Noninvasive assessment of aortic distensibility (AD) is feasible with cardiac magnetic resonance (CMR). We investigated the relationship between AD (assessed by CMR) and coronary artery disease (CAD) severity (assessed by the SYNTAX score) in patients with premature CAD. We recruited 125 patients with CAD confirmed by coronary angiography (males were <55 years old and females <65 years old). We excluded patients with significant aortic disease or contraindications to CMR. We also recruited 25 age- and sex-matched healthy patients as controls. One-year follow-up was also carried out. Aortic distensibility at the aortic root (AR) and descending aorta (DA) was significantly ( P < .001 for both) lower in the patient group. There was a significant negative correlation between SYNTAX score and AD at the AR (r = −0.56; P < .001) and DA (r = −0.34; P < .001), but insignificant correlation with distensibility at the ascending aorta (AA; r = −0.03; P = .81). AR, AA, and DA distensibility, as well as left ventricular ejection fraction were predictors of adverse events. The severity of CAD in young patients is associated with decreased AD, especially at the level of the AR. Aortic distensibility can predict adverse events in these patients.

Background: Hyperglycemia, insulin resistance, and hyperinsulinemia represent important pathophysiological components of the prediabetic stage that result in arteriosclerosis and increased arterial stiffness. We sought to compare the aortic distensibility (AD) assessed by cardiac magnetic resonance (CMR) in prediabetic patients presenting with chronic coronary artery disease (CCAD) versus patients with normal HbA1C. Ninety-eight patients with CCAD were recruited. All patients were screened for HbA1C levels and then underwent a CMR study to assess AD of the aortic root and the ascending and descending thoracic aorta. Patients were classified into two groups: 52 prediabetic (HbA1C 5.7-6.4%) (study group) and 46 with normal glycemic status (HbA1C < 5.7%) (control group). Results: AD values at the aortic root (AR) (13.93 ± 5.17 vs 34.3 ± 9.65 Kpa-1 × 10-3), ascending aorta (AA) (13.17 ± 4.81 vs 28.1 ± 8.33 Kpa-1 × 10-3), and descending thoracic aorta (DA) (18.12 ± 4.34 vs 33.68 ± 7.57 Kpa-1 × 10-3) were significantly lower in the study group than in the control group (P value for all was < 0.001). Twenty-eight patients fulfilled the criteria for metabolic syndrome, and in those patients, AD was significantly lower than in those without metabolic syndrome. Aortic distensibility