. As perfusion pressure was lowered through the autoregulatory range in open-chest dogs, net systolic back flow appeared at approximately 70 mm Hg. Imposing a series resistance (Rs), which impedes both forward and back flow, abolished

Inter-arm systolic blood pressure differences, relations with future vascular events and mortality in patients with and without manifest vascular disease.

Science.gov (United States)

Kranenburg, Guido; Spiering, Wilko; de Jong, Pim A; Kappelle, L Jaap; de Borst, Gert Jan; Cramer, Maarten J; Visseren, Frank L J; Aboyans, Victor; Westerink, Jan

2017-10-01

Inter-arm systolic blood pressure difference (SBPD) is an easily obtained patient characteristic which relates to vascular disease. We aimed to identify determinants of large inter-arm SBPD and to investigate the relation between inter-arm SBPD and vascular events in patients with and without manifest vascular disease. In a cohort of 7344 patients with manifest vascular disease or vascular risk factors alone enrolled in the Second Manifestations of ARTerial disease (SMART) study, single bilateral non-simultaneous blood pressure measurements were performed. Logistic and Cox regression was used to identify determinants of large inter-arm SBPD (≥15mmHg) and to investigate the relation between inter-arm SBPD and vascular events (composite of non-fatal myocardial infarction, stroke, and vascular mortality) and all-cause mortality. In all patients the median inter-arm SBPD was 7mmHg (IQR 3-11) and 1182 (16%) patients had inter-arm SBPD ≥15mmHg. Higher age, higher systolic blood pressure, diabetes mellitus, peripheral artery disease, carotid artery stenosis, higher carotid intima-media thickness, and lower ankle-brachial indices were related to large inter-arm SBPD (≥15mmHg). Each 5mmHg increase in inter-arm SBPD was related to a 12% higher risk of vascular events in patients without manifest vascular disease (HR 1.12; 95% CI 1.00-1.27), whereas no relation was apparent in patients with manifest vascular disease (HR 0.98; 95% CI 0.93-1.04, interaction p-value 0.036). Inter-arm SBPD was not related to all-cause mortality (HR 1.05; 95% CI 0.93-1.19). Inter-arm SBPD relates to a higher risk of vascular events in patients without manifest vascular disease, whereas this relation is not apparent in patients with manifest vascular disease. Copyright © 2017 Elsevier B.V. All rights reserved.

Transcriptional analysis of genetic region RvD1 of Mycobacterium bovis

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Víctor Manuel Tibatá R.

2004-07-01

Full Text Available Mycobacterium bovis, shares 99.9% of genomic identity with M. tuberculosis, M. africanum and M. microti. Within this 0.1 % of difference, there are two genetic regions characteristics of M. bovis that are deleted in M. tuberculo­sis H37Rv: RvD1 and RvD2. According to bioinformatic analysis, these regions contain Open Reading Frames (ORFs. With the purpose of determining if the RvD1 region transcribes the ORFs predicted by bioinformatics (ORF1, ORF2 and Rv2024; total RNA was extracted from a culture of M. bovis BCG Pasteur, at different time points along the growth curve. The RNA samples were analyzed by Real Time Reverse Transcription - Poly-merase Chain Reaction (RTq-PCR. The findings show that ORF1, ORF2 and Rv2024, were transcribed consti-tutively, something that has not been reported previously. These results are a first step in order to determine the function of M. bovis RvD1 region, its possible role in pathogenesis and its interaction with both cattle and humans. Key words: Mycobacterium bovis, BCG, RNA, Real Time, RT-PCR, RvD1

Phenomenon of declining blood pressure in elderly - high systolic levels are undervalued with Korotkoff method

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Elmståhl Sölve

2011-10-01

Full Text Available Abstract Background Systolic blood pressure (SBP decline has been reported in octogenarians. The aim was to study if it could be observed while measuring SBP with two methods: Korotkoff (K-BP and Strain-Gauge-Finger-Pletysmography (SG-BP, and which of them were more reliable in expressing vascular burden. Methods A cohort of 703 men from a population of Malmö, Sweden, were included in "Men born in 1914-study" and followed-up at ages: 68 and 81 years. 176 survivors were examined with K-BP and SG-BP at both ages, and 104 of them with Ambulatory Blood Pressure at age 81/82. Ankle Brachial Index (ABI was measured on both occasions, and Carotid Ultrasound at age 81. Results From age 68 to 81, mean K-BP decreased in the cohort with mean 8.3 mmHg, while SG-BP increased with 13.4 mmHg. K-BP decreased in 55% and SG-BP in 31% of the subjects. At age 81, K-BP was lower than SG-BP in 72% of subjects, and correlated to high K-BP at age 68 (r = --.22; p Conclusion In contrast to K-BP, values of SG-BP in octogenarians strongly correlated with Ambulatory Blood Pressure. The SG-BP decline in the last decade was rare, and increasing SG-BP better than K-BP reflected advanced atherosclerosis. It should be aware, that K-BP underdetected 46% of subjects with SG-BP equal/higher than 140 mmHg at age 81, which may lead to biased associations with risk factors due to differential misclassification by age.

Diagnostic and prognostic value of right ventricular strain in patients with pulmonary arterial hypertension and relatively preserved functional capacity studied with echocardiography and magnetic resonance.

Science.gov (United States)

da Costa Junior, Augusto Alberto; Ota-Arakaki, Jaquelina Sonoe; Ramos, Roberta Pulcheri; Uellendahl, Marly; Mancuso, Frederico José Neves; Gil, Manuel Adan; Fischer, Cláudio Henrique; Moises, Valdir Ambrosio; de Camargo Carvalho, Antonio Carlos; Campos, Orlando

2017-01-01

Right ventricular (RV) dysfunction harbingers adverse prognosis in pulmonary arterial hypertension (PAH). Although conventional two-dimensional echocardiography (2DE) is limited for RV systolic function quantitation, RV strain can be a useful tool. The diagnostic and prognostic impact of 2DE speckle-tracking RV longitudinal strain was evaluated, including other 2DE systolic indexes, in a group of PAH patients without severe impairment of functional capacity, chronic pulmonary thromboembolism or left ventricular dysfunction. Sixty-six group I PAH patients, 67 % NYHA functional class I or II (none in IV) were studied by 2DE to obtain: RV fractional area change, tricuspid annular plane systolic excursion, RV myocardial performance index, tissue Doppler tricuspid annulus systolic velocity. Global, free wall (RVFreeWSt) and septal RV longitudinal systolic strain were obtained. RV ejection fraction by cardiac magnetic resonance (CMR-RVEF) was also assessed. All patients were followed up to 3.9 years (mean 3.3 years). Combined endpoints were hospitalization for worsening PAH or cardiovascular death. Among all the 2DE indexes of RV systolic function, RVFreeWSt exhibited the best correlation with CMR-RVEF (r = 0.83; p < 0.005). Combined endpoints occurred in 15 (22.7 %) patients (6 hospitalizations and 9 deaths). Multivariate analysis identified RVFreeWSt ≤-14 % as the only 2DE independent variable associated with combined endpoints [HR 4.66 (1.25-17.37); p < 0.05]. We conclude that RVFreeWSt may be a suitable non-geometric 2DE surrogate of CMR-RVEF in PAH patients, constituting a powerful independent predictor of long-term outcome in this cohort with relatively preserved functional capacity.

Blood pressure, left ventricular geometry, and systolic function in children exposed to inorganic arsenic.

Science.gov (United States)

Osorio-Yáñez, Citlalli; Ayllon-Vergara, Julio C; Arreola-Mendoza, Laura; Aguilar-Madrid, Guadalupe; Hernández-Castellanos, Erika; Sánchez-Peña, Luz C; Del Razo, Luz M

2015-06-01

Inorganic arsenic (iAs) is a ubiquitous element present in the groundwater worldwide. Cardiovascular effects related to iAs exposure have been studied extensively in adult populations. Few epidemiological studies have been focused on iAs exposure-related cardiovascular disease in children. In this study we investigated the association between iAs exposure, blood pressure (BP), and functional and anatomical echocardiographic parameters in children. A cross-sectional study of 161 children between 3 and 8 years was conducted in Central Mexico. The total concentration of arsenic (As) species in urine (U-tAs) was determined by hydride generation-cryotrapping-atomic absorption spectrometry and lifetime iAs exposure was estimated by multiplying As concentrations measured in drinking water by the duration of water consumption in years (LAsE). BP was measured by standard protocols, and M-mode echocardiographic parameters were determined by ultrasonography. U-tAs concentration and LAsE were significantly associated with diastolic (DBP) and systolic blood pressure (SBP) in multivariable linear regression models: DBP and SBP were 0.013 (95% CI: 0.002, 0.024) and 0.021 (95% CI: 0.004, 0.037) mmHg higher in association with each 1-ng/mL increase in U-tAs (p 620 compared with 41% (95% CI: -6.44, -0.37) lower, respectively, in children with U-tAs > 70 ng/mL compared with iAs was significantly associated with higher BP and LVM and with lower EF in our study population of Mexican children.

Infection with koala retrovirus subgroup B (KoRV-B), but not KoRV-A, is associated with chlamydial disease in free-ranging koalas (Phascolarctos cinereus).

Science.gov (United States)

Waugh, Courtney A; Hanger, Jonathan; Loader, Joanne; King, Andrew; Hobbs, Matthew; Johnson, Rebecca; Timms, Peter

2017-03-09

The virulence of chlamydial infection in wild koalas is highly variable between individuals. Some koalas can be infected (PCR positive) with Chlamydia for long periods but remain asymptomatic, whereas others develop clinical disease. Chlamydia in the koala has traditionally been studied without regard to coinfection with other pathogens, although koalas are usually subject to infection with koala retrovirus (KoRV). Retroviruses can be immunosuppressive, and there is evidence of an immunosuppressive effect of KoRV in vitro. Originally thought to be a single endogenous strain, a new, potentially more virulent exogenous variant (KoRV-B) was recently reported. We hypothesized that KoRV-B might significantly alter chlamydial disease outcomes in koalas, presumably via immunosuppression. By studying sub-groups of Chlamydia and KoRV infected koalas in the wild, we found that neither total KoRV load (either viraemia or proviral copies per genome), nor chlamydial infection level or strain type, was significantly associated with chlamydial disease risk. However, PCR positivity with KoRV-B was significantly associated with chlamydial disease in koalas (p = 0.02961). This represents an example of a recently evolved virus variant that may be predisposing its host (the koala) to overt clinical disease when co-infected with an otherwise asymptomatic bacterial pathogen (Chlamydia).

Echocardiographic assessment of right ventricular functions in healthy subjects who migrated from the sea level to a moderate altitude.

Science.gov (United States)

Arısoy, Arif; Topçu, Selim; Demirelli, Selami; Altunkaş, Fatih; Karayakalı, Metin; Çelik, Ataç; Tanboğa, İbrahim Halil; Aksakal, Enbiya; Sevimli, Serdar; Gürlertop, Hanefi Yekta

2015-11-25

The aim of this study was to evaluate right ventricle (RV) functions using echocardiography in healthy subjects who migrated from the sea level to moderate altitude (1890 m). The prospective observational in this study population consisted of 33 healthy subjects (23 men; mean age 20.4±3.2 years) who migrated from the sea level to a moderate altitude (Erzurum city centre, 1890 m above sea level) for long-term stay. Subjects underwent echocardiographic evaluation within the first 48 h of exposure to the moderate altitude and at the sixth month of arrival. Conventional echocardiographic parameters such as RV sizes and areas, systolic, and diastolic functional indices [fractional area change (FAC), tricuspid flow velocities, myocardial performance index (MPI), and tricuspid annular plane systolic excursion (TAPSE)] were obtained. Systolic (S) and diastolic (E', A') velocities were acquired from the apical fourchamber view using tissue Doppler imaging. Kolmogorov-Smirnov test, student's t-test, Wilcoxon test, and chi-square test were used in this study. There were no significant changes in RV size, FAC, MPI, TAPSE, inferior inspiratory vena cava collapse, tricuspid E velocity, and tricuspid annulus E' velocity. Compared with the baseline, there was a significant increase in mean pulmonary artery pressure (p=0.001); RV end systolic area (p=0.014); right atrial end diastolic area (p=0.021); tricuspid A velocity (p=0.013); tricuspid annulus S and A' velocity (p=0.031 and p=0.006, respectively); and RV free wall S, E', and A' velocity (p=0.007, pa significant decrease in tricuspid E/A ratio (1.61±0.3 vs. 1.45±0.2, p=0.038) and tricuspid annulus E'/A' ratio (1.52±0.5 vs. 1.23±0.4, p=0.002) at the sixth month. Our study revealed that right ventricular diastolic function was altered while the systolic function was preserved in healthy subjects who migrated from the sea level to a moderate altitude.

Nesfatin-1 and Vitamin D levels may be associated with systolic and diastolic blood pressure values and hearth rate in polycystic ovary syndrome.

Science.gov (United States)

Sahin, Figen Kir; Sahin, Serap Baydur; Ural, Ulku Mete; Cure, Medine Cumhur; Senturk, Senol; Tekin, Yesim Bayoglu; Balik, Gulsah; Cure, Erkan; Yuce, Suleyman; Kirbas, Aynur

2015-07-09

Obesity, insulin resistance (IR), inflammation, and hyperandrogenism may lead to polycystic ovary syndrome (PCOS) and hypertension. Nesfatin-1 (N1) may be related to IR, obesity, and hypertension. Furthermore, a vitamin D (VD) deficiency is associated with hypertension and PCOS. We aimed to investigate N1 and VD levels in PCOS that have an effect on systolic and diastolic blood pressure (BP) and heart rate (HR).This study included 54 patients with PCOS and 48 age-body mass index (BMI)-matched healthy controls. PCOS was diagnosed according to clinical practice guidelines. Ferriman-Gallwey scores (FGS) were calculated, while N1, VD, and other hormonal and biochemical parameters were measured for all subjects. Systolic and diastolic BP was measured as well. HR was calculated using an electrocardiogram.The levels of N1 (p < 0.001), high-sensitivity C-reactive protein (hs-CRP) (p = 0.036), homeostasis model assessment as an index of insulin resistance (HOMA-IR) (p < 0.001), systolic (p < 0.001) and diastolic (p < 0.001) BP and HR (p < 0.001) in the PCOS group were significantly higher than in the control group. However, the VD levels of the PCOS group were lower than the control group (p = 0.004). N1 had a strong positive correlation with BMI, HOMA-IR, hs-CRP, luteinizing hormone, systolic and diastolic BP, and HR. VD levels were negatively correlated with HOMA-IR and luteinizing hormone.Elevated N1 and decreased VD levels may be related to the presence of high-normal BP or hypertension in PCOS subjects.  N1 level may be associated with an increased BP due to its relation to inflammation and IR.

Patient-Specific MRI-Based Right Ventricle Models Using Different Zero-Load Diastole and Systole Geometries for Better Cardiac Stress and Strain Calculations and Pulmonary Valve Replacement Surgical Outcome Predictions.

Directory of Open Access Journals (Sweden)

Dalin Tang

Full Text Available Accurate calculation of ventricular stress and strain is critical for cardiovascular investigations. Sarcomere shortening in active contraction leads to change of ventricular zero-stress configurations during the cardiac cycle. A new model using different zero-load diastole and systole geometries was introduced to provide more accurate cardiac stress/strain calculations with potential to predict post pulmonary valve replacement (PVR surgical outcome.Cardiac magnetic resonance (CMR data were obtained from 16 patients with repaired tetralogy of Fallot prior to and 6 months after pulmonary valve replacement (8 male, 8 female, mean age 34.5 years. Patients were divided into Group 1 (n = 8 with better post PVR outcome and Group 2 (n = 8 with worse post PVR outcome based on their change in RV ejection fraction (EF. CMR-based patient-specific computational RV/LV models using one zero-load geometry (1G model and two zero-load geometries (diastole and systole, 2G model were constructed and RV wall thickness, volume, circumferential and longitudinal curvatures, mechanical stress and strain were obtained for analysis. Pairwise T-test and Linear Mixed Effect (LME model were used to determine if the differences from the 1G and 2G models were statistically significant, with the dependence of the pair-wise observations and the patient-slice clustering effects being taken into consideration. For group comparisons, continuous variables (RV volumes, WT, C- and L- curvatures, and stress and strain values were summarized as mean ± SD and compared between the outcome groups by using an unpaired Student t-test. Logistic regression analysis was used to identify potential morphological and mechanical predictors for post PVR surgical outcome.Based on results from the 16 patients, mean begin-ejection stress and strain from the 2G model were 28% and 40% higher than that from the 1G model, respectively. Using the 2G model results, RV EF changes correlated negatively with

Left Atrial Systolic Force in Asymptomatic Aortic Stenosis

DEFF Research Database (Denmark)

Cioffi, Giovanni; Cramariuc, Dana; Dalsgaard, Morten

2011-01-01

LASF in the total study population was 21 ± 14 kdynes/cm(2) . The determinants of LASF were higher age, heart rate, body mass index, systolic blood pressure, left ventricular (LV) mass, mitral peak early velocity, maximal LA volume, and longer mitral deceleration time (multiple R(2) = 0.37, P ...Background: There is a limited knowledge about left atrial (LA) systolic force (LASF) and its key determinants in patients with asymptomatic mild-moderate aortic stenosis (AS). Methods: We used baseline clinic and echocardiographic data from 1,566 patients recruited in the simvastatin ezetimibe...... in aortic stenosis study evaluating the effect of placebo-controlled combined simvastatin and ezetimibe treatment in asymptomatic AS. The LASF was calculated by Manning's method. Low and high LASF were defined as 95th percentile of the distribution within the study population, respectively. Results: Mean...

Cardiac MRI assessment of right ventricular function: impact of right bundle branch block on the evaluation of cardiac performance parameters

Energy Technology Data Exchange (ETDEWEB)

Marterer, Robert; Tschauner, Sebastian; Sorantin, Erich [Medical University of Graz, Division of Pediatric Radiology, Department of Radiology, Graz (Austria); Zeng, Hongchun [First Affiliated Hospital of Xinjiang Medical University, Department of Ultrasonography, Urumqi (China); Koestenberger, Martin [Medical University of Graz, Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Graz (Austria)

2015-12-15

Right ventricular (RV) function represents a prognostic marker in patients with corrected congenital heart disease. In up to 80 % of these patients, right branch bundle block (RBBB) exists and leads to asynchronous ventricular contraction. The aim of this retrospective study was to evaluate the change of RV performance parameters considering delayed RV end-systolic contraction. RV volumes of 33 patients were assessed twice: 1) not taking account of RBBB (group I), and 2) considering RBBB (group II). According to the RV ejection fraction (EF) for both groups, RV function was classified in different categories (>50 % = normal, 40-50 % = mildly-, 30-40 % = moderately-, <30 % = severely-reduced). The mean time difference between maximal systolic contraction of the septum and RV free wall was 90.7 ms ± 42.6. Consequently, RV end-systolic volume was significantly decreased in group II (p < 0.001). Accordingly, RV stroke volume and RV EF were significantly higher in group II (p < 0.001). There was also a significant change in the assessment of RV function (p < 0.02). RBBB induced delayed RV contraction can be detected at CMR. Ignoring the RV physiology in RBBB patients leads to a statistically significant underscoring of RV performance parameters. (orig.)

Systolic trees and systolic language recognition by tree automata

Energy Technology Data Exchange (ETDEWEB)

Steinby, M

1983-01-01

K. Culik II, J. Gruska, A. Salomaa and D. Wood have studied the language recognition capabilities of certain types of systolically operating networks of processors (see research reports Cs-81-32, Cs-81-36 and Cs-82-01, Univ. of Waterloo, Ontario, Canada). In this paper, their model for systolic VLSI trees is formalised in terms of standard tree automaton theory, and the way in which some known facts about recognisable forests and tree transductions can be applied in VLSI tree theory is demonstrated. 13 references.

Is hydrotherapy an appropriate form of exercise for elderly patients with biventricular systolic heart failure?

Science.gov (United States)

Sveälv, Bente Grüner; Täng, Margareta Scharin; Cider, Åsa

2012-01-01

Hydrotherapy (exercise in warm water) is considered to be a safe and beneficial method to use in the rehabilitation of stable heart failure patients, but there is little information on the effect of the increased venous return and enhanced preload in elderly patients with biventricular heart failure. We present a case of an elderly man who was recruited to participate in a hydrotherapy study. We compared echocardiographic data during warm water immersion with land measurements, and observed increases in stroke volume from 32 mL (land) to 42 mL (water), left ventricular ejection fraction from 22% to 24%, left ventricular systolic velocity from 4.8 cm/s to 5.0 cm/s and left atrioventricular plane displacement from 2.1 mm to 2.2 mm. By contrast, right ventricular systolic velocity decreased from 11.2 cm/s to 8.4 cm/s and right atrioventricular plane displacement from 8.1 mm to 4.7 mm. The tricuspid pressure gradient rose from 18 mmHg on land to 50 mmHg during warm water immersion. Thus, although left ventricular systolic function was relatively unaffected during warm water immersion, we observed a decrease in right ventricular function with an augmented right ventricular pressure. We recommend further investigations to observe the cardiac effect of warm water immersion on patients with biventricular systolic heart failure and at risk of elevated right ventricular pressure. PMID:23341846

Left Ventricular Function in Patients with Pulmonary Arterial Hypertension: The Role of Two-Dimensional Speckle Tracking Strain.

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de Amorim Corrêa, Ricardo; de Oliveira, Fernanda Brito; Barbosa, Marcia M; Barbosa, Jose Augusto A; Carvalho, Taís Soares; Barreto, Michele Campos; Campos, Frederico Thadeu A F; Nunes, Maria Carmo Pereira

2016-09-01

Pulmonary arterial hypertension (PAH) is characterized by elevated mean pulmonary arterial pressure with abnormal right ventricular (RV) pressure overload that may alter left ventricular (LV) function. The aim of this study was to assess the impact of RV pressure overload on LV function in PAH patients using two-dimensional (2D) speckle tracking strain. The study enrolled 37 group 1 PAH patients and 38 age- and gender-matched healthy controls. LV longitudinal and radial 2D strains were measured with and without including the ventricular septum. Six-minute walk test (6MWT) and brain natriuretic peptide (BNP) levels were also obtained in patients with PAH. The mean age of patients was 46.4 ± 14.8 years, 76% women, and 16 patients (43%) had schistosomiasis. Sixteen patients (43%) were in WHO class III or IV under specific treatment for PAH. The overall 6MWT distance was 441 meters, and the BNP levels were 80 pg/mL. Patients with PAH more commonly presented with LV diastolic dysfunction and impairment of RV function when compared to controls. LV global longitudinal and radial strains were lower in patients than in controls (-17.9 ± 2.8 vs. -20.5 ± 1.9; P < 0.001 and 30.8 ± 10.5 vs. 49.8 ± 15.4; P < 0.001, respectively). After excluding septal values, LV longitudinal and radial strains remained lower in patients than in controls. The independent factors associated with global LV longitudinal strain were LV ejection fraction, RV fractional area change, and tricuspid annular systolic motion. This study showed impaired LV contractility in patients with PAH assessed by speckle tracking strain, irrespective of ventricular septal involvement. Global LV longitudinal strain was associated independently with RV fractional area change and tricuspid annular systolic motion, after adjustment for LV ejection fraction. © 2016, Wiley Periodicals, Inc.

Observation of the pulse oximeter trace to estimate systolic blood ...

African Journals Online (AJOL)

Southern African Journal of Anaesthesia and Analgesia is co-published by Medpharm .... a clinically relevant amount of time when compared with NIBP ... at the time of recruitment to the study. ... Inclusion criteria were age > 18 years, ASA Class 1 to 3 and .... measured systolic blood pressure values (mean [SD], mmHg) per.

RV-Typer: A Web Server for Typing of Rhinoviruses Using Alignment-Free Approach.

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Pandurang S Kolekar

Full Text Available Rhinoviruses (RV are increasingly being reported to cause mild to severe infections of respiratory tract in humans. RV are antigenically the most diverse species of the genus Enterovirus and family Picornaviridae. There are three species of RV (RV-A, -B and -C, with 80, 32 and 55 serotypes/types, respectively. Antigenic variation is the main limiting factor for development of a cross-protective vaccine against RV.Serotyping of Rhinoviruses is carried out using cross-neutralization assays in cell culture. However, these assays become laborious and time-consuming for the large number of strains. Alternatively, serotyping of RV is carried out by alignment-based phylogeny of both protein and nucleotide sequences of VP1. However, serotyping of RV based on alignment-based phylogeny is a multi-step process, which needs to be repeated every time a new isolate is sequenced. In view of the growing need for serotyping of RV, an alignment-free method based on "return time distribution" (RTD of amino acid residues in VP1 protein has been developed and implemented in the form of a web server titled RV-Typer. RV-Typer accepts nucleotide or protein sequences as an input and computes return times of di-peptides (k = 2 to assign serotypes. The RV-Typer performs with 100% sensitivity and specificity. It is significantly faster than alignment-based methods. The web server is available at http://bioinfo.net.in/RV-Typer/home.html.

Prognostic value of systolic mitral annular velocity measured with Doppler tissue imaging in patients with chronic heart failure caused by left ventricular systolic dysfunction

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Nikitin, N P; Loh, P H; de Silva, R; Ghosh, J; Khaleva, O Y; Goode, K; Rigby, A S; Alamgir, F; Clark, A L; Cleland, J G F

2006-01-01

Objective To assess the prognostic value of various conventional and novel echocardiographic indices in patients with chronic heart failure (CHF) caused by left ventricular (LV) systolic dysfunction. Methods 185 patients with a mean (SD) age of 67 (11) years with CHF and LV ejection fraction < 45% despite optimal pharmacological treatment were prospectively enrolled. The patients underwent two dimensional echocardiography with tissue harmonic imaging to assess global LV systolic function and obtain volumetric data. Transmitral flow was assessed with conventional pulse wave Doppler. Systolic (Sm), early, and late diastolic mitral annular velocities were measured with the use of colour coded Doppler tissue imaging. Results During a median follow up of 32 months (range 24–38 months in survivors), 34 patients died and one underwent heart transplantation. Sm velocity (hazard ratio (HR) 0.648, 95% confidence interval (CI) 0.463 to 0.907, p  =  0.011), diastolic arterial pressure (HR 0.965, 95% CI 0.938 to 0.993, p  =  0.015), serum creatinine (HR 1.006, 95% CI 1.001 to 1.011, p  =  0.023), LV ejection fraction (HR 0.945, 95% CI 0.899 to 0.992, p  =  0.024), age (HR 1.035, 95% CI 1.000 to 1.071, p  =  0.052), LV end systolic volume index (HR 1.009, 95% CI 0.999 to 1.019, p  =  0.067), and restrictive pattern of transmitral flow (HR 0.543, 95% CI 0.278 to 1.061, p  =  0.074) predicted the outcome of death or transplantation on univariate analysis. On multivariate analysis, only Sm velocity (HR 0.648, 95% CI 0.460 to 0.912, p  =  0.013) and diastolic arterial pressure (HR 0.966, 95% CI 0.938 to 0.994, p  =  0.016) emerged as independent predictors of outcome. Conclusions In patients with CHF and LV systolic dysfunction despite optimal pharmacological treatment, the strongest independent echocardiographic predictor of prognosis was Sm velocity measured with quantitative colour coded Doppler tissue

Assessment of cardiac function and hemodynamics in children and adults with right ventricular pressure overload: role of cardiac magnetic resonance imaging

NARCIS (Netherlands)

Romeih, Soha

2014-01-01

Accumulating evidence suggests that pressure overload on the right ventricle (RV) leads to RV dysfunction, with considerable morbidity and mortality. Therefore, appropriate RV evaluation is essential because timely intervention may preserve RV function and prevent irreversible RV damage. Currently,

Initial shunt type at the Norwood operation impacts myocardial function in hypoplastic left heart syndrome.

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Ruotsalainen, Hanna K; Pihkala, Jaana; Salminen, Jukka; Hornberger, Lisa K; Sairanen, Heikki; Ojala, Tiina

2017-08-01

We investigated the impact of initial shunt type, a Blalock-Taussig (BT) shunt versus a right ventricle to pulmonary artery conduit (RV-PA) on myocardial function at different stages of surgical palliation in patients with hypoplastic left heart syndrome (HLHS). A population-based cohort of 63 Finnish children with HLHS (BT n  = 23, RV-PA n  = 40) born between 2003 and 2010 were studied retrospectively by echocardiography prior to Stages 1, 2 and 3 palliation and 0.5-3 years after Stage 3. For comparison of systolic myocardial function, we evaluated the RV fractional area change (FAC), strain, strain rate and mechanical synchrony from the apical 4-chamber view by velocity vector imaging. There were no intergroup differences in demographics during the study period. At baseline, no intergroup differences were detected in RV systolic myocardial function. Before Stage 2, RV FAC was higher ( P  = 0.03) in the RV-PA conduit group. At Stage 3, an increase in all systolic myocardial functional parameters was observed in the BT shunt group. After Stage 3, the BT shunt group had better RV systolic function. In multiple regression analysis, the shunt type and the stage of palliation had an impact on myocardial function. Although patients with HLHS initially palliated with a BT shunt demonstrate lower RV FAC after Stage I, RV FAC improves after Stage 2 with better systolic performance after Stage 3 compared with those initially palliated with an RV-PA conduit. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Evaluation of the effect of systolic blood pressure and pulse pressure on cognitive function: the Women's Health and Aging Study II.

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Sevil Yasar

Full Text Available Evidence suggests that elevated systolic blood pressure (SBP and pulse pressure (PP in midlife is associated with increased risk for cognitive impairment later in life. There is mixed evidence regarding the effects of late life elevated SBP or PP on cognitive function, and limited information on the role of female gender.Effects of SBPand PPon cognitive abilities at baseline and over a 9-year period were evaluated in 337 non-demented community-dwelling female participants over age 70 in the Women's Health and Aging Study II using logistic and Cox proportional hazards regression analyses. Participants aged 76-80 years with SBP≥160 mmHg or PP≥84 mmHg showed increased incidence of impairment on Trail Making Test-Part B (TMT, Part B, a measure of executive function, over time when compared to the control group that included participants with normal and pre-hypertensive SBP (<120 and 120-139 mmHg or participants with low PP (<68 mmHg (HR = 5.05 [95%CI = 1.42, 18.04], [HR = 5.12 [95%CI = 1.11; 23.62], respectively. Participants aged 70-75 years with PP≥71 mmHg had at least a two-fold higher incidence of impairment on HVLT-I, a measure of verbal learning, over time when compared to participants with low PP (<68 mmHg (HR = 2.44 [95%CI = 1.11, 5.39].Our data suggest that elevated SBP or PP in older non-demented women increases risk for late-life cognitive impairment and that PP could be used when assessing the risk for impairment in cognitive abilities. These results warrant further, larger studies to evaluate possible effects of elevated blood pressure in normal cognitive aging.

Rotavirus shedding following administration of RV3-BB human neonatal rotavirus vaccine.

Science.gov (United States)

Cowley, Daniel; Boniface, Karen; Bogdanovic-Sakran, Nada; Kirkwood, Carl D; Bines, Julie E

2017-08-03

The RV3-BB human neonatal rotavirus vaccine aims to provide protection from severe rotavirus disease from birth. A phase IIa safety and immunogenicity trial was undertaken in Dunedin, New Zealand between January 2012 and April 2014. Healthy, full-term (≥ 36 weeks gestation) babies, who were 0-5 d old were randomly assigned (1:1:1) to receive 3 doses of oral RV3-BB vaccine with the first dose given at 0-5 d after birth (neonatal schedule), or the first dose given at about 8 weeks after birth (infant schedule), or to receive placebo (placebo schedule). Vaccine take (serum immune response or stool shedding of vaccine virus after any dose) was detected after 3 doses of RV3-BB vaccine in >90% of participants when the first dose was administered in the neonatal and infant schedules. The aim of the current study was to characterize RV3-BB shedding and virus replication following administration of RV3-BB in a neonatal and infant vaccination schedule. Shedding was defined as detection of rotavirus by VP6 reverse transcription polymerase chain reaction (RT-PCR) in stool on days 3-7 after administration of RV3-BB. Shedding of rotavirus was highest following vaccination at 8 weeks of age in both neonatal and infant schedules (19/30 and 17/27, respectively). Rotavirus was detected in stool on days 3-7, after at least one dose of RV3-BB, in 70% (21/30) of neonate, 78% (21/27) of infant and 3% (1/32) placebo participants. In participants who shed RV3-BB, rotavirus was detectable in stool on day 1 following RV3-BB administration and remained positive until day 4-5 after administration. The distinct pattern of RV3-BB stool viral load demonstrated using a NSP3 quantitative qRT-PCR in participants who shed RV3-BB, suggests that detection of RV3-BB at day 3-7 was the result of replication rather than passage through the gastrointestinal tract.

Blood pressure changes in dogs with babesiosis

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L.S. Jacobson

2000-07-01

Full Text Available Systemic arterial blood pressures were measured in 30 dogs with acute babesiosis, 10 each with mild uncomplicated, severe uncomplicated and complicated disease. Ten healthy dogs were used as controls. Hypotension was defined as more than 3 standard deviations below the control mean. Normal mean pressures (±SD were: systolic arterial pressure 151 (±11 mm Hg, diastolic arterial pressure 89 (±8 mm Hg and mean arterial pressure 107 (±10 mmHg. Hypotension was the most frequent abnormality, and increased strikingly in incidence as disease severity increased, with 5/10 dogs in the complicated group being hypotensive for systolic, diastolic and mean arterial pressures, compared with 2/10 in the severe uncomplicated group and 0/10 in the mild uncomplicated group. Systolic, diastolic and mean arterial pressures in the complicated group and severe uncomplicated group, and systolic pressure in the mild uncomplicated group, were significantly lower than in the controls. There were no significant relationships between arterial pressures and age, pulse rate, respiratory rate, temperature, mucous membrane colour or haematocrit. There was a significant negative correlation between arterial pressures and white cell and immature neutrophil counts. Arterial pressures differed significantly between dogs that were clinically collapsed and those that were not, but not between survivors and non-survivors. Pulse pressure (systolic - diastolic was low in 7/10 complicated, 1/10 mild uncomplicated, and 1/10 severe uncomplicated cases, and differed significantly between the complicated and control groups. The high incidence of hypotension in clinically severe babesiosis has important implications for therapy.

A PILOT STUDY ON THE EFFECTS OF MAGNESIUM SUPPLEMENTATION WITH HIGH AND LOW HABITUAL DIETARY MAGNESIUM INTAKE ON RESTING AND RECOVERY FROM AEROBIC AND RESISTANCE EXERCISE AND SYSTOLIC BLOOD PRESSURE

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Lindsy S. Kass

2013-03-01

Full Text Available The effects of magnesium supplementation on blood pressure (BP have been studied for over 25 years and results have been inconsistent. Blood pressure reductions in randomized studies have varied from 12 mmHg reductions to no reduction. The objective of this pilot intervention was to investigate the effect of magnesium supplementation on systolic blood pressure whilst resting and during recovery from aerobic and resistance exercise and on performance. A further objective was to see whether the effect of a high vs low habitual dietary magnesium intake affected these results. Sixteen male volunteers were randomly assigned to either a 300 mg·d-1 magnesium oxide supplementation (MO or a control group (CG for 14 days. Resting blood pressure (BP and heart rate (HR were measured before subjects performed a maximal 30 minute cycle, immediately followed by three x 5 second isometric bench press, both at baseline and after the intervention. Blood pressure and heart rate were recorded immediately post exercise and after five minutes recovery. A 3 day food diary was recorded for all subjects to measure dietary magnesium intake. At the end of the intervention, the supplemented group, had a reduction in mean resting systolic BP by 8.9 mmHg (115.125 ± 9.46 mmHg, p = 0.01 and post exercise by 13 mmHg (122.625 ± 9. 88 mmHg, p = 0.01. Recovery BP was 11.9 mmHg lower in the intervention group compared to control (p = 0.006 and HR decreased by 7 beats per minute in the experimental group (69.0 ± 11.6 bpm, p = 0. 02. Performance indicators did not change within and between the groups. Habitual dietary magnesium intake affected both resting and post exercise systolic BP and the subsequent effect of the magnesium supplementation. These results have an implication in a health setting and for health and exercise but not performance.

[Comparison of invasive blood pressure measurement in the aorta with indirect oscillometric blood pressure measurement at the wrist and forearm].

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Saul, F; Aristidou, Y; Klaus, D; Wiemeyer, A; Lösse, B

1995-09-01

Indirectly measured blood pressure at the wrist or upper arm was compared with directly measured values in the aortic arch during routinely performed diagnostic cardiac catheterization in 100 patients (31-80 years, mean 59.3 years, 60% males). The noninvasive measurements were carried out by oscillometric devices, NAiS Blood Pressure Watch for measurements at the wrist, and Hestia OZ80 at the upper arm. Systolic blood pressure measured at the wrist was 4.3 +/- 14.1 mm Hg, and the diastolic value 6.0 +/- 8.9 mm Hg higher than when measured at the aortic arch; the difference was significant in both cases. Correlation coefficients were 0.85 for systolic and 0.71 for diastolic blood pressure. In 16% of the patients the systolic blood pressure at the wrist differed more than +/- 20 mm Hg. The diastolic blood pressure at the wrist measured more than +/- 20 mm Hg higher than in the aorta in 5% of the patients. At the upper arm mean systolic values were not different to the aorta. The diastolic pressure was 9.3 +/- 9.8 mm Hg higher in the aorta than at the upper arm. To verify the accuracy of values measured with the NAiS Blood Pressure Watch compared with the standard technique at the upper arm, sequential measurements were made at wrist and ipsilateral upper arm in the same group of 100 patients. The systolic blood pressure at the left wrist was 3.4 +/- 13.3 mm Hg higher and the diastolic pressure 3.8 +/- 9.5 mm Hg lower than at the upper arm. Only 53% of systolic values lay within a range of +/- 10 mm Hg. The correspondence between wrist and upper arm values was better for diastolic blood pressure, the values differing by less than +/- 10 mm Hg in two-thirds of patients. Self-measurement of arterial blood pressure with an oscillometric device at the wrist can be recommended only in individual cases with a difference of simultaneously measured values at the upper arm of less than +/- 10 mm Hg for systolic and diastolic blood pressures. The standard method for indirectly

Echocardiographic parameters and survival in Chagas heart disease with severe systolic dysfunction.

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Rassi, Daniela do Carmo; Vieira, Marcelo Luiz Campos; Arruda, Ana Lúcia Martins; Hotta, Viviane Tiemi; Furtado, Rogério Gomes; Rassi, Danilo Teixeira; Rassi, Salvador

2014-03-01

Echocardiography provides important information on the cardiac evaluation of patients with heart failure. The identification of echocardiographic parameters in severe Chagas heart disease would help implement treatment and assess prognosis. To correlate echocardiographic parameters with the endpoint cardiovascular mortality in patients with ejection fraction Celular em Cardiopatias) - Chagas heart disease arm. The following parameters were collected: left ventricular systolic and diastolic diameters and volumes; ejection fraction; left atrial diameter; left atrial volume; indexed left atrial volume; systolic pulmonary artery pressure; integral of the aortic flow velocity; myocardial performance index; rate of increase of left ventricular pressure; isovolumic relaxation time; E, A, Em, Am and Sm wave velocities; E wave deceleration time; E/A and E/Em ratios; and mitral regurgitation. In the mean 24.18-month follow-up, 27 patients died. The mean ejection fraction was 26.6 ± 5.34%. In the multivariate analysis, the parameters ejection fraction (HR = 1.114; p = 0.3704), indexed left atrial volume (HR = 1.033; p 70.71 mL/m2 were associated with a significant increase in mortality (log rank p < 0.0001). The indexed left atrial volume was the only independent predictor of mortality in this population of Chagasic patients with severe systolic dysfunction.

[Central blood pressure and vascular damage].

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Pérez-Lahiguera, Francisco; Rodilla, Enrique; Costa, José Antonio; Pascual, José María

2015-07-20

The aim of this study was to assess the relationship between central blood pressure and vascular damage. This cross-sectional study involved 393 never treated hypertensive patients (166 women). Clinical blood pressure (BP), 24h blood pressure (BP24h) and central blood pressure (CBP) were measured. Vascular organ damage (VOD) was assessed by calculating the albumin/creatinine ratio (ACR), wave pulse pressure velocity and echocardiographic left ventricular mass index (LVMI). Patients with VOD had higher values of BP, BP24h, and CBP than patients without ACR. When comparing several systolic BP, systolic BP24h had a higher linear correlation with CBP (Z Steiger test: 2.26; P=.02) and LVMI (Z Steiger test: 3.23; P=.01) than PAC. In a multiple regression analysis corrected by age, sex and metabolic syndrome, all pressures were related with VOD but systolic BP24h showed the highest correlation. In a logistic regression analysis, having the highest tercile of systolic BP24h was the stronger predictor of VOD (multivariate odds ratio: 3.4; CI 95%: 2.5-5.5, P=.001). CBP does not have more correlation with VOD than other measurements of peripheral BP. Systolic BP24h is the BP measurement that best predicts VOD. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

Assessing pharmacy students' ability to accurately measure blood pressure using a blood pressure simulator arm.

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Bottenberg, Michelle M; Bryant, Ginelle A; Haack, Sally L; North, Andrew M

2013-06-12

To compare student accuracy in measuring normal and high blood pressures using a simulator arm. In this prospective, single-blind, study involving third-year pharmacy students, simulator arms were programmed with prespecified normal and high blood pressures. Students measured preset normal and high diastolic and systolic blood pressure using a crossover design. One hundred sixteen students completed both blood pressure measurements. There was a significant difference between the accuracy of high systolic blood pressure (HSBP) measurement and normal systolic blood pressure (NSBP) measurement (mean HSBP difference 8.4 ± 10.9 mmHg vs NSBP 3.6 ± 6.4 mmHg; pdifference between the accuracy of high diastolic blood pressure (HDBP) measurement and normal diastolic blood pressure (NDBP) measurement (mean HDBP difference 6.8 ± 9.6 mmHg vs. mean NDBP difference 4.6 ± 4.5 mmHg; p=0.089). Pharmacy students may need additional instruction and experience with taking high blood pressure measurements to ensure they are able to accurately assess this important vital sign.

Assessing Pharmacy Students’ Ability to Accurately Measure Blood Pressure Using a Blood Pressure Simulator Arm

Science.gov (United States)

Bryant, Ginelle A.; Haack, Sally L.; North, Andrew M.

2013-01-01

Objective. To compare student accuracy in measuring normal and high blood pressures using a simulator arm. Methods. In this prospective, single-blind, study involving third-year pharmacy students, simulator arms were programmed with prespecified normal and high blood pressures. Students measured preset normal and high diastolic and systolic blood pressure using a crossover design. Results. One hundred sixteen students completed both blood pressure measurements. There was a significant difference between the accuracy of high systolic blood pressure (HSBP) measurement and normal systolic blood pressure (NSBP) measurement (mean HSBP difference 8.4 ± 10.9 mmHg vs NSBP 3.6 ± 6.4 mmHg; pdifference between the accuracy of high diastolic blood pressure (HDBP) measurement and normal diastolic blood pressure (NDBP) measurement (mean HDBP difference 6.8 ± 9.6 mmHg vs. mean NDBP difference 4.6 ± 4.5 mmHg; p=0.089). Conclusions. Pharmacy students may need additional instruction and experience with taking high blood pressure measurements to ensure they are able to accurately assess this important vital sign. PMID:23788809

Association of different electrocardiographic patterns with shock index, right ventricle systolic pressure and diameter, and embolic burden score in pulmonary embolism

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Krća Bojana

2016-01-01

Full Text Available Background/Aim. Some electrocardiographic (ECG patterns are characteristic for pulmonary embolism but exact meaning of the different ECG signs are not well known. The aim of this study was to determine the association between four common ECG signs in pulmonary embolism [complete or incomplete right bundle branch block (RBBB, S-waves in the aVL lead, S1Q3T3 sign and negative T-waves in the precordial leads] with shock index (SI, right ventricle diastolic diameter (RVDD and peak systolic pressure (RVSP and embolic burden score (EBS. Methods. The presence of complete or incomplete RBBB, S waves in aVL lead, S1Q3T3 sign and negative T-waves in the precordial leads were determined at admission ECG in 130 consecutive patients admitted to the intensive care unit of a single tertiary medical center in a 5-year period. Echocardiography examination with measurement of RVDD and RVSP, multidetector computed tomography pulmonary angiography (MDCT-PA with the calculation of EBS and SI was determined during the admission process. Multivariable regression models were calculated with ECG parameters as independent variables and the mentioned ultrasound, MDCT-PA parameters and SI as dependent variables. Results. The presence of S-waves in the aVL was the only independent predictor of RVDD (F = 39.430, p < 0.001; adjusted R2 = 0.231 and systolic peak right ventricle pressure (F = 29.903, p < 0.001; adjusted R2 = 0.185. Negative T-waves in precordial leads were the only independent predictor for EBS (F = 24.177, p < 0.001; R2 = 0.160. Complete or incomplete RBBB was the independent predictor of SI (F = 20.980, p < 0.001; adjusted R2 = 0.134. Conclusion. In patients with pulmonary embolism different ECG patterns at admission correlate with different clinical, ultrasound and MDCT-PA parameters. RBBB is associated with shock, Swave in the aVL is associated with right ventricle pressure and negative T-waves with the thrombus burden in the pulmonary tree.

1993 recreational vehicle (RV) park census in Beatty and Pahrump, Nevada

International Nuclear Information System (INIS)

Levy, L.E.; Housel, M.D.

1994-01-01

This paper reports on the second annual study of seasonal nonpermanent residents in the towns of Beatty and Pahrump in southern Nye County, Nevada, situs county of the Yucca Mountain Site Characterization Project. The study used a census of recreational vehicle (RV) park managers to enumerate and characterize in demographic terms nonpermanent residents staying in RV parks. The questionnaire sought information from RV park managers which ordinarily would come from a household survey. The main objective was to study open-quotes snowbirdsclose quotes, the households of older couples who stay for a month or more each winter. The findings suggest that snowbirds are a majority of the seasonal influx of nonpermanent residents to RV parks in Pahrump. In contrast, a group called open-quotes seasonal travelersclose quotes, similar demographically but who stay less than a month, dominate the seasonal nonpermanent population in Beatty's RV parks. The study also tentatively identified the seasonality of nonpermanent resident occupancy. Because only RV parks were contacted, the study left unanswered the question of how many snowbirds live in other types of accommodations in Beatty and Pahrump

Significance of white-coat hypertension in older persons with isolated systolic hypertension: a meta-analysis using the International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes population.

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Franklin, Stanley S; Thijs, Lutgarde; Hansen, Tine W; Li, Yan; Boggia, José; Kikuya, Masahiro; Björklund-Bodegård, Kristina; Ohkubo, Takayoshi; Jeppesen, Jørgen; Torp-Pedersen, Christian; Dolan, Eamon; Kuznetsova, Tatiana; Stolarz-Skrzypek, Katarzyna; Tikhonoff, Valérie; Malyutina, Sofia; Casiglia, Edoardo; Nikitin, Yuri; Lind, Lars; Sandoya, Edgardo; Kawecka-Jaszcz, Kalina; Imai, Yutaka; Wang, Jiguang; Ibsen, Hans; O'Brien, Eoin; Staessen, Jan A

2012-03-01

The significance of white-coat hypertension in older persons with isolated systolic hypertension remains poorly understood. We analyzed subjects from the population-based 11-country International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes database who had daytime ambulatory blood pressure (BP; ABP) and conventional BP (CBP) measurements. After excluding persons with diastolic hypertension by CBP (≥90 mm Hg) or by daytime ABP (≥85 mm Hg), a history of cardiovascular disease, and persons <18 years of age, the present analysis totaled 7295 persons, of whom 1593 had isolated systolic hypertension. During a median follow-up of 10.6 years, there was a total of 655 fatal and nonfatal cardiovascular events. The analyses were stratified by treatment status. In untreated subjects, those with white-coat hypertension (CBP ≥140/<90 mm Hg and ABP <135/<85 mm Hg) and subjects with normal BP (CBP <140/<90 mm Hg and ABP <135/<85 mm Hg) were at similar risk (adjusted hazard rate: 1.17 [95% CI: 0.87-1.57]; P=0.29). Furthermore, in treated subjects with isolated systolic hypertension, the cardiovascular risk was similar in elevated conventional and normal daytime systolic BP as compared with those with normal conventional and normal daytime BPs (adjusted hazard rate: 1.10 [95% CI: 0.79-1.53]; P=0.57). However, both treated isolated systolic hypertension subjects with white-coat hypertension (adjusted hazard rate: 2.00; [95% CI: 1.43-2.79]; P<0.0001) and treated subjects with normal BP (adjusted hazard rate: 1.98 [95% CI: 1.49-2.62]; P<0.0001) were at higher risk as compared with untreated normotensive subjects. In conclusion, subjects with sustained hypertension who have their ABP normalized on antihypertensive therapy but with residual white-coat effect by CBP measurement have an entity that we have termed, "treated normalized hypertension." Therefore, one should be cautious in applying the term "white-coat hypertension" to persons

Between-visit reproducibility of inter-arm systolic blood pressure differences in treated hypertensive patients: the coconet study.

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Kim, Jang Young; Kim, Eung Ju; Namgung, June; Cho, Byung-Ryul; Nam, Chang-Wook; Kim, Young-Kwon; Park, Jeong Bae

2017-05-01

Inter-arm systolic blood pressure (BP) differences (sIADs) have recently been recognized as a risk factor for cardiovascular mortality. However, sIAD reproducibility remains unresolved from a controlled trial perspective. We evaluated the between-visit reproducibility of sIADs in hypertensive patients. We examined 1875 hypertensive participants aged 20 years and older (mean age: 62.3 years, 45.4% female) from nine primary clinics and 27 secondary and tertiary hospitals. The BPs in both arms were automatically and simultaneously measured in triplicate with a cuff-oscillometric BP device. BP measurements were obtained at baseline and at 3-month follow-up time points. Increased sIAD was defined as an absolute difference of ⩾10 mm Hg in the average systolic BPs between the left and right arms. The overall mean sIAD was 4.33±4.17 mm Hg. The prevalences of increased sIAD at baseline and at the 3-month measurements were 7.6% and 7.1%, respectively. The intraclass correlation coefficient for the between-visit sIADs was 0.304 (95% confidence interval (CI) 0.262-0.344). The κ-value between the baseline and follow-up increased sIADs was 0.165 (95% CI 0.096-0.234). The percentage of patients who exhibited an increased sIAD at 3 months compared with the initially increased sIAD at baseline was 21.8%. The reproducibility of sIAD determination between baseline and the 3-month follow-up measurements lacked agreement in the hypertensive patients. Further studies should identify the relevant variables and characteristics of this poor reproducibility (CRIS number; KCT0001235).

Conserved hypothetical protein Rv1977 in Mycobacterium tuberculosis strains contains sequence polymorphisms and might be involved in ongoing immune evasion.

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Jiang, Yi; Liu, Haican; Wang, Xuezhi; Li, Guilian; Qiu, Yan; Dou, Xiangfeng; Wan, Kanglin

2015-01-01

Host immune pressure and associated parasite immune evasion are key features of host-pathogen co-evolution. A previous study showed that human T cell epitopes of Mycobacterium tuberculosis are evolutionarily hyperconserved and thus it was deduced that M. tuberculosis lacks antigenic variation and immune evasion. Here, we selected 151 clinical Mycobacterium tuberculosis isolates from China, amplified gene encoding Rv1977 and compared the sequences. The results showed that Rv1977, a conserved hypothetical protein, is not conserved in M. tuberculosis strains and there are polymorphisms existed in the protein. Some mutations, especially one frameshift mutation, occurred in the antigen Rv1977, which is uncommon in M.tb strains and may lead to the protein function altering. Mutations and deletion in the gene all affect one of three T cell epitopes and the changed T cell epitope contained more than one variable position, which may suggest ongoing immune evasion.

Radial Velocities of Subgiant Stars and New Astrophysical Insights into RV Jitter

Science.gov (United States)

Luhn, Jacob; Bastien, Fabienne; Wright, Jason T.

2018-01-01

For nearly 20 years, the California Planet Search (CPS) has simultaneously monitored precise radial velocities and chromospheric activity levels of stars from Keck observatory to search for exoplanets. This sample provides a useful set of stars to better determine the dependence of RV jitter on flicker (which traces surface gravity) first shown in Bastien et al. (2014). We expand upon this initial work by examining a much larger sample of stars covering a much wider range of stellar parameters (effective temperature, surface gravity, and activity, among others). For more than 600 stars, there are enough RV measurements to distinguish this astrophysical jitter from accelerations due to orbital companions. To properly isolate RV jitter from these effects, we must first remove the RV signal due to these companions, including several previously unannounced giant planets around subgiant stars. We highlight some new results from our analysis of the CPS data. A more thorough understanding of the various sources of RV jitter and the underlying stellar phenomena that drive these intrinsic RV variations will enable more precise jitter estimates for RV follow-up targets such as those from K2 or the upcoming TESS mission.

Noninvasive Ambient Pressure Estimation using Ultrasound Contrast Agents -- Invoking Subharmonics for Cardiac and Hepatic Applications

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Dave, Jaydev K.

helpful. While an intravenous injection is required to inject the UCAs into the body, this procedure is considered noninvasive as per the definition provided by the Center for Medicare and Medicaid Services; invasive procedures include surgical procedures as well as catheterization procedures while minor procedures such as drawing blood (which requires a similar approach as injecting UCAs) are considered noninvasive. In vitro results showed that the standard error between catheter pressures and SHAPE results is below 10 mmHg with a correlation coefficient value of above 0.9—this experimental error of 10 mmHg is less than the errors associated with other techniques utilizing UCAs for ambient pressure estimation. In vivo results proved the feasibility of SHAPE to noninvasively estimate clinically relevant left and right ventricular (LV and RV) pressures. The maximum error in estimating the LV and RV systolic and diastolic pressures was 3.5 mmHg. Thus, the SHAPE technique may be useful for systolic and diastolic pressure estimation given that the standard recommendations require the errors for these pressure measurements to be within 5 mmHg. The ability of SHAPE to identify induced portal hypertension (PH) was also proved. The changes in the SHAPE data correlated significantly (p < 0.05) with the changes in the portal vein (PV) pressures and the absolute amplitudes of the subharmonic signal also correlated with absolute PV pressures. The SHAPE technique provides the ability to noninvasively obtain in vivo pressures. This technique is applicable not only for critically ill patients, but also for screening symptomatic patients and potentially for other clinical pressure monitoring applications, as well.

TIME VARIATION OF AV AND RV FOR TYPE Ia SUPERNOVAE BEHIND INTERSTELLAR DUST

Science.gov (United States)

Huang, Xiaosheng; Biederman, M.; Herger, B.; Aldering, G. S.

2014-01-01

TIME VARIATION OF AV AND RV FOR TYPE Ia SUPERNOVAE BEHIND NON-UNIFORM INTERSTELLAR DUST ABSTRACT We investigate the time variation of the visual extinction, AV, and the total-to-selective extinction ratio, RV, resulting from interstellar dust in front of an expanding photospheric disk of a type Ia supernova (SN Ia). We simulate interstellar dust clouds according to a power law power spectrum and produce extinction maps that either follow a pseudo-Gaussian distribution or a lognormal distribution. The RV maps are produced through a correlation between AV and RV. With maps of AV and RV generated in each case (pseudo-Gaussian and lognormal), we then compute the effective AV and RV for a SN as its photospheric disk expands behind the dust screen. We find for a small percentage of SNe the AV and RV values can vary by a large factor from day to day in the first 40 days after explosion.

Influence of geomagnetic activity and atmospheric pressure in hypertensive adults

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Azcárate, T.; Mendoza, B.

2017-09-01

We performed a study of the systolic and diastolic arterial blood pressure behavior under natural variables such as the atmospheric pressure and the horizontal geomagnetic field component. We worked with a group of eight adult hypertensive volunteers, four men and four women, with ages between 18 and 27 years in Mexico City during a geomagnetic storm in 2014. The data was divided by gender, age, and day/night cycle. We studied the time series using three methods: correlations, bivariate analysis, and superposed epoch (within a window of 2 days around the day of occurrence of a geomagnetic storm) analysis, between the systolic and diastolic blood pressure and the natural variables. The correlation analysis indicated a correlation between the systolic and diastolic blood pressure and the atmospheric pressure and the horizontal geomagnetic field component, being the largest during the night. Furthermore, the correlation and bivariate analyses showed that the largest correlations are between the systolic and diastolic blood pressure and the horizontal geomagnetic field component. Finally, the superposed epoch analysis showed that the largest number of significant changes in the blood pressure under the influence of geomagnetic field occurred in the systolic blood pressure for men.

Influence of geomagnetic activity and atmospheric pressure in hypertensive adults.

Science.gov (United States)

Azcárate, T; Mendoza, B

2017-09-01

We performed a study of the systolic and diastolic arterial blood pressure behavior under natural variables such as the atmospheric pressure and the horizontal geomagnetic field component. We worked with a group of eight adult hypertensive volunteers, four men and four women, with ages between 18 and 27 years in Mexico City during a geomagnetic storm in 2014. The data was divided by gender, age, and day/night cycle. We studied the time series using three methods: correlations, bivariate analysis, and superposed epoch (within a window of 2 days around the day of occurrence of a geomagnetic storm) analysis, between the systolic and diastolic blood pressure and the natural variables. The correlation analysis indicated a correlation between the systolic and diastolic blood pressure and the atmospheric pressure and the horizontal geomagnetic field component, being the largest during the night. Furthermore, the correlation and bivariate analyses showed that the largest correlations are between the systolic and diastolic blood pressure and the horizontal geomagnetic field component. Finally, the superposed epoch analysis showed that the largest number of significant changes in the blood pressure under the influence of geomagnetic field occurred in the systolic blood pressure for men.

Worldwide trends in blood pressure from 1975 to 2015

NARCIS (Netherlands)

Ezzati, Majid; Geleijnse, J.M.

2017-01-01

Background

Raised blood pressure is an important risk factor for cardiovascular diseases and chronic kidney disease. We estimated worldwide trends in mean systolic and mean diastolic blood pressure, and the prevalence of, and number of people with, raised blood pressure, defined as systolic

Diagnosis of childhood hypertension: is blood pressure height ratio ...

African Journals Online (AJOL)

Blood pressure was also recorded according to the standard method. Systolic and diastolic blood pressure to height ratio were then calculated. Receiver operating curves was used to assess the ability of systolic blood and diastolic blood pressure height ratio to discriminate childhood prehypertension and hypertension.

Oligomeric stability of Rapana venosa hemocyanin (RvH) and its structural subunits.

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Dolashka-Angelova, Pavlina; Schwarz, Heinz; Dolashki, Aleksandar; Stevanovic, Stefan; Fecker, Miriam; Saeed, Muhammad; Voelter, Wolfgang

2003-03-21

The two structural subunits RvH1 and RvH2 were separated after overnight dialysis of Rapana venosa Hc against 130 mM Gly/NaOH buffer, pH 9.6, on an ion exchange column Hiload 26/10 Sepharose Q using a fast performance liquid chromatography (FPLC) system. The reassociation characteristics of these two RvH isoforms and the native molecule were studied in buffers with different pH values and concentrations of Ca(2+) and Mg(2+). Reassociation of mixed RvH subunits was performed over a period of several days using a stabilizing buffer (SB) of pH 7.0 containing different concentrations of Ca(2+) and Mg(2+) ions. After 2 days of dialysis, an RvH subunit mixture of didecamers and multidecamers was observed in the presence of 100 mM CaCl(2) and MgCl(2), though RvH1 and RvH2 are biochemically and immunologically different and have also different dissociation properties. The reassociation, performed at pH 9.6 with 2 mM CaCl(2) and MgCl(2) at 4 degrees C over a period of one to several weeks, led to the formation of decameric oligomers, while didecamers formed predominantly in the SB at pH 7.0. Higher concentrations of calcium and magnesium ions led to a more rapid reassociation of RvH1 resulting in long stable multidecamers and helical tubules, which were stable and slowly dissociated into shorter multidecamers and decamers at higher pH values. The reassociation of the RvH2 structural subunit in the same buffers processed slowly and yielded didecamers, shorter tubule polymers and long multidecamers which are less stable at higher pH values. The stability of RvH isoforms under varying ionic conditions is compared with the stability of keyhole limpet (KLH, Megathura crenulata) hemocyanin (KLH) and Haliotis tuberculata hemocyanin (HtH) isoforms. The process of dissociation and reassociation is connected with changes of the fluorescence intensity at 600 nm, which can be explained by differences in opalescence of the solutions of these two isoforms. The solutions of longer tubule

Significance of White-Coat Hypertension in Older Persons With Isolated Systolic Hypertension

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Franklin, Stanley S.; Thijs, Lutgarde; Hansen, Tine W.; Li, Yan; Boggia, José; Kikuya, Masahiro; Björklund-Bodegård, Kristina; Ohkubo, Takayoshi; Jeppesen, Jørgen; Torp-Pedersen, Christian; Dolan, Eamon; Kuznetsova, Tatiana; Stolarz-Skrzypek, Katarzyna; Tikhonoff, Valérie; Malyutina, Sofia; Casiglia, Edoardo; Nikitin, Yuri; Lind, Lars; Sandoya, Edgardo; Kawecka-Jaszcz, Kalina; Imai, Yutaka; Wang, Jiguang; Ibsen, Hans; O’Brien, Eoin; Staessen, Jan A.

2013-01-01

The significance of white-coat hypertension in older persons with isolated systolic hypertension remains poorly understood. We analyzed subjects from the population-based 11-country International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes database who had daytime ambulatory blood pressure (BP; ABP) and conventional BP (CBP) measurements. After excluding persons with diastolic hypertension by CBP (≥90 mm Hg) or by daytime ABP (≥85 mm Hg), a history of cardiovascular disease, and persons hypertension. During a median follow-up of 10.6 years, there was a total of 655 fatal and nonfatal cardiovascular events. The analyses were stratified by treatment status. In untreated subjects, those with white-coat hypertension (CBP ≥140/hypertension, the cardiovascular risk was similar in elevated conventional and normal daytime systolic BP as compared with those with normal conventional and normal daytime BPs (adjusted hazard rate: 1.10 [95% CI: 0.79–1.53]; P=0.57). However, both treated isolated systolic hypertension subjects with white-coat hypertension (adjusted hazard rate: 2.00; [95% CI: 1.43–2.79]; Phypertension who have their ABP normalized on antihypertensive therapy but with residual white-coat effect by CBP measurement have an entity that we have termed, “treated normalized hypertension.” Therefore, one should be cautious in applying the term “white-coat hypertension” to persons receiving antihypertensive treatment. PMID:22252396

The evolution of systolic blood pressure as a strong predictor of cardiovascular risk and the effectiveness of fixed-dose ARB/CCB combinations in lowering levels of this preferential target

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Jean-Jacques Mourad

2008-12-01

Full Text Available Jean-Jacques MouradHypertension Unit, Avicenne Hospital – AP-HP and Paris XIII University Bobigny, FranceAbstract: Elevated blood pressure is an important cardiovascular risk factor. Although targets for both diastolic blood pressure (DBP and systolic blood pressure (SBP are defined by current guidelines, DBP has historically taken precedence in hypertension management. However, there is strong evidence that SBP is superior to DBP as a predictor of cardiovascular events. Moreover, achieving control of SBP is assuming greater importance amongst an aging population. In spite of the growing recognition of the importance of SBP in reducing cardiovascular risk and the emphasis by current guidelines on SBP control, a substantial proportion of patients still fail to achieve SBP targets, and SBP control is achieved much less frequently than DBP control. Thus, new approaches to the management of hypertension are required in order to control SBP and minimize cardiovascular risk. Fixed-dose combination (FDC therapy is an approach that offers the advantages of multiple drug administration and a reduction in regimen complexity that favors compliance. We have reviewed the latest evidence demonstrating the efficacy in targeting SBP of the most recent FDC products; combinations of the calcium channel blocker (CCB, amlodipine, with angiotensin receptor blockers (ARBs, valsartan or olmesartan. In addition, results from studies with new classes of agent are outlined.Keywords: hypertension, systolic blood pressure, angiotensin receptor blocker, calcium channel blocker, combination therapy

Correlates of blood pressure in Yanomami Indians of northwestern Brazil.

Science.gov (United States)

Crews, D E; Mancilha-Carvalho, J J

1993-01-01

We determined associations of measures of body habitus with blood pressure for 100 adult Yanomami Indians (61 men, 39 women) examined during February and March 1990. Measurements included body weight and height, four skinfolds (triceps, subscapular, suprailiac, abdomen), four circumferences (wrist, upper arm, abdomen, hip), systolic and diastolic blood pressures, pulse rate, and estimated age. Various indices of fat distribution were determined from the measurements of skinfolds, circumferences, weight, and height. Estimated age averaged 35.0 years in men and 33.4 years in women (range: 15 to 63 years). Mean systolic and diastolic blood pressures were low in both men (104.8/70.4 mm Hg) and women (94.8/63.5 mm Hg), as was body mass index (men: 20.7; women: 21.4 kg/m2). In Yanomami women, all four skinfolds, wrist circumference, and the indices of hip and abdominal fat were significant correlates of systolic blood pressure, while the abdominal skinfold and wrist and hip circumferences correlated significantly with diastolic blood pressure. Among men, there was a negative correlation between estimated age and systolic blood pressure and a positive correlation between BMI and upper arm and hip circumferences and systolic blood pressure. There was a significant positive correlation between wrist, upper arm, and hip circumferences and diastolic blood pressure among Yanomami men. We used stepwise regression to generate sex-specific predictive equations for blood pressure. For men, estimated age and hip circumference, and for women, abdominal skinfold measurement and age were included in the model for systolic blood pressure. Among men, wrist circumference and height, and among women, wrist circumference alone entered the model for diastolic blood pressure. On the basis of these results, we suggest that even in a low-blood pressure, low-body fat, no-salt setting, systolic blood pressure is associated with the amount and placement of adipose tissue. However, diastolic blood

Significance of white-coat hypertension in older persons with isolated systolic hypertension

DEFF Research Database (Denmark)

Franklin, Stanley S; Thijs, Lutgarde; Hansen, Tine W

2012-01-01

The significance of white-coat hypertension in older persons with isolated systolic hypertension remains poorly understood. We analyzed subjects from the population-based 11-country International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes database who ...... had daytime ambulatory blood pressure (BP; ABP) and conventional BP (CBP) measurements. After excluding persons with diastolic hypertension by CBP (=90 mm Hg) or by daytime ABP (=85 mm Hg), a history of cardiovascular disease, and persons...

Prevention of pneumonic plague in mice, rats, guinea pigs and non-human primates with clinical grade rV10, rV10-2 or F1-V vaccines

Science.gov (United States)

Quenee, Lauriane E.; Ciletti, Nancy A.; Elli, Derek; Hermanas, Timothy M.; Schneewind, Olaf

2012-01-01

Yersinia pestis causes plague, a disease with high mortality in humans that can be transmitted by fleabite or aerosol. A US Food and Drug Administration (FDA)-licensed plague vaccine is currently not available. Vaccine developers have focused on two subunits of Y. pestis: LcrV, a protein at the tip of type III secretion needles, and F1, the fraction 1 pilus antigen. F1-V, a hybrid generated via translational fusion of both antigens, is being developed for licensure as a plague vaccine. The rV10 vaccine is a non-toxigenic variant of LcrV lacking residues 271–300. Here we developed Current Good Manufacturing Practice (cGMP) protocols for rV10. Comparison of clinical grade rV10 with F1-V did not reveal significant differences in plague protection in mice, guinea pigs or cynomolgus macaques. We also developed cGMP protocols for rV10-2, a variant of rV10 with an altered affinity tag. Immunization with rV10-2 adsorbed to aluminum hydroxide elicited antibodies against LcrV and conferred pneumonic plague protection in mice, rats, guinea pigs, cynomolgus macaques and African Green monkeys. The data support further development of rV10-2 for FDA Investigational New Drug (IND) authorization review and clinical testing. PMID:21763383

Central Pressure Appraisal: Clinical Validation of a Subject-Specific Mathematical Model.

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Francesco Tosello

Full Text Available Current evidence suggests that aortic blood pressure has a superior prognostic value with respect to brachial pressure for cardiovascular events, but direct measurement is not feasible in daily clinical practice.The aim of the present study is the clinical validation of a multiscale mathematical model for non-invasive appraisal of central blood pressure from subject-specific characteristics.A total of 51 young male were selected for the present study. Aortic systolic and diastolic pressure were estimated with a mathematical model and were compared to the most-used non-invasive validated technique (SphygmoCor device, AtCor Medical, Australia. SphygmoCor was calibrated through diastolic and systolic brachial pressure obtained with a sphygmomanometer, while model inputs consist of brachial pressure, height, weight, age, left-ventricular end-systolic and end-diastolic volumes, and data from a pulse wave velocity study.Model-estimated systolic and diastolic central blood pressures resulted to be significantly related to SphygmoCor-assessed central systolic (r = 0.65 p <0.0001 and diastolic (r = 0.84 p<0.0001 blood pressures. The model showed a significant overestimation of systolic pressure (+7.8 (-2.2;14 mmHg, p = 0.0003 and a significant underestimation of diastolic values (-3.2 (-7.5;1.6, p = 0.004, which imply a significant overestimation of central pulse pressure. Interestingly, model prediction errors mirror the mean errors reported in large meta-analysis characterizing the use of the SphygmoCor when non-invasive calibration is performed.In conclusion, multi-scale mathematical model predictions result to be significantly related to SphygmoCor ones. Model-predicted systolic and diastolic aortic pressure resulted in difference of less than 10 mmHg in the 51% and 84% of the subjects, respectively, when compared with SphygmoCor-obtained pressures.

Association of physical activity with a systolic blood pressure difference between arms in older people.

Science.gov (United States)

Sato, Koichi; Sugiura, Tomonori; Ohte, Nobuyuki; Dohi, Yasuaki

2018-01-01

A increase in interarm systolic blood pressure difference (IASBPD) is believed to lead to increased risk of cardiovascular disease and to be a predictor of future cardiovascular events. The purpose of the present study was to test the hypothesis that an increased IASBPD is associated with reduced physical activity in older people. Older people who used a geriatric health services facility (n = 147, mean age 83.3 years) were enrolled. The prevalence of IASBPD in individuals with different levels of physical activity and factors that have a crucial effect on IASBPD were investigated. The study participants were divided into three groups according to their physical activity; ambulant persons (group A), wheelchair users (group B) and bedridden persons (group C). Blood pressure around the both brachiums was simultaneously measured using two automated devices. An IASBPD of ≥10 mmHg was considered to be significant IASBPD. The median IASBPD was 4.5 mmHg in the present study participants, and 28 participants (19.0%) had an IASBPD ≥10 mmHg. The IASBPD in group C was greater than that in group A or B. Multivariate linear regression analysis showed that physical activity was the independent predictor of IASBPD after adjustment for possible factors. Furthermore, a logistic regression analysis with the end-point of significant IASBPD showed that physical activity is an independent predictor of significant IASBPD. Physical activity simply assessed by moving ability can predict IASBPD in older individuals. In older people, reduced physical activity might indicate the progression of silent or clinical atherosclerosis and an increased risk of cardiovascular disease. Geriatr Gerontol Int 2018; 18: 95-100. © 2017 Japan Geriatrics Society.

Systolic and Diastolic Left Ventricular Mechanics during and after Resistance Exercise.

Science.gov (United States)

Stöhr, Eric J; Stembridge, Mike; Shave, Rob; Samuel, T Jake; Stone, Keeron; Esformes, Joseph I

2017-10-01

To improve the current understanding of the impact of resistance exercise on the heart, by examining the acute responses of left ventricular (LV) strain, twist, and untwisting rate ("LV mechanics"). LV echocardiographic images were recorded in systole and diastole before, during and immediately after (7-12 s) double-leg press exercise at two intensities (30% and 60% of maximum strength, one-repetition maximum). Speckle tracking analysis generated LV strain, twist, and untwisting rate data. Additionally, beat-by-beat blood pressure was recorded and systemic vascular resistance (SVR) and LV wall stress were calculated. Responses in both exercise trials were statistically similar (P > 0.05). During effort, stroke volume decreased, whereas SVR and LV wall stress increased (P mechanics (P 0.05). Immediately after exercise, systolic LV mechanics returned to baseline levels (P mechanics, but increases diastolic mechanics after exercise, suggesting that resistance exercise has a differential impact on systolic and diastolic heart muscle function. The findings may explain why acute resistance exercise has been associated with reduced stroke volume but chronic exercise training may result in increased LV volumes.

Efficacy of a classical antiobesity Unani pharmacopial formulation (Safoof-e-Muhazzil in systolic and diastolic blood pressure: A randomized, open-labeled, controlled clinical study

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Asim Ali Khan

2013-01-01

Full Text Available The aim of this study is to evaluate the efficacy of a Unani formulation in hypertension. A total of 90 patients with total cholesterol level of more than 220 mg/dl with associated conditions were included in this study. A total of 30 patients having a mean systolic blood pressure (BP of 133.86 mmHg comprising Group A received Unani formulation Safoof-e-Muhazzil (SM in its classical powder form in the dose of 5 g twice a day orally. Group B comprising of 30 patients with a mean systolic BP of 133.13 mmHg received same drug, but in compressed tablet form in the same dosage, whereas, 30 patients comprising Group C with a mean systolic BP of 129.45 mmHg, received Atorvastatin 10 mg as a standard control. Patients were evaluated on each follow-up at 2 nd , 4 th and 6 th week. The mean systolic BP in Group A and B before treatment was 133.86 ± 3.028 mmHg and 133.13 ± 2.852 mmHg, which significantly decreased to 119.33 ± 1.922 mmHg (P < 0.001 and 119 ± 1.760 mmHg (P < 0.001 respectively. In the control Group C before treatment BP was 129.45 ± 2.499 mmHg and after treatment it significantly decreased to 124.34 ± 1.794 mmHg (P < 0.01. The percentage change after treatment was 10.85%, 10.61% and 3.94% respectively in each group. Mean diastolic BP in Group A and B before treatment was 85.06 ± 2.11 mmHg and 84.56 ± 1.5 mmHg, which significantly decreased to 79.06 ± 1.56 mmHg (P < 0.001 and 79.96 ± 1.15 mmHg (P < 0.001 respectively, BP before treatment in Group C was 83.23 ± 1.588 mmHg, which was decreased to 124.34 ± 1.794 mmHg (P < 0.01. The study results indicate that the test drug was quite effective in reducing both systolic as well as diastolic BP.

Rv0004 is a new essential member of the mycobacterial DNA replication machinery.

Science.gov (United States)

Mann, Katherine M; Huang, Deborah L; Hooppaw, Anna J; Logsdon, Michelle M; Richardson, Kirill; Lee, Hark Joon; Kimmey, Jacqueline M; Aldridge, Bree B; Stallings, Christina L

2017-11-01

DNA replication is fundamental for life, yet a detailed understanding of bacterial DNA replication is limited outside the organisms Escherichia coli and Bacillus subtilis. Many bacteria, including mycobacteria, encode no identified homologs of helicase loaders or regulators of the initiator protein DnaA, despite these factors being essential for DNA replication in E. coli and B. subtilis. In this study we discover that a previously uncharacterized protein, Rv0004, from the human pathogen Mycobacterium tuberculosis is essential for bacterial viability and that depletion of Rv0004 leads to a block in cell cycle progression. Using a combination of genetic and biochemical approaches, we found that Rv0004 has a role in DNA replication, interacts with DNA and the replicative helicase DnaB, and affects DnaB-DnaA complex formation. We also identify a conserved domain in Rv0004 that is predicted to structurally resemble the N-terminal protein-protein interaction domain of DnaA. Mutation of a single conserved tryptophan within Rv0004's DnaA N-terminal-like domain leads to phenotypes similar to those observed upon Rv0004 depletion and can affect the association of Rv0004 with DnaB. In addition, using live cell imaging during depletion of Rv0004, we have uncovered a previously unappreciated role for DNA replication in coordinating mycobacterial cell division and cell size. Together, our data support that Rv0004 encodes a homolog of the recently identified DciA family of proteins found in most bacteria that lack the DnaC-DnaI helicase loaders in E. coli and B. subtilis. Therefore, the mechanisms of Rv0004 elucidated here likely apply to other DciA homologs and reveal insight into the diversity of bacterial strategies in even the most conserved biological processes.

Rv3634c from Mycobacterium tuberculosis H37Rv encodes an enzyme with UDP-Gal/Glc and UDP-GalNAc 4-epimerase activities.

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Peehu Pardeshi

Full Text Available A bioinformatics study revealed that Mycobacterium tuberculosis H37Rv (Mtb contains sequence homologs of Campylobacter jejuni protein glycosylation enzymes. The ORF Rv3634c from Mtb was identified as a sequence homolog of C. jejuni UDP-Gal/GalNAc 4-epimerase. This study reports the cloning of Rv3634c and its expression as an N-terminal His-tagged protein. The recombinant protein was shown to have UDP-Gal/Glc 4-epimerase activity by GOD-POD assay and by reverse phase HPLC. This enzyme was shown to have UDP-GalNAc 4-epimerase activity also. Residues Ser121, Tyr146 and Lys150 were shown by site-directed mutagenesis to be important for enzyme activity. Mutation of Ser121 and Tyr146 to Ala and Phe, respectively, led to complete loss of activity whereas mutation of Lys150 to Arg led to partial loss of activity. There were no gross changes in the secondary structures of any of these three mutants. These results suggest that Ser121 and Tyr146 are essential for epimerase activity of Rv3634c. UDP-Gal/Glc 4-epimerases from other organisms also have a catalytic triad consisting of Ser, Tyr and Lys. The triad carries out proton transfer from nucleotide sugar to NAD+ and back, thus effecting the epimerization of the substrate. Addition of NAD+ to Lys150 significantly abrogates the loss of activity, suggesting that, as in other epimerases, NAD+ is associated with Rv3634c.

Worldwide trends in blood pressure from 1975 to 2015

DEFF Research Database (Denmark)

Linneberg, Allan René; Sørensen, Thorkild I.A.

2017-01-01

BACKGROUND: Raised blood pressure is an important risk factor for cardiovascular diseases and chronic kidney disease. We estimated worldwide trends in mean systolic and mean diastolic blood pressure, and the prevalence of, and number of people with, raised blood pressure, defined as systolic blood...... pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher. METHODS: For this analysis, we pooled national, subnational, or community population-based studies that had measured blood pressure in adults aged 18 years and older. We used a Bayesian hierarchical model to estimate trends...... from 1975 to 2015 in mean systolic and mean diastolic blood pressure, and the prevalence of raised blood pressure for 200 countries. We calculated the contributions of changes in prevalence versus population growth and ageing to the increase in the number of adults with raised blood pressure. FINDINGS...

Case report: paradoxical ventricular septal motion in the setting of primary right ventricular myocardial failure.

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Maslow, Andrew; Schwartz, Carl; Mahmood, Feroze; Singh, Arun; Heerdt, Paul M

2009-07-01

In this report, a case of right ventricular (RV) failure, hemodynamic instability, and systemic organ failure is described to highlight how paradoxical ventricular systolic septal motion (PVSM), or a rightward systolic displacement of the interventricular septum, may contribute to RV ejection. Multiple inotropic medications and vasopressors were administered to treat right heart failure and systemic hypotension in a patient following combined aortic and mitral valve replacement. In the early postoperative period, echocardiographic evaluation revealed adequate left ventricular systolic function, akinesis of the RV myocardial tissues, and PVSM. In the presence of PVSM, RV fractional area of contraction was > or =35% despite akinesis of the primary RV myocardial walls. The PVSM appeared to contribute toward RV ejection. As a result, the need for multiple inotropes was re-evaluated, in considering that end-organ dysfunction was the result of systemic hypotension and prolonged vasopressor administration. After discontinuation of phosphodiesterase inhibitors, native vascular tone returned and the need for vasopressors declined. This was followed by recovery of systemic organ function. Echocardiographic re-evaluation two years later, revealed persistent akinesis of the RV myocardial tissues and PVSM, the latter appearing to contribute toward RV ejection. This case highlights the importance of left to RV interactions, and how PVSM may mediate these hemodynamic interactions.

Oscillometric blood pressure measurements: differences between measured and calculated mean arterial pressure.

NARCIS (Netherlands)

Kiers, H.D.; Hofstra, J.M.; Wetzels, J.F.M.

2008-01-01

Mean arterial pressure (MAP) is often used as an index of overall blood pressure. In recent years, the use of automated oscillometric blood pressure measurement devices is increasing. These devices directly measure and display MAP; however, MAP is often calculated from systolic blood pressure (SBP)

Association of Right Ventricular Pressure and Volume Overload with Non-Ischemic Septal Fibrosis on Cardiac Magnetic Resonance.

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Jiwon Kim

Full Text Available Non-ischemic fibrosis (NIF on cardiac magnetic resonance (CMR has been linked to poor prognosis, but its association with adverse right ventricular (RV remodeling is unknown. This study examined a broad cohort of patients with RV dysfunction, so as to identify relationships between NIF and RV remodeling indices, including RV pressure load, volume and wall stress.The population comprised patients with RV dysfunction (EF 6-fold more common in the highest, vs. the lowest, common tertile of PASP and RV size (p<0.001.Among wall stress components, NIF was independently associated with RV chamber dilation and afterload, supporting the concept that NIF is linked to adverse RV chamber remodeling.

THE EFFECTIVENESS OF CHRONOTHERAPY IN HYPERTENSIVE PATIENTS WITH AN INSUFFICIENT DEGREE OF SLEEP-TIME SYSTOLIC BLOOD PRESSURE DECLINE

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Petrenko O. V.

2017-12-01

Full Text Available Blood pressure (BP circadian rhythm violation, manifested as an insufficient degree of its sleep-time relative decline, is an independent cardiovascular risk factor. The main method of the correction is chronotherapeutic approach, when at least one antihypertensive drug is taken at bedtime. However, most researchers focus on normalizing the daily profile of systolic blood pressure (SBP and do not pay enough attention to changes in the daily profile of diastolic blood pressure (DBP and blood pressure in general. The aim of the study was to evaluate the influence of the chronotherapeutic approach on the SBP and DBP levels and the DBP daily profile in hypertensive patients with an insufficient degree of sleep-time relative SBP decline. The study included 12 patients with arterial hypertension (AH with an insufficient degree of sleep-time relative SBP decline. Participants were divided into two groups: group 1 included patients who take at least one antihypertensive drug at bedtime, group 2 – patients who take all antihypertensive drugs in the morning. All patients underwent 24-hour blood pressure monitoring using the computer system «Cardiosens» (KhAI Medica, Ukraine, with the oscillometric method of BP measuring when enrolling in the study and after 3 months. The type of SBP and DBP diurnal profile, the mean values of SBP, DBP and hyperbaric indices were determined and compared between groups 1 and 2 at each visit, as well as within groups between visits. The results showed that the SBP daily profile normalization in patients with insufficient degree of sleep-time relative SBP decline from group 2 was achieved only in 11 % of cases, and in group 1 SBP and DBP daily profile normalized in 1/3 patients. In some patients from group 2 SBP and DBP daily profile converted into the overdipper type, while in group 1 overdippers did not appear at the end of the study. It was concluded that conversion of daily DBP profile to overdipper as a consequence

Time course of reversed cardiac remodeling after pulmonary endarterectomy in patients with chronic pulmonary thromboembolism

Energy Technology Data Exchange (ETDEWEB)

Iino, Misako; Dymarkowski, Steven; Chaothawee, Lertlak; Bogaert, Jan [UZ Leuven, Department of Radiology, Leuven (Belgium); Delcroix, Marion [UZ Leuven, Department of Pneumology, Leuven (Belgium)

2008-04-15

To evaluate the time course of reversed remodeling after pulmonary endarterectomy (PEA) in patients with chronic thromboembolic pulmonary hypertension(CTPEH), we studied 22 patients (age: 60 {+-} 13 years) with MRI immediately before, 1 month, 3 months, and 6 months after PEA. MRI included assessment of biventricular function, aortic and pulmonary artery(PA) flow, and right ventricular (RV) overload using the ratio of RV-to-biventricular diameter. Except in one patient, who died 2 months post-surgery, clinical improvement occurred early after PEA (NYHA class: 3.3 {+-} 0.6 to 1.5 {+-} 0.8, p < 0.0001) with a decrease of systolic pulmonary artery pressures (79 {+-} 14 to 44 {+-} 14 mmHg, p < 0.0001). At 1 month post PEA, RV end-diastolic volumes decreased (198 {+-} 72 to 137 {+-} 59 ml, p < 0.0001), and the RV ejection fraction (EF) improved (31 {+-} 9 to 47 {+-} 10%, p < 0.0001). No further significant improvement in pulmonary pressures or RV function occurred at 3 months or 6 months. Although no significant change was found in LV volumes or function, aortic flow increased early after surgery. PEA had only a beneficial effect on right PA flow. RV overload decreased early after PEA (ratio RV-to-biventricular diameter: before: 0.67 {+-} 0.04, after: 0.54 {+-} 0.06, p < 0.0001), showing a good correlation with the improvement in RVEF (r = 0.7, P < 0.0001). In conclusion, reversed cardiac remodeling occurs early after PEA, to slow down after 1 month. At 6 months, cardiac remodeling is incomplete as witnessed by low-normal RV function and residually elevated PA pressures. (orig.)

A CROSS SECTIONAL STUDY TO FIND THE DIFFERENCE IN SYSTOLIC BLOOD PRESSURE BETWEEN ARMS AS A RISK MARKER FOR DIABETIC NEPHROPATHY IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

OpenAIRE

Uday Subhash Bande; Anish Anthony Tekkinadath

2016-01-01

BACKGROUND Diabetic nephropathy is the commonest cause of end-stage renal disease in the developed world. Recent studies have demonstrated that a difference in systolic blood pressure between arms is associated with cardiovascular disease and microalbuminuria. It is considered a predictor for cardiovascular disease and a surrogate marker for early kidney damage among patients with both type 2 diabetes and hypertension. AIMS AND OBJECTIVES The aim was to investigate an associ...

Nærvær i pædagogisk praksis

DEFF Research Database (Denmark)

Nærvær i pædagogisk praksis handler om, hvordan lærere og pædagoger kan arbejde med mindfulness i skole og daginstitution. Målet er at give inspiration til, hvordan man kan skabe et lærings- og udviklingsmiljø, som understøtter en praksis, hvor børn får erfaringer med at være til stede i sig selv......, ligesom de giver eksempler på nærværende kunst- og musikundervisning.   Den røde tråd er ønsket om at bistå barnet i at rumme sig selv og andre og en interesse for de muligheder, som øget nærvær kan give det enkelte barn og fællesskabet....

Correlation between the trajectory of systolic blood pressure and new renal damage in a nonhypertensive population.

Science.gov (United States)

Wang, Zhi-Jun; Jia, Dao; Tian, Jun; Liu, Jie; Li, Li-Jie; Huang, Yu-Ling; Cao, Xin-Ying; Ning, Chun-Hong; Zhao, Quan-Hui; Yu, Jun-Xing; Zhang, Rui-Ying; Zhang, Ya-Jing; Gao, Jing-Sheng; Wu, Shou-Ling

2017-10-01

This study aims to investigate the correlation between the trajectory of systolic blood pressure (SBP) and new renal damage in a nonhypertensive population. This prospective cohort study included a total of 14 382 nonhypertensive individuals, employees of Kailuan Group of Companies, who took part in five healthy examinations in 2006-2007, 2008-2009, 2010-2011, 2012-2013, and 2014-2015, and had complete data. These individuals were divided into four groups according to the different trajectories of SBP: low-low, low-stable, middle-high, and high-high groups. The correlation between the trajectory of SBP and new renal damage in a nonhypertensive population was analyzed using a multivariate Cox's proportional hazard regression model. (a) A total of 14 382 individuals had complete data and the average age of these individuals was 44.6±10.8 years. Among these, 10 888 (75.7%) individuals were men and 3494 (24.3%) individuals were women. (b) These individuals were divided into four groups according to different trajectories of blood pressure: low-low group, accounting for 13.15% (blood pressure was group, accounting for 53.91% (blood pressure was between 115 and 116 mmHg); middle-high group, accounting for 28.77% (blood pressure was between 125 and 131 mmHg); and high-high group, accounting for 4.6% (blood pressure was between 126 and 151 mmHg). (c) With the increase in the trajectory of SBP, the detection rate of renal damage increased gradually. From the low-low group to the high-high group, the detection rates of estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m were 2.3, 2.4, 3.6, and 4.3%, respectively; the positive rates of urinary protein were 1.7, 2.9, 3.8, and 5.5%, respectively; and the detection rates of eGFR less than 60 ml/min/1.73 m or positive urinary protein were 4, 5.2, 7.3, and 9.3%, respectively (Pgroup, the risk of eGFR less than 60 ml/min/1.73 m increased by nearly 1.5 times in the high-high group and in

Ratio of systolic blood pressure to left ventricular end-diastolic pressure at the time of primary percutaneous coronary intervention predicts in-hospital mortality in patients with ST-elevation myocardial infarction.

Science.gov (United States)

Sola, Michael; Venkatesh, Kiran; Caughey, Melissa; Rayson, Robert; Dai, Xuming; Stouffer, George A; Yeung, Michael

2017-09-01

To determine the ability of simple hemodynamic parameters obtained at the time of cardiac catheterization to predict in-hospital mortality following ST-elevation myocardial infarction (STEMI). Hemodynamic parameters measured at the time of primary percutaneous coronary intervention (PPCI) could potentially identify high-risk patients who would benefit from aggressive hemodynamic support in the Cardiac Catheterization laboratory. This is a retrospective single-center study of 219 consecutive patients with STEMI. Left ventricular end-diastolic pressure (LVEDP), systolic blood pressure (SBP), and aortic diastolic blood pressure were obtained after successful revascularization. The prognostic ability of LVEDP, pulse pressure, and SBP/LVEDP ratio were compared to major mortality risk scores. Patients had a mean age of 60 ±14 years, were predominantly white (73%), male (64%), with anterior wall infarcts in 39%. Comorbidities included diabetes mellitus (27%), heart failure (9%), and chronic kidney disease (7%). In-hospital mortality was 9%. Patients with SBP/LVEDP ≤ 4 had increased risk of in-hospital death (32% vs. 5.3%, P  4. The area under curve (AUC) for SBP/LVEDP ratio for in-hospital mortality (0.69) was more predictive than LVEDP (0.61, P = 0.04) or pulse pressure (0.55, P = 0.02) but similar to Shock Index (ratio of heart rate to SBP) and Modified Shock Index (ratio of HR to mean arterial pressure). An SBP/LVEDP ratio ≤ 4 identified a group of STEMI patients at high risk of in-hospital death. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Inter-arm blood pressure differences in pregnant women.

Science.gov (United States)

Poon, L C Y; Kametas, N; Strobl, I; Pachoumi, C; Nicolaides, K H

2008-08-01

To determine the prevalence of blood pressure inter-arm difference (IAD) in early pregnancy and to investigate its possible association with maternal characteristics. A cross-sectional observational study. Routine antenatal visit in a university hospital. A total of 5435 pregnant women at 11-14 weeks of gestation. Blood pressure was taken from both arms simultaneously with a validated automated device. The presence of inter-arm blood pressure difference of 10 mmHg or more. The IAD in systolic and diastolic blood pressure was 10 mmHg or more in 8.3 and 2.3% of the women, respectively. Systolic IAD was found to be significantly related to systolic blood pressure and pulse pressure, and diastolic IAD was found to be significantly related to maternal age, diastolic blood pressure and pulse pressure. The systolic and diastolic IAD were higher in the hypertensive group compared with the normotensive group and absolute IAD increased with increasing blood pressure. About 31.0 and 23.9% of cases of hypertension would have been underreported if the left arm and the right arm were used, respectively, in measuring the blood pressure. There is a blood pressure IAD in a significant proportion of the pregnant population, and its prevalence increases with increasing blood pressure. By measuring blood pressure only on one arm, there is a one in three chance of underreporting hypertension. Therefore, it would be prudent that during the booking visit blood pressure should be taken in both arms and thus provide guidance for subsequent blood pressure measurements during the course of pregnancy.

Cardiovascular disease mortality and years of life lost attributable to non-optimal systolic blood pressure and hypertension in northeastern Iran.

Science.gov (United States)

Sepanlou, Sadaf G; Newson, Roger B; Poustchi, Hossein; Malekzadeh, Masoud M; Rezanejad Asl, Parisa; Etemadi, Arash; Khademi, Hooman; Islami, Farhad; Pourshams, Akram; Pharoah, Paul D; Abnet, Christian C; Brennan, Paul; Bofetta, Paolo; Dawsey, Sanford M; Kamangar, Farin; Malekzadeh, Reza

2015-03-01

High blood pressure is the second most important risk factor of cardiovascular diseases (CVDs) in Iran. It is imperative to estimate the burden of CVDs that can be averted if high blood pressure is controlled at the population level. The aim of the current study was to estimate the avertable CVD mortality in the setting of Golestan Cohort Study (GCS). Over 50,000 participants were recruited and followed for a median of 7 years. The exposures of interest in this study were non-optimal systolic blood pressure (SBP) and hypertension measured at baseline. Deaths by cause have been precisely recorded. The Population Attributable Fraction (PAF) of deaths and Years of Life Lost (YLLs) due to CVDs attributable to exposures of interest were calculated. Overall, 223 deaths due to ischemic heart disease (IHD), 207 deaths due to cerebrovascular accidents (CVA), and 460 deaths due to all CVDs could be averted if the SBP of all subjects in the study were optimal. Similarly, 5,560 YLLs due to IHD, 4,771 YLLs due to CVA, and 11,135 YLLs due to CVDs could be prevented if SBP were optimal. In all age groups, the avertable deaths and YLLs were higher due to IHD compared with CVA. Deaths and YLLs attributable to non-optimal SBP in women were less than men. A very large proportion of CVD deaths can be averted if blood pressure is controlled in Iran. Effective interventions in primary and secondary health care setting are mandatory to be implemented as early as possible.

Influence of short-term blood pressure variability on blood pressure determinations

NARCIS (Netherlands)

Bos, W. J.; van Goudoever, J.; van Montfrans, G. A.; Wesseling, K. H.

1992-01-01

To evaluate the effect of blood pressure variability on Riva Rocci Korotkoff blood pressure determinations, we studied the intra-arterial pressure during Riva Rocci Korotkoff determinations in 25 patients. In 50 measurements with a cuff deflation rate of 2.5 mm Hg/sec, the systolic intra-arterial

Noninvasive model including right ventricular speckle tracking for the evaluation of pulmonary hypertension.

Science.gov (United States)

Mahran, Yossra; Schueler, Robert; Weber, Marcel; Pizarro, Carmen; Nickenig, Georg; Skowasch, Dirk; Hammerstingl, Christoph

2016-08-26

To find parameters from transthorathic echocardiography (TTE) including speckle-tracking (ST) analysis of the right ventricle (RV) to identify precapillary pulmonary hypertension (PH). Forty-four patients with suspected PH undergoing right heart catheterization (RHC) were consecutively included (mean age 63.1 ± 14 years, 61% male gender). All patients underwent standardized TTE including ST analysis of the RV. Based on the subsequent TTE-derived measurements, the presence of PH was assessed: Left ventricular ejection fraction (LVEF) was calculated by Simpsons rule from 4Ch. Systolic pulmonary artery pressure (sPAP) was assessed with continuous wave Doppler of systolic tricuspid regurgitant velocity and regarded raised with values ≥ 30 mmHg as a surrogate parameter for RA pressure. A concomitantly elevated PCWP was considered a means to discriminate between the precapillary and postcapillary form of PH. PCWP was considered elevated when the E/e' ratio was > 12 as a surrogate for LV diastolic pressure. E/e' ratio was measured by gauging systolic and diastolic velocities of the lateral and septal mitral valve annulus using TDI mode. The results were then averaged with conventional measurement of mitral valve inflow. Furthermore, functional testing with six minutes walking distance (6MWD), ECG-RV stress signs, NT pro-BNP and other laboratory values were assessed. PH was confirmed in 34 patients (precapillary PH, n = 15, postcapillary PH, n = 19). TTE showed significant differences in E/e' ratio (precapillary PH: 12.3 ± 4.4, postcapillary PH: 17.3 ± 10.3, no PH: 12.1 ± 4.5, P = 0.02), LV volumes (ESV: 25.0 ± 15.0 mL, 49.9 ± 29.5 mL, 32.2 ± 13.6 mL, P = 0.027; EDV: 73.6 ± 24.0 mL, 110.6 ± 31.8 mL, 87.8 ± 33.0 mL, P = 0.021) and systolic pulmonary arterial pressure (sPAP: 61.2 ± 22.3 mmHg, 53.6 ± 20.1 mmHg, 31.2 ± 24.6 mmHg, P = 0.001). STRV analysis showed significant differences for apical RV longitudinal strain (RVAS: -7.5% ± 5.6%, -13.3% ± 4.3%, -14

Hydrochemical data from R/V MIKHAIL LOMONSOV and R/V AKADEMIK VERNADSKIY in the Indian Ocean from 16 May 1966 to 01 October 1981 (NODC Accession 0000277)

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — Hydrochemical data were collected from R/V MIKHAIL LOMONSOV and R/V AKADEMIK VERNADSKIY in the Indian Ocean from 16 May 1966 to 01 October 1981. Data were collected...

Mycobacterium tuberculosislpdC, Rv0462, induces dendritic cell maturation and Th1 polarization

Energy Technology Data Exchange (ETDEWEB)

Heo, Deok Rim [Department of Microbiology and Immunology, School of Medicine, Pusan National University, Beom-eo Ri, Mulgum Eop, Yangsan, Gyeongsangnam-do 626-770 (Korea, Republic of); Shin, Sung Jae; Kim, Woo Sik [Department of Microbiology, College of Medicine, Chungnam National University, Munwha-Dong, Jung-Ku, Daejeon 301-747 (Korea, Republic of); Noh, Kyung Tae; Park, Jin Wook; Son, Kwang Hee [Department of Microbiology and Immunology, School of Medicine, Pusan National University, Beom-eo Ri, Mulgum Eop, Yangsan, Gyeongsangnam-do 626-770 (Korea, Republic of); Park, Won Sun [Department of Physiology, Kangwon National University, School of Medicine, Chuncheon 200-701 (Korea, Republic of); Lee, Min-Goo [Department of Physiology, Korea University, College of Medicine, Anam-dong, Sungbuk-Gu, Seoul 136-705 (Korea, Republic of); Kim, Daejin [Department of Anatomy, Chung-Ang University, College of Medicine, 221 Heuksuk-Dong, Dongjak-Ku, Seoul 156-756 (Korea, Republic of); Shin, Yong Kyoo [Department of Pharmacology, Chung-Ang University, College of Medicine, 221 Heuksuk-Dong, Dongjak-Ku, Seoul 156-756 (Korea, Republic of); Jung, In Duk, E-mail: jungid@pusan.ac.kr [Department of Microbiology and Immunology, School of Medicine, Pusan National University, Beom-eo Ri, Mulgum Eop, Yangsan, Gyeongsangnam-do 626-770 (Korea, Republic of); Research Institute of Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Beom-eo Ri, Mulgum Eop, Yangsan, Gyeongsangnam-do 626-770 (Korea, Republic of); Park, Yeong-Min, E-mail: immunpym@pusan.ac.kr [Department of Microbiology and Immunology, School of Medicine, Pusan National University, Beom-eo Ri, Mulgum Eop, Yangsan, Gyeongsangnam-do 626-770 (Korea, Republic of); Research Institute of Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Beom-eo Ri, Mulgum Eop, Yangsan, Gyeongsangnam-do 626-770 (Korea, Republic of)

2011-08-05

Highlights: {yields} Treatment with Rv0462 induces the expression of surface molecules and the production of cytokines in DCs. {yields} Rv0462 induces the activation of MAPKs. {yields} Rv0462-treated DCs enhances the proliferation of CD4{sup +} T cells. -- Abstract: Mycobacterium tuberculosis, the etiological factor of pulmonary tuberculosis, causes significant morbidity and mortality worldwide. Activation of host immune responses for containment of mycobacterial infections involves participation of innate immune cells, such as dendritic cells (DCs). In this study, we demonstrated that the gene encoding lipoamide dehydrogenase C (lpdC) from M. tuberculosis, Rv0462, induce maturation and activation of DCs involved in the MAPKs signaling pathway. Moreover, Rv0462-treated DCs activated naive T cells, polarized CD4{sup +} and CD8{sup +} T cells to secrete IFN-{gamma} in syngeneic mixed lymphocyte reactions, which would be expected to contribute to Th1 polarization of the immune response. Our results suggest that Rv0462 can contribute to the innate and adaptive immune responses during tuberculosis infection, and thus modulate the clinical course of tuberculosis.

Mycobacterium tuberculosislpdC, Rv0462, induces dendritic cell maturation and Th1 polarization

International Nuclear Information System (INIS)

Heo, Deok Rim; Shin, Sung Jae; Kim, Woo Sik; Noh, Kyung Tae; Park, Jin Wook; Son, Kwang Hee; Park, Won Sun; Lee, Min-Goo; Kim, Daejin; Shin, Yong Kyoo; Jung, In Duk; Park, Yeong-Min

2011-01-01

Highlights: → Treatment with Rv0462 induces the expression of surface molecules and the production of cytokines in DCs. → Rv0462 induces the activation of MAPKs. → Rv0462-treated DCs enhances the proliferation of CD4 + T cells. -- Abstract: Mycobacterium tuberculosis, the etiological factor of pulmonary tuberculosis, causes significant morbidity and mortality worldwide. Activation of host immune responses for containment of mycobacterial infections involves participation of innate immune cells, such as dendritic cells (DCs). In this study, we demonstrated that the gene encoding lipoamide dehydrogenase C (lpdC) from M. tuberculosis, Rv0462, induce maturation and activation of DCs involved in the MAPKs signaling pathway. Moreover, Rv0462-treated DCs activated naive T cells, polarized CD4 + and CD8 + T cells to secrete IFN-γ in syngeneic mixed lymphocyte reactions, which would be expected to contribute to Th1 polarization of the immune response. Our results suggest that Rv0462 can contribute to the innate and adaptive immune responses during tuberculosis infection, and thus modulate the clinical course of tuberculosis.

Flow-related Right Ventricular - Pulmonary Arterial Pressure Gradients during Exercise.

Science.gov (United States)

Wright, Stephen P; Opotowsky, Alexander R; Buchan, Tayler A; Esfandiari, Sam; Granton, John T; Goodman, Jack M; Mak, Susanna

2018-06-06

The assumption of equivalence between right ventricular and pulmonary arterial systolic pressure is fundamental to several assessments of right ventricular or pulmonary vascular hemodynamic function. Our aims were to 1) determine whether systolic pressure gradients develop across the right ventricular outflow tract in healthy adults during exercise, 2) examine the potential correlates of such gradients, and 3) consider the effect of such gradients on calculated indices of right ventricular function. Healthy untrained and endurance-trained adult volunteers were studied using right-heart catheterization at rest and during submaximal cycle ergometry. Right ventricular and pulmonary artery pressures were simultaneously transduced, and cardiac output was determined by thermodilution. Systolic pressures, peak and mean gradients, and indices of chamber, vascular, and valve function were analyzed offline. Summary data are reported as mean ± standard deviation or median [interquartile range]. No significant right ventricular outflow tract gradients were observed at rest (mean gradient = 4 [3-5] mmHg), and calculated effective orifice area was 3.6±1.0 cm2. Right ventricular systolic pressure increases during exercise were greater than that of pulmonary artery systolic pressure. Accordingly, mean gradients developed during light exercise (8 [7-9] mmHg) and increased during moderate exercise (12 [9-14] mmHg, p < 0.001). The magnitude of the mean gradient was linearly related to cardiac output (r2 = 0.70, p < 0.001). In healthy adults without pulmonic stenosis, systolic pressure gradients develop during exercise, and the magnitude is related to blood flow rate.

Normal references of right ventricular strain values by two-dimensional strain echocardiography according to the age and gender.

Science.gov (United States)

Park, Jae-Hyeong; Choi, Jin-Oh; Park, Seung Woo; Cho, Goo-Yeong; Oh, Jin Kyung; Lee, Jae-Hwan; Seong, In-Whan

2018-02-01

Right ventricular (RV) strain values by 2-dimensional strain echocardiography (STE) can be used as objective markers of RV systolic function. However, there is little data about normal reference RV strain values according to age and gender. We measured normal RV strain values by STE. RV strain values were analyzed from the digitally stored echocardiographic images from NORMAL (Normal echOcardiogRaphic diMensions and functions in KoreAn popuLation) study for the measurement of normal echocardiographic values performed in 23 Korean university hospitals. We enrolled total 1003 healthy persons in the NORMAL study. Of them, we analyzed 2-dimensional RV strain values in 493 subjects (261 females, mean 47 ± 15 years old) only with echocardiographic images by GE machines. Their LV systolic and diastolic functions were normal. RV fractional area change was 48 ± 6% and tricuspid annular plane systolic excursion was 23 ± 3 mm. Total RV global longitudinal peak systolic strain (RVGLS total ) was -21.5 ± 3.2%. Females had higher absolute RVGLS total (-22.3 ± 3.3 vs -20.7 ± 2.9%, p value to that of older males (age ≥50 years, -20.5 ± 2.8 vs -20.9 ± 3.1%, p = 0.224). We calculated normal RVGLS values in normal population. Females have higher absolute strain values than males, especially in younger age groups (<50 years old).

Interarm Difference in Systolic Blood Pressure in Different Ethnic Groups and Relationship to the "White Coat Effect": A Cross-Sectional Study.

Science.gov (United States)

Schwartz, Claire Lorraine; Clark, Christopher; Koshiaris, Constantinos; Gill, Paramjit S; Greenfield, Shelia M; Haque, Sayeed M; Heer, Gurdip; Johal, Amanpreet; Kaur, Ramandeep; Mant, Jonathan; Martin, Una; Mohammed, Mohamed A; Wood, Sally; McManus, Richard J

2017-09-01

Interarm differences (IADs) ≥10 mm Hg in systolic blood pressure (BP) are associated with greater incidence of cardiovascular disease. The effect of ethnicity and the white coat effect (WCE) on significant systolic IADs (ssIADs) are not well understood. Differences in BP by ethnicity for different methods of BP measurement were examined in 770 people (300 White British, 241 South Asian, 229 African-Caribbean). Repeated clinic measurements were obtained simultaneously in the right and left arm using 2 BPTru monitors and comparisons made between the first reading, mean of second and third and mean of second to sixth readings for patients with, and without known hypertension. All patients had ambulatory BP monitoring (ABPM). WCE was defined as systolic clinic BP ≥10 mm Hg higher than daytime ABPM. No significant differences were seen in the prevalence of ssIAD between ethnicities whichever combinations of BP measurement were used and regardless of hypertensive status. ssIADs fell between the 1st measurement (161, 22%), 2nd/3rd (113, 16%), and 2nd-6th (78, 11%) (1st vs. 2nd/3rd and 2nd-6th, P < 0.001). Hypertensives with a WCE were more likely to have ssIADs on 1st, (odds ratio [OR] 1.73 (95% confidence interval 1.04-2.86); 2nd/3rd, (OR 3.05 (1.68-5.53); and 2nd-6th measurements, (OR 2.58 (1.22-5.44). Nonhypertensive participants with a WCE were more likely to have a ssIAD on their first measurement (OR 3.82 (1.77 to -8.25) only. ssIAD prevalence does not vary with ethnicity regardless of hypertensive status but is affected by the number of readings, suggesting the influence of WCE. Multiple readings should be used to confirm ssIADs. © The Author 2017. Published by Oxford University Press on behalf of American Journal of Hypertension, Ltd.

Which is the better forecasting model? A comparison between HAR-RV and multifractality volatility

Science.gov (United States)

Ma, Feng; Wei, Yu; Huang, Dengshi; Chen, Yixiang

2014-07-01

In this paper, by taking the 5-min high frequency data of the Shanghai Composite Index as example, we compare the forecasting performance of HAR-RV and Multifractal volatility, Realized volatility, Realized Bipower Variation and their corresponding short memory model with rolling windows forecasting method and the Model Confidence Set which is proved superior to SPA test. The empirical results show that, for six loss functions, HAR-RV outperforms other models. Moreover, to make the conclusions more precise and robust, we use the MCS test to compare the performance of their logarithms form models, and find that the HAR-log(RV) has a better performance in predicting future volatility. Furthermore, by comparing the two models of HAR-RV and HAR-log(RV), we conclude that, in terms of performance forecasting, the HAR-log(RV) model is the best model among models we have discussed in this paper.

Signal quality measures for unsupervised blood pressure measurement

International Nuclear Information System (INIS)

Abdul Sukor, J; Redmond, S J; Lovell, N H; Chan, G S H

2012-01-01

Accurate systolic and diastolic pressure estimation, using automated blood pressure measurement, is difficult to achieve when the transduced signals are contaminated with noise or interference, such as movement artifact. This study presents an algorithm for automated signal quality assessment in blood pressure measurement by determining the feasibility of accurately detecting systolic and diastolic pressures when corrupted with various levels of movement artifact. The performance of the proposed algorithm is compared to a manually annotated reference scoring (RS). Based on visual representations and audible playback of Korotkoff sounds, the creation of the RS involved two experts identifying sections of the recorded sounds and annotating sections of noise contamination. The experts determined the systolic and diastolic pressure in 100 recorded Korotkoff sound recordings, using a simultaneous electrocardiograph as a reference signal. The recorded Korotkoff sounds were acquired from 25 healthy subjects (16 men and 9 women) with a total of four measurements per subject. Two of these measurements contained purposely induced noise artifact caused by subject movement. Morphological changes in the cuff pressure signal and the width of the Korotkoff pulse were extracted features which were believed to be correlated with the noise presence in the recorded Korotkoff sounds. Verification of reliable Korotkoff pulses was also performed using extracted features from the oscillometric waveform as recorded from the inflatable cuff. The time between an identified noise section and a verified Korotkoff pulse was the key feature used to determine the validity of possible systolic and diastolic pressures in noise contaminated Korotkoff sounds. The performance of the algorithm was assessed based on the ability to: verify if a signal was contaminated with any noise; the accuracy, sensitivity and specificity of this noise classification, and the systolic and diastolic pressure

Cellular and molecular basis of RV hypertrophy in congenital heart disease.

Science.gov (United States)

Iacobazzi, D; Suleiman, M-S; Ghorbel, M; George, S J; Caputo, M; Tulloh, R M

2016-01-01

RV hypertrophy (RVH) is one of the triggers of RV failure in congenital heart disease (CHD). Therefore, improving our understanding of the cellular and molecular basis of this pathology will help in developing strategic therapeutic interventions to enhance patient benefit in the future. This review describes the potential mechanisms that underlie the transition from RVH to RV failure. In particular, it addresses structural and functional remodelling that encompass contractile dysfunction, metabolic changes, shifts in gene expression and extracellular matrix remodelling. Both ischaemic stress and reactive oxygen species production are implicated in triggering these changes and will be discussed. Finally, RV remodelling in response to various CHDs as well as the potential role of biomarkers will be addressed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

What Physical Fitness Component Is Most Closely Associated With Adolescents' Blood Pressure?

Science.gov (United States)

Nunes, Heloyse E G; Alves, Carlos A S; Gonçalves, Eliane C A; Silva, Diego A S

2017-12-01

This study aimed to determine which of four selected physical fitness variables, would be most associated with blood pressure changes (systolic and diastolic) in a large sample of adolescents. This was a descriptive and cross-sectional, epidemiological study of 1,117 adolescents aged 14-19 years from southern Brazil. Systolic and diastolic blood pressure were measured by a digital pressure device, and the selected physical fitness variables were body composition (body mass index), flexibility (sit-and-reach test), muscle strength/resistance (manual dynamometer), and aerobic fitness (Modified Canadian Aerobic Fitness Test). Simple and multiple linear regression analyses revealed that aerobic fitness and muscle strength/resistance best explained variations in systolic blood pressure for boys (17.3% and 7.4% of variance) and girls (7.4% of variance). Aerobic fitness, body composition, and muscle strength/resistance are all important indicators of blood pressure control, but aerobic fitness was a stronger predictor of systolic blood pressure in boys and of diastolic blood pressure in both sexes.

Role of myocardial hypertrophy on acute and chronic right ventricular performance in relation to chronic volume overload in a porcine model: relevance for the surgical management of tetralogy of Fallot.

Science.gov (United States)

Bove, Thierry; Vandekerckhove, Kristof; Bouchez, Stefaan; Wouters, Patrick; Somers, Pamela; Van Nooten, Guido

2014-06-01

The age for correction of tetralogy of Fallot has progressively declined to the postnatal period, often despite an increased rate of transannular patch repair. However, the long-term effect of premature exposure to chronic pulmonary insufficiency on the right ventricle remains unknown. On the basis of the relationship between the duration of pressure overload and age, the role of previous pressure load-related hypertrophy on right ventricular (RV) performance after chronic volume overload was investigated in a porcine model. RV hypertrophy (RVH), induced by pulmonary artery banding, was studied in pigs with (RVH plus pulmonary insufficiency [PI]) and without (RVH) subsequent PI. The effect of volume overload was compared between these 2 groups and pigs without RVH but with PI and controls (sham). Both acute and chronic effects on RV function were studied using conductance technology and validated using echocardiography. After chronic volume overload, the end-systolic and end-diastolic volumes were smaller in the RVH+PI group than in the PI group, including a lower pulmonary regurgitation fraction (25% ± 5% vs 35% ± 5%; P = .002). RVH resulted in better preserved systolic function, confirmed by an increased preload recruitable stroke work slope (14.7 ± 1.8 vs 9.3 ± 1.3 Mw.s/mL; P = .025) and higher RV ejection fraction (51% ± 3% vs 45% ± 4%; P = .05). Myocardial stiffness was impaired in the RVH+PI group versus the PI group (β, 0.19 ± 0.03 vs 0.12 ± 0.02 mL(-1); P = .001), presenting restrictive physiology only in the condition associating RVH and PI. The results of the present study have demonstrated that RVH attenuates the RV remodeling process related to chronic PI. It enables better preservation of contractility but at the cost of sustained diastolic impairment. These findings might help to determine the timing and strategy for repair of tetralogy of Fallot when RV outflow tract morphology indicates a definite need for transannular reconstruction

High-intensity interval training, but not continuous training, reverses right ventricular hypertrophy and dysfunction in a rat model of pulmonary hypertension.

Science.gov (United States)

Brown, Mary Beth; Neves, Evandro; Long, Gary; Graber, Jeremy; Gladish, Brett; Wiseman, Andrew; Owens, Matthew; Fisher, Amanda J; Presson, Robert G; Petrache, Irina; Kline, Jeffrey; Lahm, Tim

2017-02-01

Exercise is beneficial in pulmonary arterial hypertension (PAH), although studies to date indicate little effect on the elevated pulmonary pressures or maladaptive right ventricle (RV) hypertrophy associated with the disease. For chronic left ventricle failure, high-intensity interval training (HIIT) promotes greater endothelial stimulation and superior benefit than customary continuous exercise training (CExT); however, HIIT has not been tested for PAH. Therefore, here we investigated acute and chronic responses to HIIT vs. CExT in a rat model of monocrotaline (MCT)-induced mild PAH. Six weeks of treadmill training (5 times/wk) were performed, as either 30 min HIIT or 60 min low-intensity CExT. To characterize acute hemodynamic responses to the two approaches, novel recordings of simultaneous pulmonary and systemic pressures during running were obtained at pre- and 2, 4, 6, and 8 wk post-MCT using long-term implantable telemetry. MCT-induced decrement in maximal aerobic capacity was ameliorated by both HIIT and CExT, with less pronounced pulmonary vascular remodeling and no increase in RV inflammation or apoptosis observed. Most importantly, only HIIT lowered RV systolic pressure, RV hypertrophy, and total pulmonary resistance, and prompted higher cardiac index that was complemented by a RV increase in the positive inotrope apelin and reduced fibrosis. HIIT prompted a markedly pulsatile pulmonary pressure during running and was associated with greater lung endothelial nitric oxide synthase after 6 wk. We conclude that HIIT may be superior to CExT for improving hemodynamics and maladaptive RV hypertrophy in PAH. HIIT's superior outcomes may be explained by more favorable pulmonary vascular endothelial adaptation to the pulsatile HIIT stimulus.

Determination of Relations between Systolic Blood Pressure and Heart Attack in Patients with Type 2 Diabetes with Association Rules

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Seyyed Payam Shariatpanahi

2018-03-01

Full Text Available Abstract Background: Today, the high prevalence of diabetes and its complications are one of the most important public health issues worldwide. For this reason, finding relations between diabetes risk factors is very effective in preventing and reducing complications. For discovering these relations, the data mining methods can be used. By extracting association rules, which is one of the data mining techniques, we can discover the relations between a large numbers of variables in a disease. Materials and Methods: The population of this study was 1046 patients with type 2 diabetes, whose data had recorded between 2011 and 2014 at the Special Clinic for Diabetes in Tehran's Imam Khomeini Hospital. After pre-processing step with SPSS19 software, 573 people entered the analysis phase. The FP-Growth algorithm was applied to the data set to discover the relations between heart attack and other risk factors using Rapid miner5 software. Relations, after extraction, were given to the doctor to confirm clinical validation. Results: The obtained results of studying these 573 people (Including 292 (51% women and 281 (49% men, with age range 27 to 82 years showed that the lack of blood pressure, creatinine and diastolic blood pressure at its normal level, despite higher systolic blood pressure level than normal, doesn't increase the probability of heart attack. Conclusion: Using association rules is a good way of identifying relations between the risk factors of a disease. Also, it can provide new hypotheses to do epidemiological studies for researchers.

Pulmonary hypertension due to left heart disease: diagnostic and prognostic value of CT in chronic systolic heart failure.

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Colin, Geoffrey C; Gerber, Bernhard L; de Meester de Ravenstein, Christophe; Byl, David; Dietz, Anna; Kamga, Michele; Pasquet, Agnes; Vancraeynest, David; Vanoverschelde, Jean-Louis; D'Hondt, Anne-Marie; Ghaye, Benoit; Pouleur, Anne-Catherine

2018-05-14

To evaluate the ability of chest computed tomography (CT) to predict pulmonary hypertension (PH) and outcome in chronic heart failure with reduced ejection fraction (HFrEF). We reviewed 119 consecutive patients with HFrEF by CT, transthoracic echocardiography (TTE) and right heart catheterization (RHC). CT-derived pulmonary artery (PA) diameter and PA to ascending aorta diameter ratio (PA:A ratio), left atrial, right atrial, right ventricular (RV) and left ventricular volumes were correlated with RHC mean pulmonary arterial pressure (mPAP) . Diagnostic accuracy to predict PH and ability to predict primary composite endpoint of all-cause mortality and HF events were evaluated. RV volume was significantly higher in 81 patients with PH compared to 38 patients without PH (133 ml/m 2 vs. 79 ml/m 2 , p < 0.001) and was moderately correlated with mPAP (r=0.55, p < 0.001). Also, RV volume had higher ability to predict PH (area under the curve: 0.88) than PA diameter (0.79), PA:A ratio (0.76) by CT and tricuspid regurgitation gradient (0.83) and RV basal diameter by TTE (0.84, all p < 0.001). During the follow-up period (median: 3.4 years), 51 patients (43%) had HF events or died. After correction for important clinical, TTE and RHC parameters, RV volume (adjusted hazard ratio [HR]: 1.71, 95% CI 1.31-2.23, p < 0.001) and PA diameter (HR: 1.61, 95% CI 1.18-2.22, p = 0.003) were independent predictors of the primary endpoint. In patients with HFrEF, measurement of RV volume and PA diameter on ungated CT are non-invasive markers of PH and may help to predict the patient outcome. • Right ventricular (RV) volume measured by chest CT has good ability to identify pulmonary hypertension (PH) in patients with chronic heart failure (HF) and reduced ejection fraction (HFrEF). • The accuracy of pulmonary artery (PA) diameter and PA to ascending aorta diameter ratio (PA:A ratio) to predict PH was similar to previous studies, however, with lower cut-offs (28.1 mm and 0

Clinical impact of left ventricular eccentricity index using cardiac MRI in assessment of right ventricular hemodynamics and myocardial fibrosis in congenital heart disease

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Yamasaki, Yuzo; Kamitani, Takeshi; Yamanouchi, Torahiko; Honda, Hiroshi [Kyushu University, Departments of Clinical Radiology, Graduate School of Medical Sciences, Fukuoka (Japan); Nagao, Michinobu; Kawanami, Satoshi [Kyushu University, Molecular Imaging and Diagnosis, Graduate School of Medical Sciences, Fukuoka (Japan); Yamamura, Kenichiro [Kyushu University, Pediatrics, Graduate School of Medical Sciences, Fukuoka (Japan); Sakamoto, Ichiro [Kyushu University, Cardiovascular Medicine, Graduate School of Medical Sciences, Fukuoka (Japan); Yabuuchi, Hidetake [Kyushu University, Health SciencesGraduate School of Medical Sciences, Fukuoka (Japan)

2016-10-15

To investigate the utility of eccentricity index (EI) using cardiac cine MRI for the assessment of right ventricular (RV) hemodynamics in congenital heart disease (CHD). Fifty-five patients with CHD (32 women; mean age, 40.7 ± 20.9 years) underwent both cardiac MRI and right heart catheterization. EI was defined as the ratio of the distance between the anterior-posterior wall and the septal-lateral wall measured in the short-axis of mid-ventricular cine MRI. Correlations between EIs and RV hemodynamic parameters were analyzed. EIs were compared between patients with and without late gadolinium enhancement (LGE). A strong correlation between mean pulmonary artery pressure (PAP) and systolic EI (r = 0.81, p < 0.0001) and a moderate negative correlation between diastolic EI and RV ejection fraction (EF) (r = -0.62, p < 0.0001) were observed. Receiver operating characteristic analysis revealed optimal EI thresholds for detecting patients with mean PAP ≥40 mmHg with C-statistics of 0.90 and patients with RVEF <40 % with C-statistics of 0.78. Systolic EIs were significantly greater for patients with LGE (1.45 ± 0.05) than for those without LGE (1.15 ± 0.07; p < 0.001). EI offers a simple, comprehensive index that can predict pulmonary hypertension and RV dysfunction in CHD. (orig.)

Statistical analysis of simulation-generated time series : Systolic vs. semi-systolic correlation on the Connection Machine

NARCIS (Netherlands)

Dontje, T.; Lippert, Th.; Petkov, N.; Schilling, K.

1992-01-01

Autocorrelation becomes an increasingly important tool to verify improvements in the state of the simulational art in Latice Gauge Theory. Semi-systolic and full-systolic algorithms are presented which are intensively used for correlation computations on the Connection Machine CM-2. The

Validity of predicting left ventricular end systolic pressure changes following an acute bout of exercise.

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Kappus, Rebecca M; Ranadive, Sushant M; Yan, Huimin; Lane, Abbi D; Cook, Marc D; Hall, Grenita; Harvey, I Shevon; Wilund, Kenneth R; Woods, Jeffrey A; Fernhall, Bo

2013-01-01

Left ventricular end systolic pressure (LV ESP) is important in assessing left ventricular performance and is usually derived from prediction equations. It is unknown whether these equations are accurate at rest or following exercise in a young, healthy population. Measured LV ESP vs. LV ESP values from the prediction equations were compared at rest, 15 min and 30 min following peak aerobic exercise in 60 participants. LV ESP was obtained by applanation tonometry at rest, 15 min post and 30 min post peak cycle exercise. Measured LV ESP was significantly lower (p<0.05) at all time points in comparison to the two calculated values. Measured LV ESP decreased significantly from rest at both the post15 and post30 time points (p<0.05) and changed differently in comparison to the calculated values (significant interaction; p<0.05). The two LV ESP equations were also significantly different from each other (p<0.05) and changed differently over time (significant interaction; p<0.05). The two commonly used prediction equations did not accurately predict either resting or post exercise LV ESP in a young, healthy population. Thus, LV ESP needs to be individually determined in young, healthy participants. Non-invasive measurement through applanation tonometry appears to allow for a more accurate determination of LV ESP. Copyright © 2012 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Detection of Early Right Ventricular Dysfunction in Young Patients With Thalassemia Major Using Tissue Doppler Imaging

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Bornaun, Helen; Dedeoglu, Reyhan; Oztarhan, Kazim; Dedeoglu, Savas; Erfidan, Erkan; Gundogdu, Muge; Aydogan, Gonul; Cengiz, Dicle

2016-01-01

Background Myocardial iron overload is the most common cause of mortality in patients with thalassemia major (TM), also known as beta-thalassemia. T2* cardiovascular magnetic resonance imaging (MRI) is the best way of monitoring cardiac iron, and new echocardiographic techniques can be used to assess cardiac function. Objectives The aim of this study was to assess the systolic and diastolic right ventricular (RV) function of patients with TM using tissue Doppler imaging (TDI) and to determine whether this echocardiographic technique is an adequate diagnostic tool for the screening and detection of subclinical cardiac dysfunction. Patients and Methods Eighty-four patients with TM were evaluated by conventional echocardiography and pulse-wave TDI. The data of the TM group (Group 1) were compared with that of 85 age- and sex-matched healthy controls (Group 2). Cardiovascular T2* MRI examinations were performed in 49 of the 85 patients. Results The patients with TM had significantly lower values for weight, height, body mass index, systolic arterial pressure, deceleration time, E’/A’, and ejection time (ET) than the controls. Group 1 also had significantly higher values for peak early diastolic velocity (E) over peak late diastolic velocity (A), peak early diastolic velocity of TDI (E’), peak late diastolic velocity of TDI (A’), E/E’, isovolumetric relaxation time, isovolumetric contraction time, and RV magnetic perfusion imaging (MPI) than Group 2. Conclusions RV diastolic dysfunction occurs before systolic deterioration in patients with TM and cannot be screened with conventional echocardiographic techniques. In routine practice, TDI measurements, MPI (for global function) and the E/E’ parameter (for diastolic function) can be used to screen and detect early RV dysfunction. PMID:27617076

Dose related anxiolytic effects of diazepam: relation with serum electrolytes, plasma osmolality and systolic blood pressure (sbp) in rats

International Nuclear Information System (INIS)

Farooq, R.; Haleem, D.J.; Haleem, M.A.

2008-01-01

Diazepam is an anxiolytic and anticonvulsant drug that also induces hypnosis. Changes in serum electrolyte balance, plasma osmolality and systolic blood pressure (SBP) are often associated with stress-induced anxiety. Administration of diazepam has been show to decrease stress-induced enhancement of hypothalamic pituitary adrenal cortical (HPA) axis. The present is designed to monitor the anxiolytic effects of different doses of diazepam (1 mg/kg, 2.5 mg/kg and 5 mg/kg) and its association with changes of serum electrolyte balance, plasma osmolality and SBP in rats. Administration of diazepam at doses of 1 mg/kg, 2.5 mg/kg and 5 mg/kg elicited anxiolytic effects monitored in light-dark transition test and increased serum concentration of electrolytes and plasma osmolality. Serum levels of magnesium as well as SBP decreased. The results are discussed in context of anxiolytic effects of diazepam to be mediated via a modulation of stress-induced increase in the activity of HPA-axis arid electrolytes balance. (author)

Pressure-volume Relationship in the Stress-echocardiography Laboratory: Does (Left Ventricular End-diastolic) Size Matter?

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Bombardini, Tonino; Mulieri, Louis A; Salvadori, Stefano; Costantino, Marco Fabio; Scali, Maria Chiara; Marzilli, Mario; Picano, Eugenio

2017-02-01

The variation between rest and peak stress end-systolic pressure-volume relation is an afterload-independent index of left ventricular contractility. Whether and to what extent it depends on end-diastolic volume remains unclear. The aim of this study was to assess the dependence of the delta rest-stress end-systolic pressure-volume relation on end-diastolic volume in patients with negative stress echo and all ranges of resting left ventricular function. We analyzed interpretable data obtained in 891 patients (593 men, age 63 ± 12 years) with ejection fraction 47% ± 12%: 338 were normal or near-normal or hypertensive; 229 patients had coronary artery disease; and 324 patients had ischemic or nonischemic dilated cardiomyopathy. They were studied with exercise (n = 172), dipyridamole (n = 482) or dobutamine (n = 237) stress echocardiography. The end-systolic pressure-volume relation was evaluated at rest and peak stress from raw measurement of systolic arterial pressure by cuff sphygmomanometer and end-systolic volume by biplane Simpson rule 2-dimensional echocardiography. Absolute values of delta rest-stress end-systolic pressure-volume relation were higher for exercise and dobutamine than for dipyridamole. In the overall population, an inverse relationship between end-systolic pressure-volume relation and end-diastolic volume was present at rest (r 2 = 0.69, P stress (r 2 = 0.56, P stress end-systolic pressure-volume relation was considered (r 2 = 0.13). Left ventricular end-diastolic volume does not affect the rest-stress changes in end-systolic pressure-volume relation in either normal or abnormal left ventricles during physical or pharmacological stress. Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Mitral annular systolic velocity as a marker of preclinical systolic dysfunction among patients with arterial hypertension

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Daskalov Ivaylo Rilkov

2012-11-01

Full Text Available Abstract Background The aim of this study was to investigate early changes in left ventricular longitudinal systolic function in patients with hypertension (HTN with and without concomitant diastolic dysfunction (DD and the clinical implications of these findings. Method We enrolled 299 patients with HTN and 297 age-matched patients with HTN and DD and compared both groups with an age-matched control group consisting of 100 healthy subjects. The long axis systolic function was investigated by determining the average peak systolic velocity of the septal and lateral mitral sites (Smavg using spectral pulsed wave tissue Doppler imaging (TDI. Results We found a strong negative trend toward the reduction of velocity, which is dependent on the grade of HTN, on the magnitude of DD, and also on the gender and age of the subjects (r=−0.891/-0.580; p Conclusion The strength of the study is the analysis of incremental changes in longitudinal contraction in patients with different stage of HTN but not so many the classification of the degree of systolic dysfunction. The importance of our results lies in the fact that these initial changes in systolic contraction could be used as an early sign that should prompt optimization of the treatment of HTN.

Ülemiste City kvartal Tallinnas / Mattias Agabus, Eero Endjärv, Illimar Truverk...[jt.] ; fotod: Kaido Haagen

Index Scriptorium Estoniae

2008-01-01

asendiplaan, 3 korruste plaani, 3 värv. välisvaadet, restorani Mercado sisevaade; projekteerijad: M. Agabus, E. Endjärv, I.Truverk (Agabus, Endjärv & Truverk Arhitektid); hoonete arhitektuurne osa: E. Endjärv; sisearhitektid: K. Lents, H. Kääramees, T. Aunre (restoran Mercado); konstruktorid: Ü. Suvemaa, A. Lehtla, K. Adoberg; maastikuarhitektuur: Ü. Grišakov, M. Agabus, E. Endjärv

Genome-wide association study identifies six new loci influencing pulse pressure and mean arterial pressure

NARCIS (Netherlands)

L.V. Wain (Louise); G.C. Verwoert (Germaine); P.F. O'Reilly (Paul); G. Shi (Gang); T. Johnson (Toby); M. Bochud (Murielle); K. Rice (Kenneth); P. Henneman (Peter); A.V. Smith (Albert Vernon); G.B. Ehret (Georg); N. Amin (Najaf); M.G. Larson (Martin); V. Mooser (Vincent); D. Hadley (David); M. Dörr (Marcus); J.C. Bis (Joshua); T. Aspelund (Thor); T. Esko (Tõnu); A.C.J.W. Janssens (Cécile); J.H. Zhao (Jing Hua); S.C. Heath (Simon); M. Laan (Maris); J. Fu (Jingyuan); G. Pistis (Giorgio); J. Luan; G. Lucas (Gavin); N. Pirastu (Nicola); I. Pichler (Irene); A.U. Jackson (Anne); R.J. Webster (Rebecca J.); F.F. Zhang; J. Peden (John); R. Schmidt (Reinhold); T. Tanaka (Toshiko); H. Campbell (Harry); W. Igl (Wilmar); Y. Milaneschi (Yuri); J.J. Hottenga (Jouke Jan); V. Vitart (Veronique); D.I. Chasman (Daniel); S. Trompet (Stella); J.L. Bragg-Gresham (Jennifer L.); B.Z. Alizadeh (Behrooz); J.C. Chambers (John); X. Guo (Xiuqing); T. Lehtimäki (Terho); B. Kuhnel (Brigitte); L.M. Lopez; O. Polasek (Ozren); M. Boban (Mladen); C.P. Nelson (Christopher P.); A.C. Morrison (Alanna); V. Pihur (Vasyl); S.K. Ganesh (Santhi); A. Hofman (Albert); S. Kundu (Suman); F.U.S. Mattace Raso (Francesco); F. Rivadeneira Ramirez (Fernando); E.J.G. Sijbrands (Eric); A.G. Uitterlinden (André); S.J. Hwang; R.S. Vasan (Ramachandran Srini); Y.A. Wang (Ying); S.M. Bergmann (Sven); P. Vollenweider (Peter); G. Waeber (Gérard); J. Laitinen (Jaana); A. Pouta (Anneli); P. Zitting (Paavo); W.L. McArdle (Wendy); H.K. Kroemer (Heyo); U. Völker (Uwe); H. Völzke (Henry); N.L. Glazer (Nicole); K.D. Taylor (Kent); T.B. Harris (Tamara); H. Alavere (Helene); T. Haller (Toomas); A. Keis (Aime); M.L. Tammesoo; Y.S. Aulchenko (Yurii); K-T. Khaw (Kay-Tee); P. Galan (Pilar); S. Hercberg (Serge); G.M. Lathrop (Mark); S. Eyheramendy (Susana); E. Org (Elin); S. Sõber (Siim); X. Lu (Xiaowen); I.M. Nolte (Ilja); B.W.J.H. Penninx (Brenda); T. Corre (Tanguy); C. Masciullo (Corrado); C. Sala (Cinzia); L. Groop (Leif); B.F. Voight (Benjamin); O. Melander (Olle); C.J. O'Donnell (Christopher); V. Salomaa (Veikko); P. d' Adamo (Pio); A. Fabretto (Antonella); F. Faletra (Flavio); S. Ulivi (Shelia); F. Del Greco M (Fabiola); M.F. Facheris (Maurizio); F.S. Collins (Francis); R.N. Bergman (Richard); J.P. Beilby (John); J. Hung (Judy); A.W. Musk (Arthur); M. Mangino (Massimo); S.Y. Shin (So Youn); N. Soranzo (Nicole); H. Watkins (Hugh); A. Goel (Anuj); A. Hamsten (Anders); P. Gider (Pierre); M. Loitfelder (Marisa); M. Zeginigg (Marion); D.G. Hernandez (Dena); S.S. Najjar (Samer); P. Navarro (Pau); S.H. Wild (Sarah); A.M. Corsi (Anna Maria); A. Singleton (Andrew); E.J.C. de Geus (Eco); G.A.H.M. Willemsen (Gonneke); A.N. Parker (Alex); L.M. Rose (Lynda); B.M. Buckley (Brendan M.); D.J. Stott (David. J.); M. Orrù (Marco); M. Uda (Manuela); M.M. van der Klauw (Melanie); X. Li (Xiaohui); J. Scott (James); Y.D.I. Chen (Yii-Der Ida); G.L. Burke (Greg); M. Kähönen (Mika); J. Viikari (Jorma); A. Döring (Angela); T. Meitinger (Thomas); G.S. Davis; J.M. Starr (John); V. Emilsson (Valur); A.S. Plump (Andrew); J.H. Lindeman (Jan H.); P.A.C. 't Hoen (Peter); I.R. König (Inke); J.F. Felix (Janine); R. Clarke; J. Hopewell; H. Ongen (Halit); M.M.B. Breteler (Monique); S. Debette (Stéphanie); A.L. DeStefano (Anita); M. Fornage (Myriam); G.F. Mitchell (Gary); H. Holm (Hilma); K. Stefansson (Kari); G. Thorleifsson (Gudmar); U. Thorsteinsdottir (Unnur); N.J. Samani (Nilesh); M. Preuss (Michael); I. Rudan (Igor); C. Hayward (Caroline); I.J. Deary (Ian); H.E. Wichmann (Heinz Erich); O. Raitakari (Olli); W. Palmas (Walter); J.S. Kooner (Jaspal); R.P. Stolk (Ronald); J.W. Jukema (Jan Wouter); A.F. Wright (Alan); D.I. Boomsma (Dorret); S. Bandinelli (Stefania); U. Gyllensten (Ulf); J.F. Wilson (James); L. Ferrucci (Luigi); M. Farrall (Martin); T.D. Spector (Timothy); L.J. Palmer; J. Tuomilehto (Jaakko); A. Pfeufer (Arne); P. Gasparini (Paolo); D.S. Siscovick (David); D. Altshuler (David); R.J.F. Loos (Ruth); D. Toniolo (Daniela); H. Snieder (Harold); C. Gieger (Christian); P. Meneton (Pierre); N.J. Wareham (Nick); B.A. Oostra (Ben); A. Metspalu (Andres); L.J. Launer (Lenore); R. Rettig (Rainer); D.P. Strachan (David); J.S. Beckmann (Jacques); J.C.M. Witteman (Jacqueline); J.A.P. Willems van Dijk (Ko); E.A. Boerwinkle (Eric); M. Boehnke (Michael); P.M. Ridker (Paul); M.R. Järvelin; A. Chakravarti (Aravinda); J. Erdmann (Jeanette); V. Gudnason (Vilmundur); C. Newton-Cheh (Christopher); D. Levy (Daniel); P. Arora (Pankaj); P. Munroe (Patricia); B.M. Psaty (Bruce); M. Caulfield (Mark); D.C. Rao (Dabeeru C.); P. Elliott (Paul); P. Tikka-Kleemola (Päivi); G.R. Abecasis (Gonçalo); I.E. Barroso (Inês)

2011-01-01

textabstractNumerous genetic loci have been associated with systolic blood pressure (SBP) and diastolic blood pressure (DBP) in Europeans. We now report genome-wide association studies of pulse pressure (PP) and mean arterial pressure (MAP). In discovery (N = 74,064) and follow-up studies (N =

The inter-arm systolic blood pressure difference and risk of cardiovascular mortality: A meta-analysis of cohort studies.

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Zhou, Ming; Gao, Zhen; Chen, Fei; Xu, Haijun; Dong, Xiao; Ma, Li

2016-01-01

The inter-arm systolic blood pressure difference (SBPD) is recommended to be in relation to potential cardiovascular disease (CVD). Previous studies yielded controversial results about the association between an inter-arm SBPD ≥ 10 mmHg or ≥15 mmHg and the risk of cardiovascular mortality. Therefore, we conducted this meta-analysis to investigate this association. We searched PubMed and Embase databases through December 31, 2014, and examined the references of retrieved articles to identify relevant cohort studies. We utilized Newcastle-Ottawa scale to assess the quality of included studies and calculated the summary risk estimates in a fixed/random-effect model. All data analyses were conducted using STATA version 11.0. A total of seven studies were identified. Compared with participants with an inter-arm SBPD arm SBPD ≥ 10 mmHg was 1.58 (95% CI: 1.3-1.93), and the pooled HR of cardiovascular mortality of participants with an inter-arm SBPD ≥ 15 mmHg versus those with an inter-arm SBPD arm SBPD may define a subpopulation at high risk of CVD events.

Systolic pulmonary artery pressure assessed during routine exercise Doppler echocardiography: insights of a real-world setting in patients with elevated pulmonary pressures.

Science.gov (United States)

Korff, Susanne; Enders-Gier, Patricia; Uhlmann, Lorenz; Aurich, Matthias; Greiner, Sebastian; Hirschberg, Kristof; Katus, Hugo A; Mereles, Derliz

2018-03-19

Pulmonary hypertension is a marker of disease severity. Exercise Doppler echocardiography (EDE) has proven to be feasible and reliable to assess pulmonary pressure. Increase in systolic pulmonary artery pressure (sPAP) has diagnostic and prognostic value in controlled studies. However, its value when assessed during routine examination in patients with cardiopulmonary diseases and resting sPAP > 35 mmHg is not clearly defined. Clinical documentation and offline reevaluation of digitally stored EDE examinations of patients with appropriate clinical indications for EDE were analyzed. N = 278 patients with sPAP at rest > 35 mmHg met inclusion criteria. One patient was lost to follow-up. Mean age of patients was 72 ± 10 years, 178 (64%) of the study population were men. There were no relevant differences among survivors and non-survivors concerning comorbidities. Exercise performance (3.6 ± 1.2 vs. 4.9 ± 1.4 MET, p  45 mm (HR = 2.58, p  42 mmHg (HR = 1.94, p = 0.010) and ΔsPAP increase ≥ 0.23 mmHg/Watt (HF = 1.92, p = 0.010). After multivariate analysis, NYHA functional class III (HR = 2.35, p < 0.001), LA diameter (HR = 2.28, p = 0.003) and sPAP increase ≥ 0.23 mmHg/Watt (HF = 2.19, p = 0.002) remained significant predictors of mortality, whereas a double product (HR = 0.42, p = 0.005) was associated with better prognosis. sPAP assessment during routine EDE provides relevant prognostic information comparable to findings in studies in selected populations. A higher sPAP increase at lower exercise performance shows significant association with increased of mortality.

Structure of Rv1848 (UreA), the Mycobacterium tuberculosis urease γ subunit

International Nuclear Information System (INIS)

Habel, Jeff E.; Bursey, Evan H.; Rho, Beom-Seop; Kim, Chang-Yub; Segelke, Brent W.; Rupp, Bernhard; Park, Min S.; Terwilliger, Thomas C.; Hung, Li-Wei

2010-01-01

Crystal and solution structures of Rv1848 protein and their implications in the biological assembly of Mtb urease is presented. The crystal structure of the urease γ subunit (UreA) from Mycobacterium tuberculosis, Rv1848, has been determined at 1.8 Å resolution. The asymmetric unit contains three copies of Rv1848 arranged into a homotrimer that is similar to the UreA trimer in the structure of urease from Klebsiella aerogenes. Small-angle X-ray scattering experiments indicate that the Rv1848 protein also forms trimers in solution. The observed homotrimer and the organization of urease genes within the M. tuberculosis genome suggest that M. tuberculosis urease has the (αβγ) 3 composition observed for other bacterial ureases. The γ subunit may be of primary importance for the formation of the urease quaternary structure

Maximum home blood pressure is a useful indicator of diabetic nephropathy in patients with type 2 diabetes mellitus: KAMOGAWA-HBP study.

Science.gov (United States)

Oyabu, Chikako; Ushigome, Emi; Matsumoto, Shinobu; Tanaka, Toru; Hasegawa, Goji; Nakamura, Naoto; Ohnishi, Masayoshi; Tsunoda, Sei; Ushigome, Hidetaka; Yokota, Isao; Tanaka, Muhei; Asano, Mai; Yamazaki, Masahiro; Fukui, Michiaki

2017-11-01

Maximum home systolic blood pressure has been shown to predict target organ damage. We aimed to clarify the association between maximum home systolic blood pressure and urine albumin to creatinine ratio, an indicator of early-phase diabetic nephropathy in patients with type 2 diabetes. In 1040 patients, we assessed the relationship of mean or maximum home systolic blood pressure and urine albumin to creatinine ratio, and compared the area under the receiver operating characteristic curve of mean or maximum home systolic blood pressure for diabetic nephropathy (urine albumin to creatinine ratio ⩾30 mg/g Cr). Multivariate linear regression analyses indicated that mean morning systolic blood pressure ( β = 0.010, p blood pressure ( β = 0.008, p blood pressure was 0.667 (0.634-0.700; p blood pressure, as well as mean home systolic blood pressure, was significantly associated with diabetic nephropathy in patients with type 2 diabetes.

Evaluation of the impact of atmospheric pressure in different seasons on blood pressure in patients with arterial hypertension.

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Kamiński, Marek; Cieślik-Guerra, Urszula I; Kotas, Rafał; Mazur, Piotr; Marańda, Witold; Piotrowicz, Maciej; Sakowicz, Bartosz; Napieralski, Andrzej; Trzos, Ewa; Uznańska-Loch, Barbara; Rechciński, Tomasz; Kurpesa, Małgorzata

2016-01-01

Atmospheric pressure is the most objective weather factor because regardless of if outdoors or indoors it affects all objects in the same way. The majority of previous studies have used the average daily values of atmospheric pressure in a bioclimatic analysis and have found no correlation with blood pressure changes. The main objective of our research was to assess the relationship between atmospheric pressure recorded with a frequency of 1 measurement per minute and the results of 24-h blood pressure monitoring in patients with treated hypertension in different seasons in the moderate climate of the City of Łódź (Poland). The study group consisted of 1662 patients, divided into 2 equal groups (due to a lower and higher average value of atmospheric pressure). Comparisons between blood pressure values in the 2 groups were performed using the Mann-Whitney U test. We observed a significant difference in blood pressure recorded during the lower and higher range of atmospheric pressure: on the days of the spring months systolic (p = 0.043) and diastolic (p = 0.005) blood pressure, and at nights of the winter months systolic blood pressure (p = 0.013). A significant inverse relationship between atmospheric pressure and blood pressure during the spring days and, only for systolic blood pressure, during winter nights was observed. Int J Occup Med Environ Health 2016;29(5):783-792. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

Validation of the Andon KD-5965 upper-arm blood pressure monitor for home blood pressure monitoring according to the European Society of Hypertension International Protocol revision 2010.

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Huang, Jinhua; Li, Zhijie; Li, Guimei; Liu, Zhaoying

2015-10-01

This study aimed to evaluate the accuracy of the Andon KD-5965 upper-arm blood pressure monitor according to the European Society of Hypertension International Protocol revision 2010. Systolic and diastolic blood pressures were sequentially measured in 33 adults, with 20 women using a mercury sphygmomanometer (two observers) and the Andon KD-5965 device (one supervisor). A total of 99 pairs of comparisons were obtained from 33 participants for judgments in two parts with three grading phases. The device achieved the targets in part 1 of the validation study. The number of absolute differences between the device and observers within 5, 10, and 15 mmHg was 70/99, 91/99, and 98/99, respectively, for systolic blood pressure and 81/99, 99/99, and 99/99, respectively, for diastolic blood pressure. The device also fulfilled the criteria in part 2 of the validation study. Twenty-five and 29 participants, for systolic and diastolic blood pressure, respectively, had at least two of the three device-observers differences within 5 mmHg (required≥24). Two and one participants for systolic and diastolic blood pressure, respectively, had all three device-observers comparisons greater than 5 mmHg. According to the validation results, with better performance for diastolic blood pressure than that for systolic blood pressure, the Andon automated oscillometric upper-arm blood pressure monitor KD-5965 fulfilled the requirements of the European Society of Hypertension International Protocol revision 2010, and hence can be recommended for blood pressure measurement in adults.

1.55 Å resolution X-ray crystal structure of Rv3902c from Mycobacterium tuberculosis

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Reddy, Bharat G.; Moates, Derek B. [University of Alabama at Birmingham, 1025 18th Street South, Birmingham, AL 35233 (United States); Kim, Heung-Bok [Los Alamos National Laboratory, Los Alamos, NM 87545 (United States); Green, Todd J. [University of Alabama at Birmingham, 1025 18th Street South, Birmingham, AL 35233 (United States); Kim, Chang-Yub; Terwilliger, Thomas C. [Los Alamos National Laboratory, Los Alamos, NM 87545 (United States); DeLucas, Lawrence J., E-mail: duke2@uab.edu [University of Alabama at Birmingham, 1025 18th Street South, Birmingham, AL 35233 (United States)

2014-03-25

The 1.55 Å resolution X-ray crystal structure of Rv3902c from M. tuberculosis reveals a novel fold. The crystallographic structure of the Mycobacterium tuberculosis (TB) protein Rv3902c (176 residues; molecular mass of 19.8 kDa) was determined at 1.55 Å resolution. The function of Rv3902c is unknown, although several TB genes involved in bacterial pathogenesis are expressed from the operon containing the Rv3902c gene. The unique structural fold of Rv3902c contains two domains, each consisting of antiparallel β-sheets and α-helices, creating a hand-like binding motif with a small binding pocket in the palm. Structural homology searches reveal that Rv3902c has an overall structure similar to that of the Salmonella virulence-factor chaperone InvB, with an r.m.s.d. for main-chain atoms of 2.3 Å along an aligned domain.

1.55 Å resolution X-ray crystal structure of Rv3902c from Mycobacterium tuberculosis

International Nuclear Information System (INIS)

Reddy, Bharat G.; Moates, Derek B.; Kim, Heung-Bok; Green, Todd J.; Kim, Chang-Yub; Terwilliger, Thomas C.; DeLucas, Lawrence J.

2014-01-01

The 1.55 Å resolution X-ray crystal structure of Rv3902c from M. tuberculosis reveals a novel fold. The crystallographic structure of the Mycobacterium tuberculosis (TB) protein Rv3902c (176 residues; molecular mass of 19.8 kDa) was determined at 1.55 Å resolution. The function of Rv3902c is unknown, although several TB genes involved in bacterial pathogenesis are expressed from the operon containing the Rv3902c gene. The unique structural fold of Rv3902c contains two domains, each consisting of antiparallel β-sheets and α-helices, creating a hand-like binding motif with a small binding pocket in the palm. Structural homology searches reveal that Rv3902c has an overall structure similar to that of the Salmonella virulence-factor chaperone InvB, with an r.m.s.d. for main-chain atoms of 2.3 Å along an aligned domain

Quantitative assessment of the entire right ventricle from one acoustic window: an attractive approach.

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McGhie, Jackie S; Menting, Myrthe E; Vletter, Wim B; Frowijn, René; Roos-Hesselink, Jolien W; van der Zwaan, Heleen B; Soliman, Osama I I; Geleijnse, Marcel L; van den Bosch, Annemien E

2017-07-01

The aim of this prospective study was to evaluate the feasibility and establish normal values of functional right ventricle (RV) parameters as assessed in our four, long-axis view RV model using iRotate echocardiography. Furthermore, we evaluated the potential use of this model in patients with abnormally loaded RVs. One hundred and fifty-five healthy subjects aged 20-72 years (≥28 subjects per decile) were prospectively recruited. We used non-dedicated RV speckle-tracking software to test the feasibility and to establish normal range values of peak systolic global longitudinal RV strain (RV-GLS) from the RV free-walls (septum was excluded). Also normal range values for: dimensions, tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular peak systolic velocity (TDI-S') were established. The feasibility of RV-GLS was 88, 84, and 62%, respectively, in the lateral, inferior, and anterior free wall. Mean RV-GLS normal values were -24.5 ± 4.9% for lateral wall and -25.4 ± 5.0% for anterior wall. Mean RV-GLS in the inferior wall was -23.2 ± 4.4% in the aortic (Ao) view and -20.7 ± 5.0% in the coronal (CV) view. The feasibility of mean RV-GLS was 100% in the anterior, lateral, and inferior walls in abnormally dilated RVs. The feasibility of all RV parameters assessed in the four-view iRotate model is good to excellent. Normal values for RV dimension and function of the anterior, inferior, and lateral RV walls have been established. Further studies and dedicated RV speckle-tracking software are warranted to discover the full potential of this new technique. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions, please email: journals.permissions@oup.com.

The Effect of Elective Percutaneous Coronary Intervention of the Right Coronary Artery on Right Ventricular Function

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Farahnaz Nikdoust

2014-12-01

Full Text Available Background: Right Ventricular (RV dysfunction has been introduced as a predictor of mortality in acute myocardial infarction. Objectives: This study aimed to investigate the effect of right coronary revascularization on systolic and diastolic RV dysfunction. Patients and Methods: This study was conducted on unstable angina patients who were candidate for elective Percutaneous Revascularization Intervention (PCI on the right coronary artery. The participants were initially evaluated by transthoracic echocardiography and tissue Doppler imaging prior to PCI and the RV function parameters were assessed. Echocardiography was repeated two months after PCI and the results were compared with baseline. Paired t-test was used to compare the pre- and post-procedural measurements. Besides, Pearson’s correlation was used to find out the linear association between the RV function parameters and Left Ventricular Ejection Fraction (LVEF. P value < 0.05 was considered as statistically significant. Results: This study was conducted on 30 patients (mean age = 60.00 ± 8.44 years; 24 [80%] males. In the pre-procedural echocardiography, 15 patients (50% had normal RV function, 14 patients (46.7% had grade-1 RV dysfunction, and only 1 patient (3.3% had grade-2 RV dysfunction. Following PCI, however, all the patients had normal systolic and diastolic RV functions. Comparison of echocardiographic RV function parameters showed an improvement in both systolic and diastolic functional parameters of the RV. Nonetheless, no significant correlation was observed between these parameters and Left Ventricular (LV function. Conclusions:: A significant improvement was found in RV function, but not LV function, after right coronary PCI. Revascularization of the right coronary artery may be beneficial for the patients who suffer from RV failure due to ischemia

[Clinical characteristics and medium-term prognosis of patients with heart failure and preserved systolic function. Do they differ in systolic dysfunction?].

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Ojeda, Soledad; Anguita, Manuel; Muñoz, Juan F; Rodríguez, Marcos T; Mesa, Dolores; Franco, Manuel; Ureña, Isabel; Vallés, Federico

2003-11-01

To assess the prevalence, clinical profile and medium-term prognosis in patients with heart failure and preserved systolic ventricular function compared to those with systolic dysfunction. 153 patients were included, 62 with preserved systolic ventricular function (left ventricular ejection fraction > or = 45%) and 91 with impaired systolic ventricular function (left ventricular ejection fraction < 45%). The mean follow-up period was 25 10 months. Mean age was similar (66 10 vs. 65 10; p = 0.54). There was a higher proportion of women among patients with preserved systolic function (53% vs. 28%; p < 0.01). Ischemic and idiopathic cardiomyopathy were the most common causes of heart failure in patients with systolic dysfunction, whereas valvular disease and hypertensive cardiopathy were the most common in patients with preserved systolic function. Angiotensin-converting enzyme inhibitors and beta-blockers were more often prescribed in patients with impaired systolic ventricular function (86% vs. 52%; p < 0.01 and 33% vs. 11%; p < 0.01, respectively). There were no differences between the groups in terms of mortality rate (37% vs. 29%), readmission rate for other causes (29% vs. 23%), readmission rate for heart failure (45% vs. 45%), cumulative survival (51% vs. 62%) and the likelihood of not being readmitted for heart failure (50% vs. 52%). In the multivariate analysis, left ventricular ejection fraction was not a predictor of death or readmission because of heart failure. In a large proportion of patients with heart failure, systolic ventricular function is preserved. Despite the clinical differences between patients with preserved and impaired systolic ventricular function, the medium-term prognosis was similar in both groups.

Echocardiographic Parameters and Survival in Chagas Heart Disease with Severe Systolic Dysfunction

International Nuclear Information System (INIS)

Rassi, Daniela do Carmo; Vieira, Marcelo Luiz Campos; Arruda, Ana Lúcia Martins; Hotta, Viviane Tiemi; Furtado, Rogério Gomes; Rassi, Danilo Teixeira; Rassi, Salvador

2014-01-01

Echocardiography provides important information on the cardiac evaluation of patients with heart failure. The identification of echocardiographic parameters in severe Chagas heart disease would help implement treatment and assess prognosis. To correlate echocardiographic parameters with the endpoint cardiovascular mortality in patients with ejection fraction < 35%. Study with retrospective analysis of pre-specified echocardiographic parameters prospectively collected from 60 patients included in the Multicenter Randomized Trial of Cell Therapy in Patients with Heart Diseases (Estudo Multicêntrico Randomizado de Terapia Celular em Cardiopatias) - Chagas heart disease arm. The following parameters were collected: left ventricular systolic and diastolic diameters and volumes; ejection fraction; left atrial diameter; left atrial volume; indexed left atrial volume; systolic pulmonary artery pressure; integral of the aortic flow velocity; myocardial performance index; rate of increase of left ventricular pressure; isovolumic relaxation time; E, A, Em, Am and Sm wave velocities; E wave deceleration time; E/A and E/Em ratios; and mitral regurgitation. In the mean 24.18-month follow-up, 27 patients died. The mean ejection fraction was 26.6 ± 5.34%. In the multivariate analysis, the parameters ejection fraction (HR = 1.114; p = 0.3704), indexed left atrial volume (HR = 1.033; p < 0.0001) and E/Em ratio (HR = 0.95; p = 0.1261) were excluded. The indexed left atrial volume was an independent predictor in relation to the endpoint, and values > 70.71 mL/m 2 were associated with a significant increase in mortality (log rank p < 0.0001). The indexed left atrial volume was the only independent predictor of mortality in this population of Chagasic patients with severe systolic dysfunction

Echocardiographic Parameters and Survival in Chagas Heart Disease with Severe Systolic Dysfunction

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Rassi, Daniela do Carmo, E-mail: dani.rassi@hotmail.com [Faculdade de Medicina e Hospital das Clínicas da Universidade Federal de Goiás (UFG), Goiânia, GO (Brazil); Vieira, Marcelo Luiz Campos [Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP (Brazil); Arruda, Ana Lúcia Martins [Instituto de Radiologia da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP (Brazil); Hotta, Viviane Tiemi [Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP (Brazil); Furtado, Rogério Gomes; Rassi, Danilo Teixeira; Rassi, Salvador [Faculdade de Medicina e Hospital das Clínicas da Universidade Federal de Goiás (UFG), Goiânia, GO (Brazil)

2014-03-15

Echocardiography provides important information on the cardiac evaluation of patients with heart failure. The identification of echocardiographic parameters in severe Chagas heart disease would help implement treatment and assess prognosis. To correlate echocardiographic parameters with the endpoint cardiovascular mortality in patients with ejection fraction < 35%. Study with retrospective analysis of pre-specified echocardiographic parameters prospectively collected from 60 patients included in the Multicenter Randomized Trial of Cell Therapy in Patients with Heart Diseases (Estudo Multicêntrico Randomizado de Terapia Celular em Cardiopatias) - Chagas heart disease arm. The following parameters were collected: left ventricular systolic and diastolic diameters and volumes; ejection fraction; left atrial diameter; left atrial volume; indexed left atrial volume; systolic pulmonary artery pressure; integral of the aortic flow velocity; myocardial performance index; rate of increase of left ventricular pressure; isovolumic relaxation time; E, A, Em, Am and Sm wave velocities; E wave deceleration time; E/A and E/Em ratios; and mitral regurgitation. In the mean 24.18-month follow-up, 27 patients died. The mean ejection fraction was 26.6 ± 5.34%. In the multivariate analysis, the parameters ejection fraction (HR = 1.114; p = 0.3704), indexed left atrial volume (HR = 1.033; p < 0.0001) and E/Em ratio (HR = 0.95; p = 0.1261) were excluded. The indexed left atrial volume was an independent predictor in relation to the endpoint, and values > 70.71 mL/m{sup 2} were associated with a significant increase in mortality (log rank p < 0.0001). The indexed left atrial volume was the only independent predictor of mortality in this population of Chagasic patients with severe systolic dysfunction.

Regional myocardial extraction of a radioiodinated branched chain fatty acid during right ventricular pressure overload due to acute pulmonary hypertension

International Nuclear Information System (INIS)

Hurford, W.; Lowenstein, E.; Zapol, W.; Barlai-Kovach, M.; Livni, E.; Elmaleh, D.R.; Strauss, H.W.

1985-01-01

To determine whether branched chain fatty acid extraction is reduced during right ventricular (RV) dysfunction due to acute pulmonary artery hypertension, studies were done in 6 anesthetized dogs. Regional branched chain fatty acid extraction was measured by comparing the myocardial uptake of I-125 labeled 15-[p-(iodophenyl)]-3-methylpentadecanoic acid (I-PDA) to myocardial blood flow. Acute pulmonary hypertension was induced by incremental intravenous injection of 100 micron diameter glass beads into six pentobarbital anesthetized, mechanically ventilated dogs. Myocardial blood flow was measured by radiolabeled microspheres both under baseline conditions and during pulmonary hypertension. Mean RV pressure rose from 12 +- 2 (mean +- SEM) to 30 +-3mmHg resulting in a 225 +- 16% increase in RV stroke work. RV ejection fraction, as assessed by gated blood pool scans fell from 39 +- 2 to 18 +- 2%. Left ventricular (LV) pressures, stroke work and ejection fraction were unchanged. Myocardial blood flow increased 132 + 59% in the RV free wall and 67 +- 22% in the RV septum. LV blood flow was unchanged. Despite increased RV work and myocardial blood flow, no differences were noted in the branched chain fatty acid extraction ratios among LV or RV free walls or septum. The authors conclude that early RV dysfunction associated with pulmonary artery hypertension is not due to inadequate myocardial blood flow or branched chain fatty acid extraction

Phase I trial of RV3-BB rotavirus vaccine: a human neonatal rotavirus vaccine.

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Danchin, M; Kirkwood, C D; Lee, K J; Bishop, R F; Watts, E; Justice, F A; Clifford, V; Cowley, D; Buttery, J P; Bines, J E

2013-05-28

RV3 is a human neonatal rotavirus strain (G3P[6]) that has been associated with asymptomatic neonatal infection and replicates well in the infant gut. RV3-BB rotavirus vaccine has been developed as a rotavirus vaccine candidate for administration at birth. A single-centre, double-blind, randomised placebo-controlled Phase I study evaluated the safety and tolerability of a single oral dose of the second generation RV3-BB rotavirus vaccine (8.3×10(6)FFU/mL) in 20 adults, 20 children and 20 infants (10 vaccine and 10 placebo per age cohort). Vaccine take was defined as seroconversion (a 3-fold increase in serum anti-rotavirus IgA or serum neutralising antibody (SNA) from baseline at day 28 post-dose) or evidence of RV3-BB viral replication in the faeces by RT-PCR analysis 3-6 days post-vaccination. RV3-BB presence was confirmed by sequence analysis. The RV3-BB vaccine was well tolerated in all participants, with no pattern of adverse events shown to be associated with the study vaccine. In the infant cohort, vaccine take was demonstrated in 8/9 infants following a single dose of vaccine compared with 2/7 placebo recipients. In the infant vaccine group, 5/9 infants exhibited either IgA or SNA seroconversion and 7/9 infants had evidence of RV3-BB replication on days 3-6, compared with 2/7 infants who seroconverted and 0/10 infants with evidence of replication in the placebo group. Two infants in the placebo group had serological evidence of a rotavirus infection within the 28-day study period: one demonstrated an IgA and the other an SNA response, with wild-type virus replication detected in another infant. A single dose of RV3-BB rotavirus vaccine was well tolerated in adults, children and infants. Most infants (8/9) who received RV3-BB demonstrated vaccine take following a single dose. These data support progression of RV3-BB to Phase II immunogenicity and efficacy trials. Copyright © 2013 Elsevier Ltd. All rights reserved.

Teadlase eetika / Magnus Ilmjärv

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Ilmjärv, Magnus, 1961-

2008-01-01

Vastukaja art.: Valge, Jaak. Pätsi riigipööret ei inspireeritud väljastpoolt // Postimees (2008) 26. apr., lk. 13. President Konstantin Pätsi kohta leitud uutest arhiivimaterjalidest. Raamatu "Hääletu alistumine" autor, ajaloolane Magnus Ilmjärv peab Jaak Valge kriitikat tema suhtes põhjendamatult suureks

Comprehensive sieve analysis of breakthrough HIV-1 sequences in the RV144 vaccine efficacy trial.

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Paul T Edlefsen

2015-02-01

Full Text Available The RV144 clinical trial showed the partial efficacy of a vaccine regimen with an estimated vaccine efficacy (VE of 31% for protecting low-risk Thai volunteers against acquisition of HIV-1. The impact of vaccine-induced immune responses can be investigated through sieve analysis of HIV-1 breakthrough infections (infected vaccine and placebo recipients. A V1/V2-targeted comparison of the genomes of HIV-1 breakthrough viruses identified two V2 amino acid sites that differed between the vaccine and placebo groups. Here we extended the V1/V2 analysis to the entire HIV-1 genome using an array of methods based on individual sites, k-mers and genes/proteins. We identified 56 amino acid sites or "signatures" and 119 k-mers that differed between the vaccine and placebo groups. Of those, 19 sites and 38 k-mers were located in the regions comprising the RV144 vaccine (Env-gp120, Gag, and Pro. The nine signature sites in Env-gp120 were significantly enriched for known antibody-associated sites (p = 0.0021. In particular, site 317 in the third variable loop (V3 overlapped with a hotspot of antibody recognition, and sites 369 and 424 were linked to CD4 binding site neutralization. The identified signature sites significantly covaried with other sites across the genome (mean = 32.1 more than did non-signature sites (mean = 0.9 (p < 0.0001, suggesting functional and/or structural relevance of the signature sites. Since signature sites were not preferentially restricted to the vaccine immunogens and because most of the associations were insignificant following correction for multiple testing, we predict that few of the genetic differences are strongly linked to the RV144 vaccine-induced immune pressure. In addition to presenting results of the first complete-genome analysis of the breakthrough infections in the RV144 trial, this work describes a set of statistical methods and tools applicable to analysis of breakthrough infection genomes in general vaccine

Serum Endoglin Levels in Patients Suffering from Systemic Sclerosis and Elevated Systolic Pulmonary Arterial Pressure

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Paola Ximena Coral-Alvarado

2010-01-01

Full Text Available Background. Pulmonary arterial hypertension (PAH is the main cause of morbimortality in systemic sclerosis (SSc. Increased Eng expression has been demonstrated in SSc patients. Objective. Ascertaining serum levels of Eng in SSc patients with and without elevated systolic pulmonary arterial pressure (sPAP and comparing them with that of healthy volunteers. Methods. A cross-sectional study was carried out. A commercial ELISA kit was used for measuring serum concentrations of Eng in 60 subjects: 40 patients with SSc with and without elevated sPAP, compared to 20 healthy control subjects. Elevated sPAP was detected by echocardiogram. Results. No association between positive Eng and elevated sPAP was found when compared to the SSc without elevated sPAP group (OR=2.85; 0.65–12.88 95% CI; P=.11; however, an association was found between positive Eng and elevated sPAP compared to healthy controls (OR=23.22; 2.46–1050.33 95% CI; P=.001, and weak association was found between the positive Eng with SSc without elevated sPAP group compared to healthy controls (OR=8.14, 0.8–393.74 95% CI; P=.046. Conclusion. Raised serum levels of Eng in SSc patients compared to healthy controls were found, suggesting a role for Eng in SSc vasculopathy and not just in elevated sPAP. However, prospective studies are needed to verify such observations.

Blood pressure normalization post-jugular venous balloon angioplasty.

Science.gov (United States)

Sternberg, Zohara; Grewal, Prabhjot; Cen, Steven; DeBarge-Igoe, Frances; Yu, Jinhee; Arata, Michael

2015-05-01

This study is the first in a series investigating the relationship between autonomic nervous system dysfunction and chronic cerebrospinal venous insufficiency in multiple sclerosis patients. We screened patients for the combined presence of the narrowing of the internal jugular veins and symptoms of autonomic nervous system dysfunction (fatigue, cognitive dysfunction, sleeping disorders, headache, thermal intolerance, bowel/bladder dysfunction) and determined systolic and diastolic blood pressure responses to balloon angioplasty. The criteria for eligibility for balloon angioplasty intervention included ≥ 50% narrowing in one or both internal jugular veins, as determined by the magnetic resonance venography, and ≥ 3 clinical symptoms of autonomic nervous system dysfunction. Blood pressure was measured at baseline and post-balloon angioplasty. Among patients who were screened, 91% were identified as having internal jugular veins narrowing (with obstructing lesions) combined with the presence of three or more symptoms of autonomic nervous system dysfunction. Balloon angioplasty reduced the average systolic and diastolic blood pressure. However, blood pressure categorization showed a biphasic response to balloon angioplasty. The procedure increased blood pressure in multiple sclerosis patients who presented with baseline blood pressure within lower limits of normal ranges (systolic ≤ 105 mmHg, diastolic ≤ 70 mmHg) but decreased blood pressure in patients with baseline blood pressure above normal ranges (systolic ≥ 130 mmHg, diastolic ≥ 80 mmHg). In addition, gender differences in baseline blood pressure subcategories were observed. The coexistence of internal jugular veins narrowing and symptoms of autonomic nervous system dysfunction suggests that the two phenomena may be related. Balloon angioplasty corrects blood pressure deviation in multiple sclerosis patients undergoing internal jugular vein dilation. Further studies should investigate the

Etiology and diagnosis of systolic murmurs in adults.

Science.gov (United States)

McGee, Steven

2010-10-01

It is unknown whether echocardiography can provide insights into the origin of systolic murmurs and the modern value of bedside cardiovascular diagnosis. The author examined 376 inpatients and compared their physical findings to transthoracic echocardiography, exploring the associations between echocardiography and systolic murmurs and investigating the diagnostic accuracy of physical examination for pathologic murmurs. Four echocardiographic variables predict the presence of systolic murmurs: peak aortic velocity (P onomatopoeia and classifying systolic murmurs into 1 of 6 patterns is diagnostically helpful. Copyright © 2010. Published by Elsevier Inc.

Clinical characteristics of the respiratory and cardiovascular systems in patients with combination of chronic obstructive pulmonary disease and heart failure

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I. I. Vyshnyvetskyy

2017-06-01

deterioration of the heart geometry (increasing of myocardial mass index, indexes of LV end-systolic and end-diastolic volumes, increased frequency of all variants of LV pathological remodeling detection, RV wall thickness, the ratio of RV/LV diastolic function impairment (increased frequency of all types diastolic dysfunction detection; development of pulmonary hypertension (increasing of the maximum flow velocity, pressure gradient, and the systolic pressure in the pulmonary artery, the frequency of detection of the absence of a-wave. Conclusions. The presence of heart failure in patients with COPD worsens important clinical, laboratory and instrumental parameters of the cardiovascular and respiratory systems.

Myocardial fatty acid imaging with 123I-BMIPP in patients with chronic right ventricular pressure overload. Clinical significance of reduced uptake in interventricular septum

International Nuclear Information System (INIS)

Hori, Yoshiro; Ishida, Yoshio; Fukuchi, Kazuki; Hayashida, Kouhei; Takamiya, Makoto

2002-01-01

Regionally reduced 123 I-beta-methyliodophenyl pentadecanoic acid (123I-BMIPP) uptake in the interventricular septum (SEP) is observed in some patients with chronic right ventricular (RV) pressure overload. We studied the significance of this finding by comparing it with mean pulmonary arterial pressure (mPAP). 123 I-BMIPP SPECT imaging was carried out in 21 patients with pulmonary hypertension (PH; 51+-14 years; 11 men and 10 women; 7 with primary pulmonary hypertension, 11 with pulmonary thromboembolism, and 3 with atrial septal defect). mPAP ranged from 25 to 81 mmHg (49±16 mmHg). Using a midventricular horizontal long-axis plane, regional BMIPP distributions in the RV free wall and SEP were estimated by referring to those in the LV free wall. Count ratios of the RV free wall and SEP to the LV free wall (RV/LV, SEP/LV) were determined by ROI analysis. RV/LV showed a linear correlation with mPAP (r=0.42). However, SEP/LV was inversely correlated with mPAP (r=-0.49). When SEP/RV was compared among three regions of SEP in each patient, basal SEP/RV was most sensitively decreased in response to increased mPAP (r=-0.70). These results suggest that the assessment of septal tracer uptake in 123 I-BMIPP SPECT imaging is useful for evaluating the severity of RV pressure overload in patients with PH. (author)

Effects of Ramadan fasting on blood pressure in hypertensive patients: a systematic review

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Maryam Alinezhad-Namaghi

2016-03-01

Full Text Available Ramadan is a holy month for Muslims and fasting in this month is the rule for any healthy matured person. Nutritional and behavioral changes occurred during Ramadan fasting may lead to several physiological change, such as blood pressure (2. Studies evaluated the effects of Ramadan fasting on blood pressure in hypertensive patients, are scarce and reported inadequate results. In this paper a systematic review was performed to accumulate the results of published literature designed to evaluate blood pressure changes in hypertensive patients due to Ramadan fasting. All prospective, English studies which evaluated the effects of Ramadan fasting on blood pressure in hypertensive patients and measured systolic and diastolic blood pressure twice at least ( before Ramadan and during last week of Ramadan or after Ramadan fasting were included in systematic review . Five studies reported the effect of Ramadan fasting on blood pressure in hypertensive patients in full text. Although significant reduction in systolic blood pressure during Ramadan fasting were seen in 3 studies (3-5, other 3 studies reported no significant difference between systolic blood pressure before and after Ramadan fasting (6, 7. Among 6 studies that reviewed in this paper, 4 studies reported no significant changes in diastolic blood pressure (4, 6, 7. While 2 other studies reported significant reduction in systolic blood pressure after Ramadan fasting (3, 5. This systematic review suggested that Ramadan fasting can be safe in treated essential hypertensive patients with continuation of previous medications. Also it can improve systolic and diastolic blood pressures.

Systolic array processing of the sequential decoding algorithm

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Chang, C. Y.; Yao, K.

1989-01-01

A systolic array processing technique is applied to implementing the stack algorithm form of the sequential decoding algorithm. It is shown that sorting, a key function in the stack algorithm, can be efficiently realized by a special type of systolic arrays known as systolic priority queues. Compared to the stack-bucket algorithm, this approach is shown to have the advantages that the decoding always moves along the optimal path, that it has a fast and constant decoding speed and that its simple and regular hardware architecture is suitable for VLSI implementation. Three types of systolic priority queues are discussed: random access scheme, shift register scheme and ripple register scheme. The property of the entries stored in the systolic priority queue is also investigated. The results are applicable to many other basic sorting type problems.

Simultaneously measured inter-arm and inter-leg systolic blood pressure differences and cardiovascular risk stratification: a systemic review and meta-analysis.

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Singh, Sukhchain; Sethi, Ankur; Singh, Mukesh; Khosla, Kavia; Grewal, Navsheen; Khosla, Sandeep

2015-08-01

Association of inter-arm systolic blood pressure difference (IASBPD) with cardiovascular (CV) morbidity and mortality remains controversial. We aimed to thoroughly examine all available evidence on inter-limb blood pressure (BP) difference and its association with CV risk and outcomes. We searched PubMed, EMBASE, CINAHL, Cochrane library, and Ovid for studies reporting bilateral simultaneous BP measurements in arms or legs and risk of peripheral arterial disease (PAD), coronary artery disease, cerebrovascular disease, subclavian stenosis, or mortality. Random-effect meta-analysis was performed to compare effect estimates. Twenty-seven studies met inclusion criteria, but only 17 studies (18 cohorts) were suitable for analysis. IASBPD of 10 mmHg or more was associated with PAD (risk ratios, 2.22; 1.41-3.5; P = .0006; sensitivity 16.6%; 6.7-35.4; specificity 91.9%; 83.1-96.3; 8 cohorts; 4774 subjects), left ventricular mass index (standardized mean difference 0.21; 0.03-0.39; P = .02; 2 cohort; 1604 subjects), and brachial-ankle pulse wave velocity (PWV) (one cohort). Association of PAD remained significant at cutoff of 15 mmHg (risk ratios, 1.91; 1.28-2.84; P = .001; 5 cohorts; 1914 subjects). We could not find statistically significant direct association of coronary artery disease, cerebrovascular disease, CV, and all-cause mortality in subjects with IASBPD of 10 mmHg or more, 15 mmHg or more, and inter-leg systolic BP difference of 15 mmHg or more. Inter-leg BP difference of 15 mmHg or more was strong predictor of PAD (P = .0001) and brachial-ankle PWV (P = .0001). Two invasive studies showed association of IASBPD and subclavian stenosis (estimates could not be combined). In conclusion, inter-arm and leg BP differences are strong predictors of PAD. IASBPD may be associated with subclavian stenosis, high left ventricular mass effect, and higher brachial-ankle PWVs. Inter-leg BP difference may also be associated with high left ventricular mass effect and higher

Systolic Blood Pressure Trajectory, Frailty, and All-Cause Mortality >80 Years of Age: Cohort Study Using Electronic Health Records.

Science.gov (United States)

Ravindrarajah, Rathi; Hazra, Nisha C; Hamada, Shota; Charlton, Judith; Jackson, Stephen H D; Dregan, Alex; Gulliford, Martin C

2017-06-13

Clinical trials show benefit from lowering systolic blood pressure (SBP) in people ≥80 years of age, but nonrandomized epidemiological studies suggest lower SBP may be associated with higher mortality. This study aimed to evaluate associations of SBP with all-cause mortality by frailty category >80 years of age and to evaluate SBP trajectories before death. A population-based cohort study was conducted using electronic health records of 144 403 participants ≥80 years of age registered with family practices in the United Kingdom from 2001 to 2014. Participants were followed for ≤5 years. Clinical records of SBP were analyzed. Frailty status was classified using the e-Frailty Index into the categories of fit, mild, moderate, and severe. All-cause mortality was evaluated by frailty status and mean SBP in Cox proportional-hazards models. SBP trajectories were evaluated using person months as observations, with mean SBP and antihypertensive treatment status estimated for each person month. Fractional polynomial models were used to estimate SBP trajectories over 5 years before death. During follow-up, 51 808 deaths occurred. Mortality rates increased with frailty level and were greatest at SBP mortality was 7.7 per 100 person years at SBP 120 to 139 mm Hg, 15.2 at SBP 110 to 119 mm Hg, and 22.7 at SBP mortality may be accounted for by reverse causation if participants with lower blood pressure values are closer, on average, to the end of life. © 2017 The Authors.

Studies Comparing Ambulatory Blood Pressure and Home Blood Pressure on Cardiovascular Disease and Mortality Outcomes: A Systematic Review

Science.gov (United States)

Shimbo, Daichi; Abdalla, Marwah; Falzon, Louise; Townsend, Raymond R.; Muntner, Paul

2015-01-01

Ambulatory blood pressure monitoring (ABPM) is more commonly recommended for assessing out-of-clinic blood pressure than home blood pressure monitoring (HBPM). We conducted a systematic review to examine whether ABPM or HBPM is more strongly associated with cardiovascular disease events and/or mortality. Of 1,007 abstracts published through July 20, 2015, nine articles, reporting results from seven cohorts, were identified. After adjustment for blood pressure on HBPM, blood pressure on ABPM was associated with an increased risk of outcomes in two of four cohorts for systolic blood pressure and two of three cohorts for diastolic blood pressure. After adjustment for blood pressure on ABPM, systolic blood pressure on HBPM was associated with outcomes in zero of three cohorts; an association was present in one of two cohorts for diastolic blood pressure on HBPM. There is a lack of strong empiric evidence supporting ABPM or HBPM over the other approach for predicting cardiovascular events or mortality. PMID:26822864

Contribution of the Arterial System and the Heart to Blood Pressure during Normal Aging - A Simulation Study.

Science.gov (United States)

Maksuti, Elira; Westerhof, Nico; Westerhof, Berend E; Broomé, Michael; Stergiopulos, Nikos

2016-01-01

During aging, systolic blood pressure continuously increases over time, whereas diastolic pressure first increases and then slightly decreases after middle age. These pressure changes are usually explained by changes of the arterial system alone (increase in arterial stiffness and vascular resistance). However, we hypothesise that the heart contributes to the age-related blood pressure progression as well. In the present study we quantified the blood pressure changes in normal aging by using a Windkessel model for the arterial system and the time-varying elastance model for the heart, and compared the simulation results with data from the Framingham Heart Study. Parameters representing arterial changes (resistance and stiffness) during aging were based on literature values, whereas parameters representing cardiac changes were computed through physiological rules (compensated hypertrophy and preservation of end-diastolic volume). When taking into account arterial changes only, the systolic and diastolic pressure did not agree well with the population data. Between 20 and 80 years, systolic pressure increased from 100 to 122 mmHg, and diastolic pressure decreased from 76 to 55 mmHg. When taking cardiac adaptations into account as well, systolic and diastolic pressure increased from 100 to 151 mmHg and decreased from 76 to 69 mmHg, respectively. Our results show that not only the arterial system, but also the heart, contributes to the changes in blood pressure during aging. The changes in arterial properties initiate a systolic pressure increase, which in turn initiates a cardiac remodelling process that further augments systolic pressure and mitigates the decrease in diastolic pressure.

Rationale and design of the ranolazine PH-RV study: a multicentred randomised and placebo-controlled study of ranolazine to improve RV function in patients with non-group 2 pulmonary hypertension.

Science.gov (United States)

Han, Yuchi; Forfia, Paul R; Vaidya, Anjali; Mazurek, Jeremy A; Park, Myung H; Ramani, Gautam; Chan, Stephen Y; Waxman, Aaron B

2018-01-01

A major determining factor on outcomes in patients with pulmonary arterial hypertension (PAH) is right ventricular (RV) function. Ranolazine, which is currently approved for chronic stable angina, has been shown to improve RV function in an animal model and has been shown to be safe in small human studies with PAH. We aim to study the effect of ranolazine on RV function using cardiovascular magnetic resonance (CMR) in patients with pulmonary hypertension (non-group 2 patients) and monitor the effect of ranolazine on metabolism using metabolic profiling and changes of microRNA. This study is a longitudinal, randomised, double-blind, placebo-controlled, multicentre proof-of-concept study in 24 subjects with pulmonary hypertension and RV dysfunction treated with ranolazine over 6 months. Subjects who meet the protocol definition of RV dysfunction (CMR RV ejection fraction (EF) <45%) will be randomised to ranolazine or placebo with a ratio of 2:1. Enrolled subjects will be assessed for functional class, 6 min walk test and health outcome based on SF-36 tool. Peripheral blood will be obtained for N-terminal-pro brain natriuretic peptide, metabolic profiling, and microRNA at baseline and the conclusion of the treatment period. CMR will be performed at baseline and the conclusion of the treatment period. The primary outcome is change in RVEF. The exploratory outcomes include clinical, other CMR parameters, metabolic and microRNA changes. The trial protocol was approved by Institutional Review Boards. The trial findings will be disseminated in scientific journals and meetings. NCT01839110 and NCT02829034; Pre-results.

Cardiorespiratory Fitness and Blood Pressure: A Longitudinal Analysis.

Science.gov (United States)

Agostinis-Sobrinho, César; Ruiz, Jonatan R; Moreira, Carla; Abreu, Sandra; Lopes, Luís; Oliveira-Santos, José; Mota, Jorge; Santos, Rute

2018-01-01

To examine the association between cardiorespiratory fitness and cardiovascular indices 2 years later, and to determine whether changes in cardiorespiratory fitness are associated with cardiovascular indices at a 2-year follow-up in adolescents. The sample comprised 734 adolescents (349 girls) aged 12-18 years followed for 3 years from the LabMed Physical Activity Study. Cardiorespiratory fitness was assessed by the 20-meter shuttle run test. Height, weight, waist circumference, and resting blood pressure (BP) were measured according to standard procedures. Regression analyses showed a significant inverse association between cardiorespiratory fitness at baseline and systolic BP (B = -0.126; P = .047) and rate pressure product (B = -29.94; P = .016), at follow-up after adjustments for age, sex, height, pubertal stage, socioeconomic status, and waist circumference. Significant differences were found between cardiorespiratory fitness groups (fit vs unfit) at baseline and systolic BP and rate pressure product at follow-up (P fitness changes and systolic BP (P = .024) and rate pressure product (P = .014), after adjustment for age, sex, height, pubertal status, socioeconomic status, and waist circumference. Changes in cardiorespiratory fitness during adolescence were associated with cardiovascular indices over a 2-year period. Adolescents with persistently low levels of cardiorespiratory fitness exhibited the highest levels of systolic BP and rate pressure product. Copyright © 2017 Elsevier Inc. All rights reserved.

The effect of chronic digitalization on pump function in systolic heart failure.

Science.gov (United States)

Hassapoyannes, C A; Easterling, B M; Chavda, K; Chavda, K K; Movahed, M R; Welch, G W

2001-10-01

Short- and intermediate-term use of cardiac glycosides promotes inotropy and improves the ejection fraction in systolic heart failure. To determine whether chronic digitalization alters left ventricular function and performance. Eighty patients with mild-to-moderate systolic heart failure (baseline ejection fraction < or =45%) participated from our institution in a multi-center, chronic, randomized, double-blind study of digitalis vs. placebo. Of the 40 survivors, 38 (20 allocated to the digitalis arm and 18 to the placebo arm) were evaluated at the end of follow-up (mean, 48.4 months). Left ventricular systolic function was assessed by both nuclear ventriculography and echocardiography. The ejection fraction was measured scintigraphically, while the ventricular volumes were computed echocardiographically. The groups did not differ, at baseline or end-of-study, with respect to the ejection fraction and the loading conditions (arterial pressure, ventricular volumes and heart rate) by either intention-to-treat or actual-treatment-received analysis. Over the course of the trial, the digitalis arm exhibited no significant increase in the use of diuretics (18%, P=0.33), in distinction from the placebo group (78%, P=0.004), and a longer stay on study drug among those patients who withdrew from double-blind treatment (28.6 vs. 11.4 months, P=0.01). Following chronic use of digitalis for mild-to-moderate heart failure, cross-sectional comparison with a control group from the same inception cohort showed no appreciable difference in systolic function or performance. Thus, the suggested clinical benefit cannot be explained by an inotropic effect.

Prevalence of inter-arm blood pressure difference among clinical out-patients.

Science.gov (United States)

Sharma, Balkishan; Ramawat, Pramila

2016-04-01

An increased inter-arm blood pressure difference is an easily determined physical finding, may use as an indicator of cardio vascular event and other sever diseases. Authors evaluated 477 patients to determine the prevalence and significance of inter-arm blood pressure difference. 477 routine outdoor patients selected to observe the inter-arm blood pressure difference. Age, height, weight, body mass index, history of disease and blood pressure recorded. The prevalence of ≥10 mmHg systolic inter-arm blood pressure difference was 5.0% was more as compared to 3.8% had diastolic inter-arm blood pressure difference. The prevalence of systolic and diastolic inter-arm difference between 6 to 10 mmHg was 31.4% and 27.9% respectively. Mean systolic inter-arm blood pressure difference was significantly higher among those patients had a multisystem disorder (10.57±0.98 mmHg) and followed by patients with cardiovascular disease (10.22±0.67 mmHg) as compared to healthy patients (2.71±0.96 mmHg). Various diseases highly influenced the increase in blood pressure irrespective of systolic or diastolic was confirmed strongly significant (pdifferent inter arm blood pressure difference levels. This study supports the view of inter-arm blood pressure difference as an alarming stage of increased disease risk that incorporated to investigate potential problems at an early diagnostic stage. A significant mean difference between left and right arm blood pressure recorded for many diseases.

Higher Plasma Myostatin Levels in Cor Pulmonale Secondary to Chronic Obstructive Pulmonary Disease.

Science.gov (United States)

Ju, Chun-Rong; Chen, Miao; Zhang, Jian-Heng; Lin, Zhi-Ya; Chen, Rong-Chang

2016-01-01

To analyze plasma myostatin levels and investigate their relationship with right ventricular (RV) function in patients with cor pulmonale secondary to chronic obstructive pulmonary disease (COPD). The study recruited 81 patients with advanced COPD and 40 age-matched controls. The patients were divided into two groups: those with cor pulmonale and those without. Echocardiography was used to evaluate RV function and morphology, and the value of tricuspid annular plane systolic excursion (TAPSE) less than 16 mm was considered RV dysfunction. Plasma myostatin levels were analyzed by enzyme-linked immunosorbent assay, and B-type natriuretic peptide (BNP) levels were analyzed as a comparison of myostatin. The data detected cor pulmonale in 39/81 patients, with the mean value of TAPSE of 14.3 mm. Plasma myostatin levels (ng/mL) were significantly higher in patients with cor pulmonale (16.68 ± 2.95) than in those without (13.56 ± 3.09), and much higher than in controls (8.79±2.79), with each pmyostatin levels were significantly correlated with the values of TAPSE and RV myocardium performance index among the COPD patients, and that BNP levels were significantly correlated only with systolic pulmonary arterial pressure, with each pmyostatin levels are increased in COPD patients who have cor pulmonale. Stronger correlations of plasma myostatin levels with echocardiographic indexes of the right heart suggest that myostatin might be superior to BNP in the early diagnosis of cor pulmonale in COPD.

Relationship of central and peripheral blood pressure to left ventricular mass in hypertensive patients.

Science.gov (United States)

Pérez-Lahiguera, Francisco J; Rodilla, Enrique; Costa, Jose A; Gonzalez, Carmen; Martín, Joaquin; Pascual, Jose M

2012-12-01

The purpose of the present study was to assess the relationship of central and peripheral blood pressure to left ventricular mass. Cross-sectional study that included 392 never treated hypertensive individuals. Measurement of office, 24-h ambulatory, and central blood pressure (obtained using applanation tonometry) and determination of left ventricular mass by echocardiography were performed in all patients. In a multiple regression analysis, with adjustment for age, gender and metabolic syndrome, 24-h blood pressure was more closely related to ventricular mass than the respective office and central blood pressures. Systolic blood pressures always exhibited a higher correlation than diastolic blood pressures in all 3 determinations. The correlation between left ventricular mass index and 24-h systolic blood pressure was higher than that of office (P<.002) or central systolic blood pressures (P<.002). Changes in 24-h systolic blood pressure caused the greatest variations in left ventricular mass index (P<.001). In our population of untreated middle-aged hypertensive patients, left ventricular mass index is more closely related to 24-h ambulatory blood pressure than to office or central blood pressure. Central blood pressure does not enable us to better identify patients with left ventricular hypertrophy. Copyright © 2012 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

Associations of ambulatory blood pressure with urinary caffeine and caffeine metabolite excretions.

Science.gov (United States)

Guessous, Idris; Pruijm, Menno; Ponte, Belén; Ackermann, Daniel; Ehret, Georg; Ansermot, Nicolas; Vuistiner, Philippe; Staessen, Jan; Gu, Yumei; Paccaud, Fred; Mohaupt, Markus; Vogt, Bruno; Pechère-Bertschi, Antoinette; Pechère-Berstchi, Antoinette; Martin, Pierre-Yves; Burnier, Michel; Eap, Chin B; Bochud, Murielle

2015-03-01

Intake of caffeinated beverages might be associated with reduced cardiovascular mortality possibly via the lowering of blood pressure. We estimated the association of ambulatory blood pressure with urinary caffeine and caffeine metabolites in a population-based sample. Families were randomly selected from the general population of Swiss cities. Ambulatory blood pressure monitoring was conducted using validated devices. Urinary caffeine, paraxanthine, theophylline, and theobromine excretions were measured in 24 hours urine using ultrahigh performance liquid chromatography tandem mass spectrometry. We used mixed models to explore the associations of urinary excretions with blood pressure although adjusting for major confounders. The 836 participants (48.9% men) included in this analysis had mean age of 47.8 and mean 24-hour systolic and diastolic blood pressure of 120.1 and 78.0 mm Hg. For each doubling of caffeine excretion, 24-hour and night-time systolic blood pressure decreased by 0.642 and 1.107 mm Hg (both P values theobromine excretion was not associated with blood pressure. Anti-hypertensive therapy, diabetes mellitus, and alcohol consumption modify the association of caffeine urinary excretion with systolic blood pressure. Ambulatory systolic blood pressure was inversely associated with urinary excretions of caffeine and other caffeine metabolites. Our results are compatible with a potential protective effect of caffeine on blood pressure. © 2014 American Heart Association, Inc.

Impact of surgical correction of tetralogy of fallot on short-term right and left ventricular function as determined by 2-dimensional speckle tracking echocardiography

Science.gov (United States)

Li, Yuman; Wang, Xinfang; Lv, Qing; Wang, Jing; Yang, YaLi; He, Lin; Yuan, Li; Zhang, Li; Xie, Mingxing

2016-01-01

Abstract Right ventricular (RV) and left ventricular (LV) dysfunction is an important determinant of poor clinical status in repaired patients with tetralogy of Fallot (TOF). The purpose of our study is to assess the impact of surgical repair on short-term RV and LV function by 2-dimensional speckle tracking echocardiography (STE). Sixty-seven patients (median age 12 months) with TOF before and 6 months after repair and 35 healthy subjects were studied. The patients were divided into the younger (age at surgery ≤12 months) and older (age at surgery >12 months) subgroups. RV and LV global longitudinal systolic strain and strain rate (SR), and LV global circumferential and radial systolic strain and SR were measured by STE. After repair, RV longitudinal strain and SR increased in the younger patients, whereas RV longitudinal SR was decreased in the older patients. LV deformation parameters were unchanged in all patients. In the multivariate analysis, patients with better RV and LV deformation parameters preoperatively were identified to have better RV and LV strain and SR postoperatively (P < 0.05 for all). The surgical approach of the pulmonary valve ring was predictive of RV and LV systolic function postoperatively (P < 0.05 for all). After TOF repair, short-term RV function improvement is identified in the younger but not in the older patients, whereas LV function is unchanged in all patients. The preoperative RV and LV deformational indices are the determinant of postoperative biventricular function improvement. STE appears to be a valuable tool for assessment of biventricular function after congenital heart disease surgery. PMID:27495064

Development and validation of optimal cut-off value in inter-arm systolic blood pressure difference for prediction of cardiovascular events.

Science.gov (United States)

Hirono, Akira; Kusunose, Kenya; Kageyama, Norihito; Sumitomo, Masayuki; Abe, Masahiro; Fujinaga, Hiroyuki; Sata, Masataka

2018-01-01

An inter-arm systolic blood pressure difference (IAD) is associated with cardiovascular disease. The aim of this study was to develop and validate the optimal cut-off value of IAD as a predictor of major adverse cardiac events in patients with arteriosclerosis risk factors. From 2009 to 2014, 1076 patients who had at least one cardiovascular risk factor were included in the analysis. We defined 700 randomly selected patients as a development cohort to confirm that IAD was the predictor of cardiovascular events and to determine optimal cut-off value of IAD. Next, we validated outcomes in the remaining 376 patients as a validation cohort. The blood pressure (BP) of both arms measurements were done simultaneously using the ankle-brachial blood pressure index (ABI) form of automatic device. The primary endpoint was the cardiovascular event and secondary endpoint was the all-cause mortality. During a median period of 2.8 years, 143 patients reached the primary endpoint in the development cohort. In the multivariate Cox proportional hazards analysis, IAD was the strong predictor of cardiovascular events (hazard ratio: 1.03, 95% confidence interval: 1.01-1.05, p=0.005). The receiver operating characteristic curve revealed that 5mmHg was the optimal cut-off point of IAD to predict cardiovascular events (p<0.001). In the validation cohort, the presence of a large IAD (IAD ≥5mmHg) was significantly associated with the primary endpoint (p=0.021). IAD is significantly associated with future cardiovascular events in patients with arteriosclerosis risk factors. The optimal cut-off value of IAD is 5mmHg. Copyright © 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Quantitative MRI comparison of pulmonary hemodynamics in mustard/senning-repaired patients suffering from transposition of the great arteries and healthy volunteers at rest

International Nuclear Information System (INIS)

Laffon, Eric; Latrabe, Valerie; Jimenez, Maria; Ducassou, Dominique; Laurent, Francois; Marthan, Roger

2006-01-01

In Mustard/Senning-repaired (MSR) patients, the right and left ventricles (RV, LV) act as the systemic and pulmonary ventricle, respectively. The purpose of the study was to compare non-invasively, at rest, pulmonary ventricle systolic function and hemodynamics in MSR patients with those of healthy volunteers. Velocity-encoded MR imaging was performed at the level of the main pulmonary artery (MPA) in ten male patients late after a Mustard/Senning correction performed early in infancy and in ten male volunteers. Both blood flow and MPA cross-sectional area variations were recorded over a complete cardiac cycle. MPA distensibility, body surface area (BSA)-normalized pulmonary ventricle systolic power and work were significantly lower in the MSR patients compared to volunteers. In particular, BSA-normalized LV systolic power and work in MSR patients were equal to 82 and 77% on average of those of the RV in volunteers (0.32 vs. 0.39 W/m 2 and 0.10 vs. 0.13 J/m 2 ), respectively. We conclude that in MSR patients at rest two unrelated findings were observed: (1) a reduced MPA distensibility and (2) a significantly lower systolic mechanical performance of the pulmonary LV compared to that of the RV in healthy volunteers. The latter quantification indirectly confirms the lowest systemic RV systolic mechanical performance previously published. (orig.)

Prevalence of Eligibility Criteria for the Systolic Blood Pressure Intervention Trial in US Adults Among Excluded Groups: Age Diabetes Mellitus, or a History of Stroke.

Science.gov (United States)

Bress, Adam P; Tanner, Rikki M; Hess, Rachel; Gidding, Samuel S; Colantonio, Lisandro D; Shimbo, Daichi; Muntner, Paul

2016-07-12

Adults diabetes mellitus, or a history of stroke were not enrolled in the Systolic Blood Pressure Intervention Trial (SPRINT). Estimating the size and characteristics of these excluded groups who meet the other SPRINT eligibility criteria may provide information on the potential impact of providers extending the SPRINT findings to these populations. We analyzed the National Health and Nutrition Examination Survey 2003-2012 (n=25 076) to estimate the percentage and characteristics of US adults ≥20 years in 3 populations (age diabetes mellitus, or history of stroke) excluded from SPRINT who otherwise meet the trial eligibility criteria: age ≥50 years, systolic blood pressure (SBP) 130-180 mm Hg, high cardiovascular disease risk, and not having trial exclusion criteria. Overall, 1.0% (95% CI 0.8-1.3) of US adults age diabetes mellitus, and 19.0% (95% CI 16.0-22.4) with history of stroke met the other SPRINT eligibility criteria. Among US adults with SBP ≥130 mm Hg, other SPRINT eligibility criteria were met by 7.5% (95% CI 6.1-9.2) of those age diabetes mellitus, and 23.0% (95% CI 19.4-27.0) with history of stroke. Among US adults meeting the other SPRINT eligibility criteria, antihypertensive medication was being taken by 31.0% (95% CI 23.9-41.3) of those diabetes mellitus, and 68.9% (95% CI 59.4-77.1) with a history of stroke. A substantial percentage of US adults with diabetes mellitus or history of stroke and a small percentage <50 years old meet the other SPRINT eligibility criteria. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Measurement of digital blood pressure after local cooling

DEFF Research Database (Denmark)

Nielsen, S L; Lassen, N A

1977-01-01

A double-inlet plastic cuff was designed for local cooling and systolic blood pressure measurement on the middle phalanx of the fingers. With a tourniquet on the proximal phalanx of one finger, cooling for 5 min made the digital artery temperature equal the skin temperature. The difference between...... the systolic pressure in a control finger and in the cooled finger give the reopening pressure in the digital arteries. At 30, 25, 20, 15, and 10 degrees C, respectively the percent decrease of the finger pressure was 0.2 (0.2), 1.5 (2.5), 8.5 (3.7), 11.4 (3.4), and 15.3 (3.1) in normal young women...

Blood Pressure, Sexual Activity, and Dysfunction in Women With Hypertension: Baseline Findings From the Systolic Blood Pressure Intervention Trial (SPRINT).

Science.gov (United States)

Foy, Capri G; Newman, Jill C; Berlowitz, Dan R; Russell, Laurie P; Kimmel, Paul L; Wadley, Virginia G; Thomas, Holly N; Lerner, Alan J; Riley, William T

2016-09-01

Sexual function, an important component of quality of life, is gaining increased research and clinical attention in older women with hypertension. To assess the association between systolic blood pressure (SBP) and other variables, and sexual activity and sexual dysfunction in hypertensive women. Baseline analysis of 635 women participants of a larger randomized clinical trial of 9361 men and women. Self-reported sexual activity (yes/no), and sexual function using the Female Sexual Function Inventory (FSFI). 452 participants (71.2%) reported having no sexual activity during the previous 4 weeks. The mean (SD) FSFI score for sexually active participants was 25.3 (6.0), and 52.6% of the sample reported a FSFI score ≤26.55 designating sexual dysfunction. In logistic regression models, SBP was not significantly associated with sexual activity (AOR = 1.002; P > .05). Older age (AOR = 0.95, P sexually active, as was living alone versus living with others (AOR = 0.56, P sexually active (AOR = 1.39; P sexually active participants, SBP was not associated with sexual dysfunction (AOR = 1.01; P > .05). Higher depressive symptoms from the Patient Health Questionnaire-9 (PHQ-9) was associated with higher odds of sexual dysfunction (AOR = 1.24, P sexually active in participants with chronic kidney disease (AOR = 0.33, P sexually active in a sample of middle-aged and older women with hypertension. Increased depressive symptoms and increased physical comorbidities were significantly associated with increased odds of sexual dysfunction. SBP was not significantly associated with sexual activity or sexual dysfunction. Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Effects on peripheral and central blood pressure of cocoa with natural or high-dose theobromine: a randomized, double-blind crossover trial.

Science.gov (United States)

van den Bogaard, Bas; Draijer, Richard; Westerhof, Berend E; van den Meiracker, Anton H; van Montfrans, Gert A; van den Born, Bert-Jan H

2010-11-01

Flavanol-rich cocoa products have been reported to lower blood pressure. It has been suggested that theobromine is partially responsible for this effect. We tested whether consumption of flavanol-rich cocoa drinks with natural or added theobromine could lower peripheral and central blood pressure. In a double-blind, placebo-controlled 3-period crossover trial we assigned 42 healthy individuals (age 62±4.5 years; 32 men) with office blood pressure of 130 to 159 mm Hg/85 to 99 mm Hg and low added cardiovascular risk to a random treatment sequence of dairy drinks containing placebo, flavanol-rich cocoa with natural dose consisting of 106 mg of theobromine, or theobromine-enriched flavanol-rich cocoa with 979 mg of theobromine. Treatment duration was 3 weeks with a 2-week washout. The primary outcome was the difference in 24-hour ambulatory systolic blood pressure between placebo and active treatment after 3 weeks. The difference in central systolic blood pressure between placebo and active treatment was a secondary outcome. Treatment with theobromine-enriched cocoa resulted in a mean±SE of 3.2±1.1 mm Hg higher 24-hour ambulatory systolic blood pressure compared with placebo (Ptheobromine-enriched cocoa, laboratory peripheral systolic blood pressure was not different from placebo, whereas central systolic blood pressure was 4.3±1.4 mm Hg lower (P=0.001). Natural dose theobromine cocoa did not significantly change either 24-hour ambulatory or central systolic blood pressure compared with placebo. In conclusion, theobromine-enriched cocoa significantly increased 24-hour ambulatory systolic blood pressure while lowering central systolic blood pressure.

Rv2477c is an antibiotic-sensitive manganese-dependent ABC-F ATPase in Mycobacterium tuberculosis.

Science.gov (United States)

Daniel, Jaiyanth; Abraham, Liz; Martin, Amanda; Pablo, Xyryl; Reyes, Shelby

2018-01-01

The Rv2477c protein of Mycobacterium tuberculosis (Mtb) belongs to the ATP-binding cassette (ABC) subfamily F that contains proteins with tandem nucleotide-binding domains but lacking transmembrane domains. ABC-F subfamily proteins have been implicated in diverse cellular processes such as translation, antibiotic resistance, cell growth and nutrient sensing. In order to investigate the biochemical characteristics of Rv2477c, we expressed it in Escherichia coli, purified it and characterized its enzymatic functions. We show that Rv2477c displays strong ATPase activity (V max  = 45.5 nmol/mg/min; K m  = 90.5 μM) that is sensitive to orthovanadate. The ATPase activity was maximal in the presence of Mn 2+ at pH 5.2. The Rv2477c protein was also able to hydrolyze GTP, TTP and CTP but at lower rates. Glutamate to glutamine substitutions at amino acid residues 185 and 468 in the two Walker B motifs of Rv2477c severely inhibited its ATPase activity. The antibiotics tetracycline and erythromycin, which target protein translation, were able to inhibit the ATPase activity of Rv2477c. We postulate that Rv2477c could be involved in mycobacterial protein translation and in resistance to tetracyclines and macrolides. This is the first report of the biochemical characterization of an ABC-F subfamily protein in Mtb. Copyright © 2017 Elsevier Inc. All rights reserved.

Right ventricular pressure response to exercise in adults with isolated ventricular septal defect closed in early childhood.

Science.gov (United States)

Moller, Thomas; Lindberg, Harald; Lund, May Brit; Holmstrom, Henrik; Dohlen, Gaute; Thaulow, Erik

2018-06-01

We previously demonstrated an abnormally high right ventricular systolic pressure response to exercise in 50% of adolescents operated on for isolated ventricular septal defect. The present study investigated the prevalence of abnormal right ventricular systolic pressure response in 20 adult (age 30-45 years) patients who underwent surgery for early ventricular septal defect closure and its association with impaired ventricular function, pulmonary function, or exercise capacity. The patients underwent cardiopulmonary tests, including exercise stress echocardiography. Five of 19 patients (26%) presented an abnormal right ventricular systolic pressure response to exercise ⩾ 52 mmHg. Right ventricular systolic function was mixed, with normal tricuspid annular plane systolic excursion and fractional area change, but abnormal tricuspid annular systolic motion velocity (median 6.7 cm/second) and isovolumetric acceleration (median 0.8 m/second2). Left ventricular systolic and diastolic function was normal at rest as measured by the peak systolic velocity of the lateral wall and isovolumic acceleration, early diastolic velocity, and ratio of early diastolic flow to tissue velocity, except for ejection fraction (median 53%). The myocardial performance index was abnormal for both the left and right ventricle. Peak oxygen uptake was normal (mean z score -0.4, 95% CI -2.8-0.3). There was no association between an abnormal right ventricular systolic pressure response during exercise and right or left ventricular function, pulmonary function, or exercise capacity. Abnormal right ventricular pressure response is not more frequent in adult patients compared with adolescents. This does not support the theory of progressive pulmonary vascular disease following closure of left-to-right shunts.

Cognitive Function and Kidney Disease: Baseline Data From the Systolic Blood Pressure Intervention Trial (SPRINT).

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Weiner, Daniel E; Gaussoin, Sarah A; Nord, John; Auchus, Alexander P; Chelune, Gordon J; Chonchol, Michel; Coker, Laura; Haley, William E; Killeen, Anthony A; Kimmel, Paul L; Lerner, Alan J; Oparil, Suzanne; Saklayen, Mohammad G; Slinin, Yelena M; Wright, Clinton B; Williamson, Jeff D; Kurella Tamura, Manjula

2017-09-01

Chronic kidney disease is common and is associated with cardiovascular disease, cerebrovascular disease, and cognitive function, although the nature of this relationship remains uncertain. Cross-sectional cohort using baseline data from the Systolic Blood Pressure Intervention Trial (SPRINT). Participants in SPRINT, a randomized clinical trial of blood pressure targets in older community-dwelling adults with cardiovascular disease, chronic kidney disease, or high cardiovascular disease risk and without diabetes or known stroke, who underwent detailed neurocognitive testing in the cognition substudy, SPRINT-Memory and Cognition in Decreased Hypertension (SPRINT-MIND). Urine albumin-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR). Cognitive function, a priori defined as 5 cognitive domains based on 11 cognitive tests using z scores, and abnormal white matter volume quantified by brain magnetic resonance imaging. Of 9,361 SPRINT participants, 2,800 participated in SPRINT-MIND and 2,707 had complete data; 637 had brain imaging. Mean age was 68 years, 37% were women, 30% were black, and 20% had known cardiovascular disease. Mean eGFR was 70.8±20.9mL/min/1.73m 2 and median urine ACR was 9.7 (IQR, 5.7-22.5) mg/g. In adjusted analyses, higher ACR was associated with worse global cognitive function, executive function, memory, and attention, such that each doubling of urine ACR had the same association with cognitive performance as being 7, 10, 6, and 14 months older, respectively. Lower eGFR was independently associated with worse global cognitive function and memory. In adjusted models, higher ACR, but not eGFR, was associated with larger abnormal white matter volume. Cross-sectional only, no patients with diabetes were included. In older adults, higher urine ACR and lower eGFR have independent associations with global cognitive performance with different affected domains. Albuminuria concurrently identifies a higher burden of abnormal brain

Mycobacterium tuberculosis Universal Stress Protein Rv2623 Regulates Bacillary Growth by ATP Binding: Requirement for Establishing Chronic Persistent Infection

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Drumm, J.; Mi, K; Bilder, P; Sun, M; Lim, J; Bielefeldt-Ohmann, H; Basaraba, R; So, M; Zhu, G; et. al.

2009-01-01

Tuberculous latency and reactivation play a significant role in the pathogenesis of tuberculosis, yet the mechanisms that regulate these processes remain unclear. The Mycobacterium tuberculosisuniversal stress protein (USP) homolog, rv2623, is among the most highly induced genes when the tubercle bacillus is subjected to hypoxia and nitrosative stress, conditions thought to promote latency. Induction of rv2623 also occurs when M. tuberculosis encounters conditions associated with growth arrest, such as the intracellular milieu of macrophages and in the lungs of mice with chronic tuberculosis. Therefore, we tested the hypothesis that Rv2623 regulates tuberculosis latency. We observed that an Rv2623-deficient mutant fails to establish chronic tuberculous infection in guinea pigs and mice, exhibiting a hypervirulence phenotype associated with increased bacterial burden and mortality. Consistent with this in vivo growth-regulatory role, constitutive overexpression of rv2623 attenuates mycobacterial growth in vitro. Biochemical analysis of purified Rv2623 suggested that this mycobacterial USP binds ATP, and the 2.9-A-resolution crystal structure revealed that Rv2623 engages ATP in a novel nucleotide-binding pocket. Structure-guided mutagenesis yielded Rv2623 mutants with reduced ATP-binding capacity. Analysis of mycobacteria overexpressing these mutants revealed that the in vitro growth-inhibitory property of Rv2623 correlates with its ability to bind ATP. Together, the results indicate that i M. tuberculosis Rv2623 regulates mycobacterial growth in vitro and in vivo, and ii Rv2623 is required for the entry of the tubercle bacillus into the chronic phase of infection in the host; in addition, iii Rv2623 binds ATP; and iv the growth-regulatory attribute of this USP is dependent on its ATP-binding activity. We propose that Rv2623 may function as an ATP-dependent signaling intermediate in a pathway that promotes persistent infection.

Three-dimensional models of Mycobacterium tuberculosis proteins Rv1555, Rv1554 and their docking analyses with sildenafil, tadalafil, vardenafil drugs, suggest interference with quinol binding likely to affect protein's function.

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Dash, Pallabini; Bala Divya, M; Guruprasad, Lalitha; Guruprasad, Kunchur

2018-04-18

Earlier based on bioinformatics analyses, we had predicted the Mycobacterium tuberculosis (M.tb) proteins; Rv1555 and Rv1554, among the potential new tuberculosis drug targets. According to the 'TB-drugome' the Rv1555 protein is 'druggable' with sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra) drugs. In the present work, we intended to understand via computer modeling studies, how the above drugs are likely to inhibit the M.tb protein's function. The three-dimensional computer models for M.tb proteins; Rv1555 and Rv1554 constructed on the template of equivalent membrane anchor subunits of the homologous E.coli quinol fumarate reductase respiratory protein complex, followed by drug docking analyses, suggested that the binding of above drugs interferes with quinol binding sites. Also, we experimentally observed the in-vitro growth inhibition of E.coli bacteria containing the homologous M.tb protein sequences with sildenafil and tadalafil drugs. The predicted binding sites of the drugs is likely to affect the above M.tb proteins function as quinol binding is known to be essential for electron transfer function during anaerobic respiration in the homologous E.coli protein complex. Therefore, sildenafil and related drugs currently used in the treatment of male erectile dysfunction targeting the human phosphodiesterase 5 enzyme may be evaluated for their plausible role as repurposed drugs to treat human tuberculosis.

Validation of the SCIAN LD-735 wrist blood pressure monitor for home blood pressure monitoring according to the European Society of Hypertension International Protocol revision 2010.

Science.gov (United States)

Kang, Yuan-Yuan; Chen, Qi; Li, Yan; Wang, Ji-Guang

2016-08-01

This study aimed to evaluate the accuracy of the automated oscillometric wrist blood pressure monitor SCIAN LD-735 for home blood pressure monitoring according to the International Protocol of the European Society of Hypertension revision 2010. Systolic and diastolic blood pressures were measured sequentially in 33 adult Chinese participants (10 women, mean age 44.8 years) using a mercury sphygmomanometer (two observers) and the SCIAN LD-735 device (one supervisor). A total of 99 pairs of comparisons were obtained from 33 participants for judgments in two parts with three grading phases. The SCIAN LD-735 device achieved the targets in part 1 of the validation study. The number of absolute differences between device and observers within 5, 10, and 15 mmHg was 86/99, 97/99, and 98/99, respectively, for systolic blood pressure and 85/99, 98/99, and 99/99, respectively, for diastolic blood pressure. The device also fulfilled the criteria in part 2 of the validation study. In total, 30 and 33 participants for systolic and diastolic blood pressure, respectively, had at least two of the three device-observer differences within 5 mmHg (required ≥24). No participant had all of the three device-observer comparisons greater than 5 mmHg for systolic or diastolic blood pressure. The SCIAN wrist blood pressure monitor LD-735 has passed the requirements of the International Protocol revision 2010, and hence can be recommended for home use in adults.

Validation of the AVITA BPM17 wrist blood pressure monitor for home blood pressure monitoring according to the European Society of Hypertension International Protocol revision 2010.

Science.gov (United States)

Kang, Yuan-Yuan; Chen, Qi; Liu, Chang-Yuan; Li, Yan; Wang, Ji-Guang

2017-08-01

The aim of the present study was to evaluate the accuracy of the automated oscillometric wrist blood pressure monitor AVITA BPM17 for home blood pressure monitoring according to the International Protocol of the European Society of Hypertension revision 2010. Systolic and diastolic blood pressures were sequentially measured in 33 adult Chinese (19 men, 45.7 years of mean age) using a mercury sphygmomanometer (two observers) and the AVITA BPM17 device (one supervisor). Ninety-nine pairs of comparisons were obtained from 33 participants for judgments in two parts with three grading phases. The AVITA BPM17 device achieved the targets in part 1 of the validation study. The number of absolute differences between device and observers within 5, 10, and 15 mmHg was 94/99, 98/99, and 98/99, respectively, for systolic blood pressure and 92/99, 99/99, and 99/99, respectively, for diastolic blood pressure. The device also fulfilled the criteria in part 2 of the validation study. Overall, 32 participants for both systolic and diastolic blood pressure, respectively, had at least two of the three device-observerss differences within 5 mmHg (required ≥24). None had all the three device-observers comparisons greater than 5 mmHg for systolic and diastolic blood pressure. The AVITA wrist blood pressure monitor BPM17 has passed the requirements of the International Protocol revision 2010, and hence can be recommended for home use in adults.

Aging increases oxidative stress and renal expression of oxidant and antioxidant enzymes that are associated with an increased trend in systolic blood pressure.

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Gomes, Pedro; Simão, Sónia; Silva, Elisabete; Pinto, Vanda; Amaral, João S; Afonso, Joana; Serrão, Maria Paula; Pinho, Maria João; Soares-da-Silva, Patrício

2009-01-01

The aim of this study was to investigate whether the effects of aging on oxidative stress markers and expression of major oxidant and antioxidant enzymes associate with impairment of renal function and increases in blood pressure. To explore this, we determined age-associated changes in lipid peroxidation (urinary malondialdehyde), plasma and urinary hydrogen peroxide (H(2)O(2)) levels, as well as renal H(2)O(2) production, and the expression of oxidant and antioxidant enzymes in young (13 weeks) and old (52 weeks) male Wistar Kyoto (WKY) rats. Urinary lipid peroxidation levels and H(2)O(2) production by the renal cortex and medulla of old rats were higher than their young counterparts. This was accompanied by overexpression of NADPH oxidase components Nox4 and p22(phox) in the renal cortex of old rats. Similarly, expression of superoxide dismutase (SOD) isoforms 2 and 3 and catalase were increased in the renal cortex from old rats. Renal function parameters (creatinine clearance and fractional excretion of sodium), diastolic blood pressure and heart rate were not affected by aging, although slight increases in systolic blood pressure were observed during this 52-week period. It is concluded that overexpression of renal Nox4 and p22(phox) and the increases in renal H(2)O(2) levels in aged WKY does not associate with renal functional impairment or marked increases in blood pressure. It is hypothesized that lack of oxidative stress-associated effects in aged WKY rats may result from increases in antioxidant defenses that counteract the damaging effects of H(2)O(2).

Allergic rhinitis and arterial blood pressure: a population-based study.

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Sakallioglu, O; Polat, C; Akyigit, A; Cetiner, H; Duzer, S

2018-05-01

To investigate the likelihood of allergic rhinitis and potential co-morbidities, and to assess whether allergic rhinitis is associated with arterial blood pressure and hypertension. In this population-based study, 369 adults with allergic rhinitis and asthma were assessed via a questionnaire and immunoglobulin E levels. There were four groups: control (n = 90), allergic rhinitis (n = 99), asthma (n = 87) and hypertension (n = 93). Arterial blood pressure was measured in all groups. There were no significant differences in systolic or diastolic blood pressure between males and females in any group. Pairwise comparisons revealed no significant differences between: the control and allergic rhinitis groups, the control and asthma groups, or the allergic rhinitis and asthma groups. The systolic and diastolic blood pressure values of males and females were significantly higher in the hypertension group than the allergic rhinitis group. There were no significant differences in systolic blood pressure or diastolic blood pressure for seasonal and perennial allergic rhinitis patients. Rhinitis was not associated with increased blood pressure. Allergic rhinitis can coincide with asthma and hypertension. The findings do not support the need for blood pressure follow up in allergic rhinitis patients.

Effects of neighborhood socioeconomic status on blood pressure in older adults

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Katia Jakovljevic Pudla Wagner

Full Text Available ABSTRACT OBJECTIVE To test if the neighborhood socioeconomic status is associated with systolic blood pressure and hypertension in older adults. METHODS A cross-sectional population-based study with a sample of 1,705 older adults from Florianópolis, SC, Southern Brazil. The contextual variable used was the average years of schooling of the head of the household in census tracts. Participants were considered hypertensive when the systolic blood pressure was ≥ 140 mmHg, diastolic ≥ 90 mmHg, or both. Additionally, the use of antihypertensive medication was also considered. Data were analyzed by using multilevel models of logistic and linear regression. RESULTS The average age of the sample was 70.7 years and the average of systolic and diastolic blood pressure was 133.5 mmHg (SD = 20.5 mmHg and 81.9 mmHg (SD = 12.5 mmHg, respectively. The systolic blood pressure was 4.46 mmHg (95%CI 1.00–7.92 higher and the chance of hypertension was 1.80 (95%CI 1.26–2.57 among those who lived in census tracts with lower level of schooling. When the use of antihypertensive medication was combined with blood pressure levels, none association was found between the outcome and the level of schooling of the census tract. CONCLUSIONS Analytical models more robust (such as multilevel analysis in Brazil are still little used, with a small number of articles published. Neighborhood socioeconomic status is associated with systolic blood pressure and the chance of hypertension, regardless of individual characteristics.

Maximum home systolic blood pressure is a useful indicator of arterial stiffness in patients with type 2 diabetes mellitus: post hoc analysis of a cross-sectional multicenter study.

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Ushigome, Emi; Fukui, Michiaki; Hamaguchi, Masahide; Tanaka, Toru; Atsuta, Haruhiko; Mogami, Shin-ichi; Tsunoda, Sei; Yamazaki, Masahiro; Hasegawa, Goji; Nakamura, Naoto

2014-09-01

Maximum (max) home systolic blood pressure (HSBP) as well as mean HSBP or HSBP variability was reported to increase the predictive value of target organ damage. Yet, the association between max HSBP and target organ damage in patients with type 2 diabetes has never been reported. The aim of this study was to investigate the association between max HSBP and pulse wave velocity (PWV), a marker of arterial stiffness which in turn is a marker of target organ damage, in patients with type 2 diabetes. We assessed the relationship of mean HSBP or max HSBP to PWV, and compared area under the receiver-operating characteristic curve (AUC) of mean HSBP or max HSBP for arterial stiffness in 758 patients with type 2 diabetes. In the univariate analyses, age, duration of diabetes mellitus, body mass index, mean clinic systolic blood pressure (SBP), mean HSBP and max HSBP were associated with PWV. Multivariate linear regression analyses indicated that mean morning SBP (β=0.156, P=0.001) or max morning SBP (β=0.146, P=0.001) were significantly associated with PWV. AUC (95% CI) for arterial stiffness, defined as PWV equal to or more than 1800 cm per second, in mean morning SBP and max morning SBP were 0.622 (0.582-0.662; P<0.001) and 0.631 (0.591-0.670; P<0.001), respectively. Our findings implicate that max HSBP as well as mean HSBP was significantly associated with arterial stiffness in patients with type 2 diabetes. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Prognostic incremental role of right ventricular function in acute decompensation of advanced chronic heart failure.

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Frea, Simone; Pidello, Stefano; Bovolo, Virginia; Iacovino, Cristina; Franco, Erica; Pinneri, Francesco; Galluzzo, Alessandro; Volpe, Alessandra; Visconti, Massimiliano; Peirone, Andrea; Morello, Mara; Bergerone, Serena; Gaita, Fiorenzo

2016-05-01

The purpose of this study was to evaluate the additional prognostic value of echocardiography in acute decompensation of advanced chronic heart failure (CHF), focusing on right ventricular (RV) dysfunction and its interaction with loading conditions. Few data are available on the prognostic role of echocardiography in acute HF and on the significance of pulmonary hypertension in patients with severe RV failure. A total of 265 NYHA IV patients admitted for acute decompensation of advanced CHF (EF 22 ± 7%, systolic blood pressure 107 ± 20 mmHg) were prospectively enrolled. Fifty-nine patients met the primary composite endpoint of cardiac death, urgent heart transplantation, and urgent mechanical circulatory support implantation at 90 days. Pulmonary hypertension failed to predict events, while patients with a low transtricuspid systolic gradient (TR gradient statistic from 0.59 to 0.73 (P advanced CHF, pulmonary hypertension failed to predict events. The in-hospital and short-term prognosis can be better predicted by eRAP and RVCPI. © 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology.

Methyl mercury, but not inorganic mercury, associated with higher blood pressure during pregnancy.

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Wells, Ellen M; Herbstman, Julie B; Lin, Yu Hong; Hibbeln, Joseph R; Halden, Rolf U; Witter, Frank R; Goldman, Lynn R

2017-04-01

Prior studies addressing associations between mercury and blood pressure have produced inconsistent findings; some of this may result from measuring total instead of speciated mercury. This cross-sectional study of 263 pregnant women assessed total mercury, speciated mercury, selenium, and n-3 polyunsaturated fatty acids in umbilical cord blood and blood pressure during labor and delivery. Models with a) total mercury or b) methyl and inorganic mercury were evaluated. Regression models adjusted for maternal age, race/ethnicity, prepregnancy body mass index, neighborhood income, parity, smoking, n-3 fatty acids and selenium. Geometric mean total, methyl, and inorganic mercury concentrations were 1.40µg/L (95% confidence interval: 1.29, 1.52); 0.95µg/L (0.84, 1.07); and 0.13µg/L (0.10, 0.17), respectively. Elevated systolic BP, diastolic BP, and pulse pressure were found, respectively, in 11.4%, 6.8%, and 19.8% of mothers. In adjusted multivariable models, a one-tertile increase of methyl mercury was associated with 2.83mmHg (0.17, 5.50) higher systolic blood pressure and 2.99mmHg (0.91, 5.08) higher pulse pressure. In the same models, an increase of one tertile of inorganic mercury was associated with -1.18mmHg (-3.72, 1.35) lower systolic blood pressure and -2.51mmHg (-4.49, -0.53) lower pulse pressure. No associations were observed with diastolic pressure. There was a non-significant trend of higher total mercury with higher systolic blood pressure. We observed a significant association of higher methyl mercury with higher systolic and pulse pressure, yet higher inorganic mercury was significantly associated with lower pulse pressure. These results should be confirmed with larger, longitudinal studies. Copyright © 2017 Elsevier Inc. All rights reserved.

Healing of ulcers on the feet correlated with distal blood pressure measurements in occlusive arterial disease

DEFF Research Database (Denmark)

Holstein, P; Lassen, N A

1980-01-01

The frequency of healing in subchronic ulcers in 66 feet in 62 patients with arterial occlusive disease was correlated with the systolic digital blood pressure (SDBP) and the systolic ankle blood pressure (SABP), both measured with a strain gauge, and with the skin perfusion pressure on the heel...

Validation of the AVITA BPM15S wrist blood pressure monitor for home blood pressure monitoring according to the European Society of Hypertension International Protocol revision 2010.

Science.gov (United States)

Kang, Yuan-Yuan; Zeng, Wei-Fang; Zhang, Lu; Li, Yan; Wang, Ji-Guang

2014-06-01

The present study aimed to evaluate the accuracy of the automated oscillometric wrist blood pressure monitor AVITA BPM15S for home blood pressure monitoring according to the International Protocol revision 2010 of the European Society of Hypertension. Systolic and diastolic blood pressures were sequentially measured in 33 Chinese adults (15 women, mean age 51 years) using a mercury sphygmomanometer (two observers) and the AVITA BPM15S device (one supervisor). Ninety-nine pairs of comparisons were obtained from 33 participants for judgments in two parts with three grading phases. The AVITA BPM15S device achieved the targets in part 1 of the validation study. The number of absolute differences between the device and observers within 5, 10, and 15 mmHg were 85/99, 94/99, and 98/99, respectively, for systolic blood pressure, and 82/99, 96/99, and 98/99, respectively, for diastolic blood pressure. The device also achieved the criteria in part 2 of the validation study. Thirty-two and 28 participants for systolic and diastolic blood pressure, respectively, had at least two of the three device-observer differences within 5 mmHg (required ≥ 24). No participant had all of the three device-observer comparisons greater than 5 mmHg for systolic or diastolic blood pressure. The AVITA wrist blood pressure monitor BPM15S fulfilled the requirements of the International Protocol revision 2010 and hence can be recommended for home use in an adult population.

Altered Immune Cytokine Expression Associated with KoRV B Infection and Season in Captive Koalas

Science.gov (United States)

Higgins, Damien P.

2016-01-01

Koala (Phascolarctos cinereus) populations are increasingly vulnerable and one of the main threats is chlamydial infection. Koala retrovirus (KoRV) has been proposed as an underlying cause of the koala’s susceptibility to infection with Chlamydia and high rates of lymphoid neoplasia; however, the regionally ubiquitous, endogenous nature of this virus suggests that KoRV A infection is not sufficient for immune suppression to occur. A recently discovered exogenous variant of KoRV, KoRV B, has several structural elements that cause increased pathogenicity in related retroviruses and was associated with lymphoid neoplasia in one study. The present study assesses whether KoRV B infection is associated with alterations in immune function. Cytokine gene expression by mitogen stimulated lymphocytes of KoRV B positive (n = 5–6) and negative (n = 6–7) captive koalas was evaluated by qPCR four times (April 2014-February 2015) to control for seasonal variation. Key immune genes in the Th1 pathway (IFNγ, TNFα), Th2 pathway (IL 10, IL4, IL6) and Th17 pathway (IL17A), along with CD4:CD8 ratio, were assessed. KoRV B positive koalas showed significantly increased up-regulation of IL17A and IL10 in three out of four sampling periods and IFNγ, IL6, IL4 and TNFα in two out of four. IL17A is an immune marker for chlamydial pathogenesis in the koala; increased expression of IL17A in KoRV B positive koalas, and concurrent immune dysregulation, may explain the differences in susceptibility to chlamydial infection and severity of disease seen between individuals and populations. There was also marked seasonal variation in up-regulation for most of the cytokines and the CD4:CD8 ratio. The up-regulation in both Th1 and Th2 cytokines mirrors changes associated with immune dysregulation in humans and felids as a result of retroviral infections. This is the first report of altered immune expression in koalas infected by an exogenous variant of KoRV and also the first report of

Minimal distal pressure rise after reconstructive arterial surgery in patients with multiple obstructive arteriosclerosis

DEFF Research Database (Denmark)

Noer, Ivan; Tønnesen, K H; Sager, P

1980-01-01

fifteen had ischemic ulcers. The preoperative median pressure index (per cent of arm systolic pressure) was 10% on the 1st toe. At the 10th postoperative day the median toe pressure rose to 25%. A further rise took place at the one month control to 30% which was unchanged throughout the study. All...... patients with a persistent postoperative toe pressure above 20% of arm systolic pressure were ultimately relieved from rest pain and chronic ulcers....

Comparison study of upper arm and forearm non-invasive blood pressures in adult Emergency Department patients.

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Schimanski, Karen; Jull, Andrew; Mitchell, Nancy; McLay, Jessica

2014-12-01

Forearm blood pressures have been suggested as an alternative site to measure blood pressures when the upper arm is unavailable. However there is little evidence utilising clinical populations to support this substitution. To determine agreement between blood pressures measured in the left upper arm and forearm using a singular oscillometric non-invasive device in adult Emergency Department patients. The secondary objective was to explore the relationship of blood pressure differences with age, sex, ethnicity, smoking history and obesity. Single centre comparison study. Adult Emergency Department, Tertiary Trauma Centre. Forty-four participants who met inclusion/exclusion criteria selected sequentially from the Emergency Department arrival board. A random assignment of order of measurement for left upper arm and forearm blood pressures was utilised. Participants were eligible if they were aged 18 years or older, had been assigned an Australasian Triage Scale code of 2, 3, 4, or 5, were able to consent, and able to have blood pressures measured on their left arm whilst lying at a 45° angle. The Bland-Altman method of statistical analysis was used, with the level of agreement for clinical acceptability for the systolic, diastolic and mean arterial pressure defined as ±10 mmHg. The forearm measure overestimated systolic (mean difference 2.2 mmHg, 95% limits of agreement ±19 mmHg), diastolic (mean difference 3.4 mmHg, 95% limits of agreement ±14.4 mmHg), and mean arterial pressures (mean difference 4.1 mmHg, 95% limits of agreement ±13.7 mmHg). The systolic measure was not significantly different from zero. Evidence of better agreement was found with upper arm/forearm systolic measures below 140 mmHg compared to systolic measures above 140 mmHg using the Levene's test (p=0.002, F-statistic=11.09). Blood pressure disparity was not associated with participant characteristics. Forearm measures cannot routinely replace upper arm measures for blood pressure measurement

Roles of inflammation and apoptosis in experimental brain death-induced right ventricular failure.

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Belhaj, Asmae; Dewachter, Laurence; Rorive, Sandrine; Remmelink, Myriam; Weynand, Birgit; Melot, Christian; Galanti, Laurence; Hupkens, Emeline; Sprockeels, Thomas; Dewachter, Céline; Creteur, Jacques; McEntee, Kathleen; Naeije, Robert; Rondelet, Benoît

2016-12-01

Right ventricular (RV) dysfunction remains the leading cause of early death after cardiac transplantation. Methylprednisolone is used to improve graft quality; however, evidence for that remains empirical. We sought to determine whether methylprednisolone, acting on inflammation and apoptosis, might prevent brain death-induced RV dysfunction. After randomization to placebo (n = 11) or to methylprednisolone (n = 8; 15 mg/kg), 19 pigs were assigned to a brain-death procedure. The animals underwent hemodynamic evaluation at 1 and 5 hours after Cushing reflex (i.e., hypertension and bradycardia). The animals euthanized, and myocardial tissue was sampled. This was repeated in a control group (n = 8). At 5 hours after the Cushing reflex, brain death resulted in increased pulmonary artery pressure (27 ± 2 vs 18 ± 1 mm Hg) and in a 30% decreased ratio of end-systolic to pulmonary arterial elastances (Ees/Ea). Cardiac output and right atrial pressure did not change. This was prevented by methylprednisolone. Brain death-induced RV dysfunction was associated with increased RV expression of heme oxygenase-1, interleukin (IL)-6, IL-10, IL-1β, tumor necrosis factor (TNF)-α, IL-1 receptor-like (ST)-2, signal transducer and activator of transcription-3, intercellular adhesion molecules-1 and -2, vascular cell adhesion molecule-1, and neutrophil infiltration, whereas IL-33 expression decreased. RV apoptosis was confirmed by terminal deoxynucleotide transferase-mediated deoxy uridine triphosphate nick-end labeling staining. Methylprednisolone pre-treatment prevented RV-arterial uncoupling and decreased RV expression of TNF-α, IL-1 receptor-like-2, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, and neutrophil infiltration. RV Ees/Ea was inversely correlated to RV TNF-α and IL-6 expression. Brain death-induced RV dysfunction is associated with RV activation of inflammation and apoptosis and is partly limited by methylprednisolone. Copyright © 2016

[Systolic blood pressure and functional outcome in patients with acute stroke: a Mexican registry of acute cerebrovascular disease (RENAMEVASC)].

Science.gov (United States)

Baños-González, Manuel; Cantú-Brito, Carlos; Chiquete, Erwin; Arauz, Antonio; Ruiz-Sandoval, José Luís; Villarreal-Careaga, Jorge; Barinagarrementeria, Fernando; Lozano, José Juan

2011-01-01

To analyze the association between the admission systolic blood pressure (SBP) and 30-day outcome in patients with acute cerebrovascular disease. The REgistro NAcional Mexicano de Enfermedad VAScular Cerebral (RENAMEVASC) is a hospital-based multicenter registry performed between November 2002 and October 2004. A total of 2000 patients with clinical syndromes of acute cerebrovascular disease confirmed by neuroimaging were registered. The modified Rankin scale was used for outcome stratification. We analyzed 1721 patients who had registered their SBP: 78 (4.5%) had transient ischemic attack, 894 (51.9%) brain infarction, 534 (30.9%) intracerebral hemorrhage, 165 (9.6%) subarachnoid hemorrhage and 50 (2.9%) cerebral venous thrombosis. Among 1036 (60.2%) patients with the antecedent of hypertension, only 32.4% had regular treatment. The 30-day case fatality rate presented a J pattern with respect to SBP, so that the risk of death was highest in 65 years (RR: 2.16, IC 95%: 1.74 - 2.67). Both hypotension and significant arterial hypertension at hospital admission are associated with an adverse outcome after acute cerebrovascular disease. Nevertheless, a good functional outcome can be attained in a wide range of SBP.

Blood pressure and sexual maturity in adolescents: the Heartfelt Study.

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Cho, S D; Mueller, W H; Meininger, J C; Liehr, P; Chan, W

2001-01-01

This study investigates sexual maturity as a predictor of resting blood pressures independent of other known predictors, in 179 boys and 204 girls 11-16 years of age from the Heartfelt Study. The sample included youth of African (n = 140), Mexican (n = 117), and European and "other" (n = 126) backgrounds. Sexual maturity was assessed during clinical examination of three standard indicators for each sex. Systolic and diastolic blood pressures were higher in children of maturity stages IV and V, compared to stages I-III, in each gender/ethnic group (P maturity for their age group, had significantly higher systolic blood pressures (but not diastolic) than the less advanced in linear models that included height, body mass index (BMI), ethnicity, and age as co-predictors. Diastolic blood pressures were predicted by height in boys and by age and the BMI in girls. This analysis, using a very conservative approach, suggests that sexual maturity provides important and independent information on systolic blood pressure in adolescents. Further investigation of its role in 24-hr blood pressures and in blood pressures taken during physical and emotional stress, is recommended.

Validation of the inverse pulse wave transit time series as surrogate of systolic blood pressure in MVAR modeling.

Science.gov (United States)

Giassi, Pedro; Okida, Sergio; Oliveira, Maurício G; Moraes, Raimes

2013-11-01

Short-term cardiovascular regulation mediated by the sympathetic and parasympathetic branches of the autonomic nervous system has been investigated by multivariate autoregressive (MVAR) modeling, providing insightful analysis. MVAR models employ, as inputs, heart rate (HR), systolic blood pressure (SBP) and respiratory waveforms. ECG (from which HR series is obtained) and respiratory flow waveform (RFW) can be easily sampled from the patients. Nevertheless, the available methods for acquisition of beat-to-beat SBP measurements during exams hamper the wider use of MVAR models in clinical research. Recent studies show an inverse correlation between pulse wave transit time (PWTT) series and SBP fluctuations. PWTT is the time interval between the ECG R-wave peak and photoplethysmography waveform (PPG) base point within the same cardiac cycle. This study investigates the feasibility of using inverse PWTT (IPWTT) series as an alternative input to SBP for MVAR modeling of the cardiovascular regulation. For that, HR, RFW, and IPWTT series acquired from volunteers during postural changes and autonomic blockade were used as input of MVAR models. Obtained results show that IPWTT series can be used as input of MVAR models, replacing SBP measurements in order to overcome practical difficulties related to the continuous sampling of the SBP during clinical exams.

Systolic blood pressure, routine kidney variables and renal ultrasonographic findings in cats naturally infected with feline immunodeficiency virus.

Science.gov (United States)

Taffin, Elien Rl; Paepe, Dominique; Ghys, Liesbeth Fe; De Roover, Katrien; Van de Maele, Isabel; Saunders, Jimmy H; Duchateau, Luc; Daminet, Sylvie

2017-06-01

Objectives Hypertension is a common cause of proteinuria in HIV-infected people. In cats, feline immunodeficiency virus (FIV) infection appears to be associated with proteinuria. Therefore, the results from systolic blood pressure (SBP) measurements in naturally infected FIV-positive cats were reviewed to assess whether hypertension contributes to the observed proteinuria in these cats. Ultrasonographic findings in FIV-positive cats were reviewed to complete renal assessment and to extend the scant knowledge on renal ultrasonography in cats. Methods Data from client-owned, naturally infected FIV-positive cats were retrospectively reviewed. To obtain a control group, records were reviewed from age-matched, privately owned, FIV-negative cats. Results Data from 91 FIV-infected and 113 control cats were compared. FIV-infected cats showed a significantly lower SBP ( P 0.4) occurred more frequently in FIV-infected cats ( P <0.001). Renal ultrasonography showed abnormalities in 60/91 FIV-infected cats, with hyperechogenic cortices in 39/91 and enlarged kidneys in 31/91. Conclusions and relevance Hypertension can be excluded as a common cause of renal damage leading to proteinuria in FIV-infected cats. Proteinuria and poorly concentrated urine are common in naturally infected FIV-positive cats, in contrast to azotaemia. Clinicians should cautiously interpret ultrasonographic abnormalities as these occur in over half of FIV-infected cats.

Arrhythmias and sudden death among older children and young adults following tetralogy of Fallot repair in the current era: are previously reported risk factors still applicable?

Science.gov (United States)

Arya, Swati; Kovach, Julie; Singh, Harinder; Karpawich, Peter P

2014-01-01

Young adult patients (pts) with repaired tetralogy of Fallot (TOF) remain at risk for arrhythmias (Ar) and sudden cardiac death (SCD). Based on past studies with earlier pt subsets, Ar/SCD events were associated with right ventricular (RV) systolic pressures >60 mm Hg, outflow tract gradients >20 mm Hg, and QRS duration >180 ms. However, there are limited recent studies to evaluate these risk factors in the current patient generation. Patients with TOF followed over the past 50 years were grouped by presence of any arrhythmias (group 1), absence of arrhythmias (group 2), and presence of SCD or significant ventricular arrhythmias (group 3) and correlated with current pt age, gender, age at repair, repair types, echocardiogram, cardiac magnetic resonance imaging, electrocardiogram/Holter, hemodynamics, and electrophysiology findings. Of 109 pts, 52 were male aged 17-58 years. Of these, 59 (54%) had Ar, two of whom had SCD. These 59 pts were chronologically older at the time of analysis, with repair at an older age and wider QRS duration (78-240, mean 158 ms) when compared with those without Ar. However, there was no correlation with surgical era, surgical repair, gender, RV pressure >60 mm Hg, right ventricular outflow tract gradient >20 mm Hg, or RV end-diastolic volume on CMRI. Ar/SCD risk continues to correlate with repair age and advancing pt age. QRS duration is longer in these patients but at a shorter interval (mean 158 ms) and less RV pressure (mean 43 mm Hg) than previously reported. In the current TOF patient generation, neither surgical era, type of repair, RV outflow gradient nor RV volume correlate with Ar/SCD. Electrophysiologic testing to verify and identify arrhythmias remains clinically effective. © 2013 Wiley Periodicals, Inc.

Exercise Blood Pressure and the Risk for Future Hypertension Among Normotensive Middle‐Aged Adults

Science.gov (United States)

Berger, Assaf; Grossman, Ehud; Katz, Moshe; Kivity, Shaye; Klempfner, Robert; Segev, Shlomo; Goldenberg, Ilan; Sidi, Yehezkel; Maor, Elad

2015-01-01

Background The aim of the present study was to examine whether exercise blood pressure can be used to predict the development of hypertension in normotensive middle‐aged adults. Methods and Results We investigated 7082 normotensive subjects who were annually screened in a tertiary medical center and completed maximal treadmill exercise tests at each visit. After the initial 3 years, subjects were divided into approximate quartiles according to their average exercise systolic and diastolic blood pressure responses (≤158; 158 to 170; 170 to 183; ≥183 mm Hg for systolic blood pressure and ≤73; 73 to 77; 77 to 82; ≥82 mm Hg for diastolic blood pressure). Mean age of the study population was 48±9 years and 73% were men. Average baseline resting blood pressure was 120/77±12/7 mm Hg. During a follow‐up of 5±3 years, 1036 (14.6%) subjects developed hypertension. The cumulative probability of new‐onset hypertension at 5 years was significantly increased with increasing quartiles of exercise systolic blood pressure (5%, 9%, 17%, and 35%, respectively; Pexercise either systolic or diastolic blood pressures were independently associated with respective 11% (Phypertension. Conclusions In normotensive middle‐aged individuals, blood pressure response to exercise is associated with future development of hypertension. PMID:25904593

Validation of the AVITA BPM63S upper arm blood pressure monitor for home blood pressure monitoring according to the European Society of Hypertension International Protocol revision 2010.

Science.gov (United States)

Kang, Yuan-Yuan; Zeng, Wei-Fang; Liu, Ming; Li, Yan; Wang, Ji-Guang

2014-02-01

The present study aimed to evaluate the accuracy of the AVITA BPM63S upper arm blood pressure monitor for home blood pressure monitoring according to the International Protocol of the European Society of Hypertension revision 2010. Systolic and diastolic blood pressures were sequentially measured in 33 adult Chinese (14 women, mean age of 47 years) using a mercury sphygmomanometer (two observers) and the AVITA BPM63S device (one supervisor). Ninety-nine pairs of comparisons were obtained from 33 participants for judgments in two parts with three grading phases. All the blood pressure requirements were fulfilled. The AVITA BPM63S device achieved the targets in part 1 of the validation study. The number of absolute differences between device and observers within 5, 10, and 15 mmHg was 68/99, 89/99, and 96/99, respectively, for systolic blood pressure, and 75/99, 95/99, and 97/99, respectively, for diastolic blood pressure. The device also achieved the criteria in part 2 of the validation study. Twenty-four and 25 participants for systolic and diastolic blood pressure, respectively, had at least two of the three device-observers differences within 5 mmHg (required ≥24). One and two participants for systolic and diastolic blood pressure, respectively, had all three device-observers differences greater than 5 mmHg. The AVITA BPM63S automated oscillometric upper arm blood pressure monitor has passed the requirements of the International Protocol revision 2010, and hence can be recommended for blood pressure measurement at home in adults.

[Effects of acupuncture on circadian rhythm of blood pressure in patients with essential hypertension].

Science.gov (United States)

Lei, Yun; Jin, Jiu; Ban, Haipeng; Du, Yuzheng

2017-11-12

To observe the effects of acupuncture combined with medication on circadian rhythm of blood pressure in patients with essential hypertension. Sixty-four patients of essential hypertension were randomly divided into an observation group and a control group, 32 cases in each group. All the patients maintained original treatment (taking antihypertensive medication); the patients in the observation group were treated with acupuncture method of " Huoxue Sanfeng , Shugan Jianpi ", once a day, five times per week, for totally 6 weeks (30 times). The circadian rhythm of blood pressure and related dynamic parameters were observed before and after treatment in the two groups. (1) The differences of daytime average systolic blood pressure (dASBP), daytime average diastolic blood pressure (dADBP), nighttime average systolic blood pressure (nASBP) and circadian rhythm of systolic blood pressure before and after treatment were significant in the observation group (all P circadian rhythm of blood pressure and related dynamic parameters before and after treatment were insignificant in the control group (all P >0.05). The nASBP and circadian rhythm of systolic blood pressure in the observation group were significantly different from those in the control group (all P circadian rhythm of blood pressure in the observation group was higher than that in the control group ( P circadian rhythm of blood pressure and related dynamic parameters in patients with essential hypertension.

Sleep deprivation increases blood pressure in healthy normotensive elderly and attenuates the blood pressure response to orthostatic challenge.

Science.gov (United States)

Robillard, Rébecca; Lanfranchi, Paola A; Prince, François; Filipini, Daniel; Carrier, Julie

2011-03-01

To determine how aging affects the impact of sleep deprivation on blood pressure at rest and under orthostatic challenge. Subjects underwent a night of sleep and 24.5 h of sleep deprivation in a crossover counterbalanced design. Sleep laboratory. Sixteen healthy normotensive men and women: 8 young adults (mean 24 years [SD 3.1], range 20-28 years) and 8 elderly adults (mean 64.1 years [SD 3.4], range 60-69 years). Sleep deprivation. Brachial cuff arterial blood pressure and heart rate were measured in semi-recumbent and upright positions. These measurements were compared across homeostatic sleep pressure conditions and age groups. Sleep deprivation induced a significant increase in systolic and diastolic blood pressure in elderly but not young adults. Moreover, sleep deprivation attenuated the systolic blood pressure orthostatic response in both age groups. Our results suggest that sleep deprivation alters the regulatory mechanisms of blood pressure and might increase the risk of hypertension in healthy normotensive elderly.

Dose-Response Head-to-Head Comparison of Inodilators Dobutamine, Milrinone, and Levosimendan in Chronic Experimental Pulmonary Hypertension.

Science.gov (United States)

Tavares-Silva, Marta; Alaa, Mohamed; Leite, Sara; Oliveira-Pinto, José; Lopes, Lucas; Leite-Moreira, Adelino F; Lourenço, André P

2017-09-01

The choice of inodilator drug in the acute management of patients with pulmonary hypertension (PH) having right ventricular (RV) failure remains unsettled and challenging. Comprehensive experimental evaluations may provide further insight and fundamental translational research clues to support inodilator selection and clinical trial design. Our aim was to compare acute dose-response hemodynamic effects of inodilators dobutamine (DOB), milrinone (MIL), and levosimendan (LEV) in chronic experimental PH. Seven-week-old male Wistar rats were randomly injected with 60 mg·kg -1 monocrotaline (MCT) or vehicle (Ctrl, n = 7) and underwent systemic and pulmonary artery (PA) pressure and RV pressure-volume (PV) hemodynamic evaluation under halogenate anesthesia 24 to 30 days after injection. The MCT-injected animals (n = 7 each) randomly received dose-response infusions of DOB (1, 3, 6 and 12 μg·kg -1 ·min -1 ), MIL (MIL: 1, 3, 6 and 12 μg·kg -1 ·min -1 ), or LEV (0.3, 0.6, 1.2 and 2.4 μg·kg -1 ·min -1 ). Load-independent indexes were obtained by inferior vena cava occlusion at baseline and after the last dose. All inodilators increased RV ejection fraction, preload recruitable stroke work, and ventricular-vascular coupling without jeopardizing perfusion pressure. Dobutamine raised heart rate and PA pressure. Only LEV increased cardiac index and decreased PA elastance and pulmonary vascular resistance (PVR). Moreover, only LEV downward-shifted the end-diastolic PV relationship, thereby improving RV compliance. Adding sildenafil to LEV further decreased PVR. Levosimendan had beneficial acute systolic and diastolic functional effects in experimental chronic PH and RV afterload compared to DOB and MIL. It should be further tested in clinical trials enrolling patients with PH in the perioperative and critical care settings.

Right ventricular global longitudinal strain in repaired tetralogy of Fallot.

Science.gov (United States)

Toro, Kamill Del; Soriano, Brian D; Buddhe, Sujatha

2016-10-01

Echocardiogram has limitations in effectively assessing right ventricular (RV) function in children post tetralogy of Fallot (TOF) repair. We evaluated the utility of speckle tracking echocardiography (STE)-based RV global longitudinal strain (GLS) for the assessment of RV systolic function. All patients with repaired TOF who had both echocardiograms and cardiac MRI (CMR) within a 6-month interval were included. RV volumes and ejection fraction (EF) were obtained by CMRs. Traditional echocardiographic function parameters and RV GLS were compared to CMR-derived RV EF. Subjects were divided into two groups based on CMR RV EF (group I: RV EF ≥45%; and group II: RV EF <45%). A total of 57 subjects were included. Mean age was 13.0±3.6 years and 58% were males. Group I had 39 subjects and group II had 18. Only six of the 18 patients (33%) in group II were identified as having at least mild RV dysfunction by echocardiogram. The mean RV GLS was significantly abnormal in group II (-15.3±3.8%) compared to group I (-20.9±3.3%; P<.001). By ROC analysis, an RV GLS cutoff value of -18% had 78% sensitivity and 77% specificity in identifying RV EF <45% (area under curve .87, P<.001). Intra- and inter-observer reproducibility of RV GLS were good. RV GLS is a simple and effective tool for the assessment of RV systolic function in patients post TOF repair. This technique would help further refine patient selection for timing of CMR and management. © 2016, Wiley Periodicals, Inc.

Evaluating combined effect of noise and heat on blood pressure changes among males in climatic chamber.

Science.gov (United States)

Dehghan, Habibollah; Bastami, Mohamad Taghi; Mahaki, Behzad

2017-01-01

Exposure to noise and heat causes individuals to experience some changes in the function of cardiovascular system in workplaces. This study aimed to find the combined effect of heat and noise on systolic and diastolic types of blood pressure in experimentally controlled conditions. This quasi-experimental study was performed with 12 male students in a climatic chamber in 2014. Blood pressure including systolic and diastolic was measured in the following conditions: 15 min after rest in exposure to heat (40°C, relative humidity [RH]: 30%), exposure to noise with 75, 85, and 95 dB rates in thermal comfort condition (22.1 ± 0.9 wet-bulb globe temperature), and combined exposure to heat (40°C, RH: 30%) and noise with 75, 85, and 95 dB. Friedman test was used to analyze the data. The mean change of systolic blood pressure was different significantly before and after exposure to heat and noise levels including 75, 85, and 95 dB ( P = 0.015, P = 0.001, P > 0.001, P = 0.027, respectively). Although systolic and diastolic blood pressures changed drastically, it was not significantly different in simultaneous exposure to heat and noise. Both systolic and diastolic blood pressures decreased in exposure to heat, while exposure to different levels of noise elevates systolic and diastolic blood pressures. However, when exposed to a combination of heat and noise, subtle changes of blood pressure were traced, which can be characterized as average, considering heat-only and noise-only tension situations.

Semi-quantitative assessment of right ventricular function in comparison to a 3D volumetric approach: A cardiovascular magnetic resonance study

Energy Technology Data Exchange (ETDEWEB)

Nijveldt, Robin; Germans, Tjeerd; Rossum, Albert C. van [VU University Medical Center, Department of Cardiology, Amsterdam (Netherlands); Interuniversity Cardiology Institute of the Netherlands, Utrecht (Netherlands); McCann, Gerald P. [University Hospitals Leicester, Department of Cardiology, Leicester (United Kingdom); Beek, Aernout M. [VU University Medical Center, Department of Cardiology, Amsterdam (Netherlands)

2008-11-15

Right ventricular (RV) volume measurements with cardiovascular magnetic resonance (CMR) is considered the gold standard, but acquisition and analysis remain time-consuming. The aim of our study was therefore to investigate the accuracy and performance of a semi-quantitative assessment of RV function in CMR, compared to the standard quantitative approach. Seventy-five subjects with pulmonary hypertension (15), anterior myocardial infarction (15), inferior myocardial infarction (15), Brugada syndrome (15) and normal subjects (15) underwent cine CMR. RV end-systolic and end-diastolic volumes were determined to calculate RV ejection fraction (EF). Four-chamber cine images were used to measure tricuspid annular plane systolic excursion (TAPSE). RV fractional shortening (RVFS) was calculated by dividing TAPSE by the RV end-diastolic length. RV EF correlated significantly with TAPSE (r = 0.62, p < 0.01) and RVFS (r = 0.67, p < 0.01). Sensitivity to predict RV dysfunction was comparable between TAPSE and RVFS, with higher specificity for RVFS, but comparable areas under the ROC curve. Intra- and inter-observer variability of RV EF was better than TAPSE (3%/4% versus 7%/15%, respectively). For routine screening in clinical practice, TAPSE and RVFS seem reliable and easy methods to identify patients with RV dysfunction. The 3D volumetric approach is preferred to assess RV function for research purposes or to evaluate treatment response. (orig.)

Systolic blood pressure reduction during the first 24 h in acute heart failure admission: friend or foe?

Science.gov (United States)

Cotter, Gad; Metra, Marco; Davison, Beth A; Jondeau, Guillaume; Cleland, John G F; Bourge, Robert C; Milo, Olga; O'Connor, Christopher M; Parker, John D; Torre-Amione, Guillermo; van Veldhuisen, Dirk J; Kobrin, Isaac; Rainisio, Maurizio; Senger, Stefanie; Edwards, Christopher; McMurray, John J V; Teerlink, John R

2018-02-01

Changes in systolic blood pressure (SBP) during an admission for acute heart failure (AHF), especially those leading to hypotension, have been suggested to increase the risk for adverse outcomes. We analysed associations of SBP decrease during the first 24 h from randomization with serum creatinine changes at the last time-point available (72 h), using linear regression, and with 30- and 180-day outcomes, using Cox regression, in 1257 patients in the VERITAS study. After multivariable adjustment for baseline SBP, greater SBP decrease at 24 h from randomization was associated with greater creatinine increase at 72 h and greater risk for 30-day all-cause death, worsening heart failure (HF) or HF readmission. The hazard ratio (HR) for each 1 mmHg decrease in SBP at 24 h for 30-day death, worsening HF or HF rehospitalization was 1.01 [95% confidence interval (CI) 1.00-1.02; P = 0.021]. Similarly, the HR for each 1 mmHg decrease in SBP at 24 h for 180-day all-cause mortality was 1.01 (95% CI 1.00-1.03; P = 0.038). The associations between SBP decrease and outcomes did not differ by tezosentan treatment group, although tezosentan treatment was associated with a greater SBP decrease at 24 h. In the current post hoc analysis, SBP decrease during the first 24 h was associated with increased renal impairment and adverse outcomes at 30 and 180 days. Caution, with special attention to blood pressure monitoring, should be exercised when vasodilating agents are given to AHF patients. © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

Crystallization and preliminary X-ray analysis of a novel esterase Rv0045c from Mycobacterium tuberculosis

International Nuclear Information System (INIS)

Xu, Lipeng; Guo, Jiubiao; Zheng, Xiangdong; Wen, Tingyi; Sun, Fei; Liu, Siguo; Pang, Hai

2010-01-01

The novel esterase Rv0045c from M. tuberculosis was expressed and purified to homogeneity. The crystals of native and SeMet-labelled Rv0045c protein that were obtained diffracted to resolutions of 2.7 and 3.0 Å, respectively. The Rv0045c protein is predicted to be an esterase that is involved in lipid metabolism in Mycobacterium tuberculosis. The protein was overproduced in Escherichia coli, purified and crystallized using the hanging-drop vapour-diffusion method. The Rv0045c protein crystals diffracted to a resolution of 2.7 Å using a synchrotron-radiation source and belonged to space group P3 1 or P3 2 , with unit-cell parameters a = b = 73.465, c = 48.064 Å, α = β = 90, γ = 120°. Purified SeMet-labelled Rv0045c protein was also crystallized and formed crystals that diffracted to a resolution of 3.0 Å using an in-house X-ray radiation source

Treatment of anemia with darbepoetin alfa in systolic heart failure

DEFF Research Database (Denmark)

Swedberg, Karl; Young, James B; Anand, Inder S

2013-01-01

Patients with systolic heart failure and anemia have worse symptoms, functional capacity, and outcomes than those without anemia. We evaluated the effects of darbepoetin alfa on clinical outcomes in patients with systolic heart failure and anemia.......Patients with systolic heart failure and anemia have worse symptoms, functional capacity, and outcomes than those without anemia. We evaluated the effects of darbepoetin alfa on clinical outcomes in patients with systolic heart failure and anemia....

Thallium-201 myocardial scintigram in primary pulmonary hypertension

International Nuclear Information System (INIS)

Fujii, Isao; Handa, Shunnosuke; Yamazaki, Hajime; Nakamura, Yoshiro

1984-01-01

Right heart catheterization is needed for the diagnosis of pulmonary hypertension in patients with primary pulmonary hypertension (PPH), though the procedure was reported to have an unusually high risk. We examined the usefulness of thallium-201 myocardial scintigraphy for the evaluation of right ventricular overloading in patients with PPH. This study includes 5 patients with PPH, diagnosed by the clinical criteria of research committee of PPH in the Ministry of Health and Welfare in Japan (1976). Autopsy was done and diagnosis was confirmed in 4 cases. The right ventricular (RV) free wall was visualized in all cases. They were divided into 2 groups by the degree of visualization. The cases with heavier visualization had a higher pulmonary arterial resistence. The shape of the interventricular septum was deformed in all cases. It was straight in 3 cases and convex to the left ventricle (LV) in 3. In the later group, a systolic LV-RV pressure difference was less than 25 mmHg. One of these 3 cases showed reversed pressure difference. We concluded that thallium-201 myocardial scintigraphy could non-invasively assess the degree of RV overloading in PPH. (author)

Classification of peripheral occlusive arterial diseases based on symptoms, signs and distal blood pressure measurements

DEFF Research Database (Denmark)

Tønnesen, K H; Noer, Ivan; Paaske, William

1980-01-01

Systolic blood pressures at toe and ankle were measured in 459 consecutive patients with occlusive arterial disease. Fifty-eight per cent had intermittent claudication with arterial disease of all degrees of severity. Seventeen per cent complained of rest pain having toe systolic pressures below 30...

Use of Dobutamine Stress Echocardiography for Periprocedural Evaluation of a Case of Critical Valvular Pulmonary Stenosis with Delayed Presentation.

Science.gov (United States)

Barik, Ramachandra; Akula, Siva Prasad; Damera, Sheshagiri Rao

2016-01-01

We report a case illustrating a 39-year-old man with delayed presentation of severe pulmonary valve (PV) stenosis, clinical evidence of congestive right heart failure in the form of enlarged liver, raised jugular venous pressure, and anasarca without cyanosis. Echocardiography (echo) was used both for diagnosis and monitoring this patient as main tool. The contractile reserve of the right ventricle (RV) was evaluated by infusion of dobutamine and diuretic for 4 days before pulmonary balloon valvotomy. Both the tricuspid annular peak systolic excursion and diastolic (diastolic anterograde flow through PV) function of RV improved after percutaneous balloon pulmonary valvotomy. These improvements were clinically apparent by complete resolution of anasarca, pericardial effusion, and normalization albumin-globulin ratio. The periprocedural echo findings were quite unique in this illustration.

Association of Inter-Arm Systolic Blood Pressure Difference with Coronary Atherosclerotic Disease Burden Using Calcium Scoring.

Science.gov (United States)

Her, Ae Young; Cho, Kyoung Im; Garg, Scot; Kim, Yong Hoon; Shin, Eun Seok

2017-09-01

There are no sufficient data on the correlation between inter-arm blood pressure (BP) difference and coronary atherosclerosis found using coronary artery calcium score (CACS). We aimed to investigate if the increased difference in inter-arm BP is independently associated with severity of CACS. Patients who had ≥3 cardiovascular risk factors or an intermediate Framingham Risk Score (FRS; ≥10) were enrolled. Inter-arm BP difference was defined as the absolute difference in BP in both arms. Quantitative CACS was measured by using coronary computed tomography angiography with the scoring system. A total of 261 patients were included in this study. Age (r=0.256, parm systolic BP (SBP; r=0.172, p=0.005), mean of left arm SBP (r=0.190, p=0.002), inter-arm SBP difference (r=0.152, p=0.014), and the FRS (r=0.278, parm SBP difference (≥6 mm Hg) was significantly associated with CACS ≥300 [odds ratio (OR) 2.17, 95% confidence interval (CI) 1.12-4.22; p=0.022]. In multivariable analysis, the inter-arm SBP difference ≥6 mm Hg was also significantly associated with CACS ≥300 after adjusting for clinical risk factors (OR 2.34, 95 % CI 1.06-5.19; p=0.036). An increased inter-arm SBP difference (≥6 mm Hg) is associated with coronary atherosclerotic disease burden using CACS, and provides additional information for predicting severe coronary calcification, compared to models based on traditional risk factors. © Copyright: Yonsei University College of Medicine 2017

Cost-effectiveness of Intensive Blood Pressure Management

DEFF Research Database (Denmark)

Richman, Ilana B; Fairley, Michael; Jørgensen, Mads Emil

2016-01-01

Importance: Among high-risk patients with hypertension, targeting a systolic blood pressure of 120 mm Hg reduces cardiovascular morbidity and mortality compared with a higher target. However, intensive blood pressure management incurs additional costs from treatment and from adverse events......-effectiveness of intensive blood pressure management among 68-year-old high-risk adults with hypertension but not diabetes. We used the Systolic Blood Pressure Intervention Trial (SPRINT) to estimate treatment effects and adverse event rates. We used Centers for Disease Control and Prevention Life Tables to project age...... and accrued $155 261 in lifetime costs, while intensive management yielded 10.5 QALYs and accrued $176 584 in costs. Intensive blood pressure management cost $23 777 per QALY gained. In a sensitivity analysis, serious adverse events would need to occur at 3 times the rate observed in SPRINT and be 3 times...

ORANGE JUICE AND BLOOD PRESSURE

Directory of Open Access Journals (Sweden)

M. F. VALIM

2009-01-01

Full Text Available

Blood pressure is the force of blood against artery walls. It is measured in millimeters of mercury (mm Hg and recorded as two numbers: systolic pressure (as the heart contracts over diastolic pressure (as the heart relaxes between beats. High blood pressure (hypertension is defined as chronically elevated high blood pressure, with systolic blood pressure (SBP of 140 mm Hg or greater, and diastolic blood pressure (DBP of 90 mm Hg or greater. High blood pressure (HBP, smoking, abnormal blood lipid levels, obesity and diabetes are risk factors for coronary heart disease, the leading cause of death in the US. Lifestyle modifications such as engaging in regular physical activity, quitting smoking and eating a healthy diet (limiting intake of saturated fat and sodium and increasing consumption of fiber, fruits and vegetables are advocated for the prevention, treatment, and control of HBP. As multiple factors influence blood pressure, the effects of each factor are typically modest, particularly in normotensive subjects, yet the combined effects can be substantial. Nutrition plays an important role in influencing blood pressure. Orange juice should be included as part of any low sodium diet and/or any blood pressure reducing eating plan, as it is sodium free, fat-free and can help meet recommended levels of potassium intake that may contribute to lower BP.

The distal blood pressure predicts healing of amputations on the feet

DEFF Research Database (Denmark)

Holstein, P

1984-01-01

The healing of digital and transmetatarsal forefoot amputations was compared with the systolic digital and ankle blood pressure, both measured with a strain-gauge, and with the skin perfusion pressure on the forefoot measured with the isotope washout technique. In 85 out of 134 legs (63 per cent......) the amputation healed. The frequency of healing correlated statistically significantly with all three measures of distal blood pressures, the closest correlation being with the systolic digital blood pressure (SDBP). As measured in 110 cases the healing rates were: SDBP less than 20 mm Hg: four out of 23; SDBP...

Daily blood pressure profile in Cushing's syndrome before and after surgery

Directory of Open Access Journals (Sweden)

Kreze A.

1999-01-01

Full Text Available No significant difference has been demonstrated in the altered circadian blood pressure pattern between the pituitary-dependent and adrenal forms of Cushing's syndrome before surgery. The effect of therapy, however, proved to be different. The mesor was normalized in the pituitary-dependent Cushing's syndrome more conspicuously for systolic than for diastolic blood pressure. In Cushing's syndrome due to adrenal adenoma, systolic and diastolic blood pressure mesors have been even significantly "overnormalized" after treatment, being 11 to 27 and 2 to 13 mmHg (95% confidence lower than corresponding mesors in controls. There was no difference between forms in the effect of treatment on blood pressure amplitudes, which remained significantly lower than in controls. Finally, acrophase patterns were partly normalized after treatment of the pituitary-dependent form only for diastolic blood pressure, while both systolic and diastolic blood pressure acrophases were normalized in the treated adrenal form. In conclusion, complete normalization of the pattern of daily blood pressure profile has not been achieved in either form of the syndrome. This may be one of the reasons for the reduced long-term survival after surgical cure of hypercortisolism, than expected.

Strain-encoding cardiovascular magnetic resonance for assessment of right-ventricular regional function

Directory of Open Access Journals (Sweden)

Abraham M Roselle

2008-07-01

Full Text Available Abstract Background Tissue tagging by cardiovascular magnetic resonance (CMR is a comprehensive method for the assessment of cardiac regional function. However, imaging the right ventricle (RV using this technique is problematic due to the thin wall of the RV relative to tag spacing which limits assessment of regional function using conventional in-plane tagging. Hypothesis We hypothesize that the use of through-plane tags in the strain-encoding (SENC CMR technique would result in reproducible measurements of the RV regional function due to the high image quality and spatial resolution possible with SENC. Aim To test the intra- and inter-observer variabilities of RV peak systolic strain measurements with SENC CMR for assessment of RV regional function (systolic strain in healthy volunteers. Methods Healthy volunteers (n = 21 were imaged using SENC. A four-chamber view was acquired in a single breath-hold. Circumferential strain was measured during systole at six equidistant points along the RV free wall. Peak contraction is defined as the maximum value of circumferential strain averaged from the six points, and regional function is defined as the strain value at each point at the time of peak contraction. Results Mean values for peak circumferential strain (± standard deviation of the basal, mid, and apical regions of the RV free wall were -20.4 ± 2.9%, -18.8 ± 3.9%, and -16.5 ± 5.7%, Altman plots showed good intra- and inter-observer agreements with mean difference of 0.11% and 0.32% and limits of agreement of -4.038 to 4.174 and -4.903 to 5.836, respectively. Conclusion SENC CMR allows for rapid quantification of RV regional function with low intra- and inter-observer variabilities, which could permit accurate quantification of regional strain in patients with RV dysfunction.

Differences Between Right and Left Arm Blood Pressures in the Elderly

OpenAIRE

Hashimoto, Fred; Hunt, William C.; Hardy, Linda

1984-01-01

Recommendations vary on whether blood pressures should be measured in the right or in the left arm because no frequency distributions for a pressure difference between the arms exist. We took a total of 12 blood pressure determinations in both arms of 174 elderly persons and analyzed the data by a least-squares components of variance method. The mean difference between the arms (right minus left) was 0.93 mm of mercury for systole and 0.70 mm of mercury for diastole. For systole the proportio...

Hyper-systolic matrix multiplication

NARCIS (Netherlands)

Lippert, Th.; Petkov, N.; Palazzari, P.; Schilling, K.

A novel parallel algorithm for matrix multiplication is presented. It is based on a 1-D hyper-systolic processor abstraction. The procedure can be implemented on all types of parallel systems. (C) 2001 Elsevier Science B,V. All rights reserved.

Purification, crystallization and preliminary X-ray crystallographic studies of Rv3705c from Mycobacterium tuberculosis

International Nuclear Information System (INIS)

Lu, Feifei; Gao, Feng; Li, Honglin; Gong, Weimin; Zhou, Lin; Bi, Lijun

2014-01-01

The cloning, expression, purification, crystallization and preliminary X-ray diffraction analysis of Rv3705c from M. tuberculosis are described. The conserved protein Rv3705c from Mycobacterium tuberculosis has been cloned, expressed, purified and crystallized by the sitting-drop vapour-diffusion method using PEG 3350 as a precipitant. The Rv3705c crystals exhibited space group P6 1 22 or P6 5 22, with unit-cell parameters a = b = 198.0, c = 364.1 Å, α = β = 90, γ = 120°, and diffracted to a resolution of 3.3 Å

Purification, crystallization and preliminary X-ray crystallographic studies of Rv3705c from Mycobacterium tuberculosis

Energy Technology Data Exchange (ETDEWEB)

Lu, Feifei [East China University of Science and Technology, 130 Meilong Road, Shanghai 200237, People’s Republic of (China); Gao, Feng [Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, People’s Republic of (China); Li, Honglin [East China University of Science and Technology, 130 Meilong Road, Shanghai 200237, People’s Republic of (China); Gong, Weimin [Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, People’s Republic of (China); Zhou, Lin, E-mail: gdtb-bg@vip.163.com [Center for Tuberculosis Control of Guangdong Province, Guangzhou, People’s Republic of (China); Bi, Lijun, E-mail: gdtb-bg@vip.163.com [East China University of Science and Technology, 130 Meilong Road, Shanghai 200237, People’s Republic of (China)

2014-07-23

The cloning, expression, purification, crystallization and preliminary X-ray diffraction analysis of Rv3705c from M. tuberculosis are described. The conserved protein Rv3705c from Mycobacterium tuberculosis has been cloned, expressed, purified and crystallized by the sitting-drop vapour-diffusion method using PEG 3350 as a precipitant. The Rv3705c crystals exhibited space group P6{sub 1}22 or P6{sub 5}22, with unit-cell parameters a = b = 198.0, c = 364.1 Å, α = β = 90, γ = 120°, and diffracted to a resolution of 3.3 Å.

Blood pressure measurement in obese patients: comparison between upper arm and forearm measurements.

Science.gov (United States)

Pierin, Angela M G; Alavarce, Débora C; Gusmão, Josiane L; Halpern, Alfredo; Mion, Décio

2004-06-01

It is well known that blood pressure measurement with a standard 12-13 cm wide cuff is erroneous for large arms. To compare arm blood pressure measurements with an appropriate cuff and forearm blood pressure measurements (BPM) with a standard cuff, and both measurements by the Photopletismography (Finapres) method. One hundred and twenty-nine obese patients were studied (body mass index=40+/-7 kg/m2). The patients had three arm BPM taken by an automatic oscillometric device using an appropriate cuff and three forearm BPM with a standard cuff in the sitting position after a five-minute rest. Data were analysed by the analysis of variance. The correction values were obtained by the linear regression test. Systolic and diastolic arm BPM with an appropriate cuff were significantly lower (pforearm BPM with a standard cuff. The measurements obtained by Finapres were significantly lower (pforearm systolic and diastolic blood pressures and upper arm diastolic blood pressure. The equation to correct BPM in forearm in obese patients with arm circumference between 32-44 cm was: systolic BPM=33.2+/-0.68 x systolic forearm BPM, and diastolic BPM=25.2+0.59 x forearm diastolic BPM. This study showed that forearm blood pressure measurement overestimates the values of arm blood pressure measurement. In addition, it is possible to correct forearm BPM with an equation.

A high-sugar and high-fat diet impairs cardiac systolic and diastolic function in mice.

Science.gov (United States)

Carbone, Salvatore; Mauro, Adolfo G; Mezzaroma, Eleonora; Kraskauskas, Donatas; Marchetti, Carlo; Buzzetti, Raffaella; Van Tassell, Benjamin W; Abbate, Antonio; Toldo, Stefano

2015-11-01

Heart failure (HF) is a clinical syndrome characterized by dyspnea, fatigue, exercise intolerance and cardiac dysfunction. Unhealthy diet has been associated with increased risk of obesity and heart disease, but whether it directly affects cardiac function, and promotes the development and progression of HF is unknown. We fed 8-week old male or female CD-1 mice with a standard diet (SD) or a diet rich in saturated fat and sugar, resembling a "Western" diet (WD). Cardiac systolic and diastolic function was measured at baseline and 4 and 8 weeks by Doppler echocardiography, and left ventricular (LV) end-diastolic pressure (EDP) by cardiac catheterization prior to sacrifice. An additional group of mice received WD for 4 weeks followed by SD (wash-out) for 8 weeks. WD-fed mice experienced a significant decreased in LV ejection fraction (LVEF), reflecting impaired systolic function, and a significant increase in isovolumetric relaxation time (IRT), myocardial performance index (MPI), and LVEDP, showing impaired diastolic function, without any sex-related differences. Switching to a SD after 4 weeks of WD partially reversed the cardiac systolic and diastolic dysfunction. A diet rich in saturated fat and sugars (WD) impairs cardiac systolic and diastolic function in the mouse. Further studies are required to define the mechanism through which diet affects cardiac function, and whether dietary interventions can be used in patients with, or at risk for, HF. Published by Elsevier Ireland Ltd.

Mycophenolate mofetil attenuates pulmonary arterial hypertension in rats

International Nuclear Information System (INIS)

Suzuki, Chihiro; Takahashi, Masafumi; Morimoto, Hajime; Izawa, Atsushi; Ise, Hirohiko; Hongo, Minoru; Hoshikawa, Yasushi; Ito, Takayuki; Miyashita, Hiroshi; Kobayashi, Eiji; Shimada, Kazuyuki; Ikeda, Uichi

2006-01-01

Pulmonary arterial hypertension (PAH) is characterized by abnormal proliferation of smooth muscle cells (SMCs), leading to occlusion of pulmonary arterioles, right ventricular (RV) hypertrophy, and death. We investigated whether mycophenolate mofetil (MMF), a potent immunosuppresssant, prevents the development of monocrotaline (MCT)-induced PAH in rats. MMF effectively decreased RV systolic pressure and RV hypertrophy, and reduced the medial thickness of pulmonary arteries. MMF significantly inhibited the number of proliferating cell nuclear antigen (PCNA)-positive cells, infiltration of macrophages, and expression of P-selectin and interleukin-6 on the endothelium of pulmonary arteries. The infiltration of T cells and mast cells was not affected by MMF. In vitro experiments revealed that mycophenolic acid (MPA), an active metabolite of MMF, dose-dependently inhibited proliferation of human pulmonary arterial SMCs. MMF attenuated the development of PAH through its anti-inflammatory and anti-proliferative properties. These findings provide new insight into the potential role of immunosuppressants in the treatment of PAH

Theoretical study of a novel refrigeration compressor - Part II: Performance of a rotating discharge valve in the revolving vane (RV) compressor

Energy Technology Data Exchange (ETDEWEB)

Teh, Y.L.; Ooi, K.T. [Thermal and Fluids Engineering Division, School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, S639798 (Singapore); Djamari, D. Wibowo [Engineering Mechanics Division, School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, S639798 (Singapore)

2009-08-15

A new refrigeration compressor, named 'Revolving Vane (RV) compressor', has been introduced in Part I of this paper series. For a first time in refrigeration compressors, a rotating discharge valve is employed in the RV compressor mainly due to the rotation of the entire cylinder. This paper presents a theoretical investigation on the dynamic behavior of a reed-type discharge valve undergoing rotatory motion, with the primary objective of elucidating the applicability of such valves in refrigeration compressors. Under the application of the Euler-Bernoulli beam theory, a mathematical model of the rotating valve is formulated and the transient response of the valve under centrifugal loads in addition to pressure forces is analyzed. Results have shown that under careful design considerations, the performance as well as the reliability of the rotating discharge valve can be enhanced as compared to a non-rotating valve that has been used in all refrigeration compressors currently. (author)

Exercise blood pressure and the risk for future hypertension among normotensive middle-aged adults.

Science.gov (United States)

Berger, Assaf; Grossman, Ehud; Katz, Moshe; Kivity, Shaye; Klempfner, Robert; Segev, Shlomo; Goldenberg, Ilan; Sidi, Yehezkel; Maor, Elad

2015-04-22

The aim of the present study was to examine whether exercise blood pressure can be used to predict the development of hypertension in normotensive middle-aged adults. We investigated 7082 normotensive subjects who were annually screened in a tertiary medical center and completed maximal treadmill exercise tests at each visit. After the initial 3 years, subjects were divided into approximate quartiles according to their average exercise systolic and diastolic blood pressure responses (≤158; 158 to 170; 170 to 183; ≥183 mm Hg for systolic blood pressure and ≤73; 73 to 77; 77 to 82; ≥82 mm Hg for diastolic blood pressure). Mean age of the study population was 48 ± 9 years and 73% were men. Average baseline resting blood pressure was 120/77 ± 12/7 mm Hg. During a follow-up of 5 ± 3 years, 1036 (14.6%) subjects developed hypertension. The cumulative probability of new-onset hypertension at 5 years was significantly increased with increasing quartiles of exercise systolic blood pressure (5%, 9%, 17%, and 35%, respectively; Pexercise either systolic or diastolic blood pressures were independently associated with respective 11% (Phypertension. In normotensive middle-aged individuals, blood pressure response to exercise is associated with future development of hypertension. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

The right ventricle following prolonged endurance exercise: are we overlooking the more important side of the heart? A meta-analysis.

Science.gov (United States)

Elliott, Adrian D; La Gerche, Andre

2015-06-01

Prolonged endurance exercise is associated with elevated biomarkers associated with myocardial damage and modest evidence of left ventricular (LV) dysfunction. Recent studies have reported more profound effects on right ventricular (RV) function following endurance exercise. We performed a meta-analysis of studies reporting RV function pre-endurance and postendurance exercise. We performed a search of peer-reviewed studies with the criteria for inclusion in the analysis being (1) healthy adult participants; (2) studies examining RV function following an event of at least 90 min duration; (3) studies reporting RV fractional area change (RVFAC), RV strain (S), RV ejection fraction (RVEF) or tricuspid annular plane systolic excursion (TAPSE) and (4) studies evaluating RV function immediately (exercise. Fourteen studies were included with 329 participants. A random-effects meta-analysis revealed significant impairments of RV function when assessed by RVFAC (weighted mean difference (WMD) -5.78%, 95% CI -7.09% to -4.46%), S (WMD 3.71%, 95% CI 2.79% to 4.63%), RVEF (WMD -7.05%, 95% CI -12.3% to -1.8%) and TAPSE (WMD -4.77 mm, 95% CI -8.3 to -1.24 mm). Modest RV dilation was evident in studies reporting RV systolic area postexercise (WMD 1.79 cm(2), 95% CI 0.5 to 3.08 cm(2)). In contrast, no postexercise changes in LV systolic function (expressed as LVFAC or LVEF) were observed in the included studies (standardised mean difference 0.03%, 95% CI -0.13% to 0.18%). Intense prolonged exercise is associated with a measurable reduction in RV function while LV function is relatively unaffected. Future studies should examine the potential clinical consequences of repeated prolonged endurance exercise on the right ventricle. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.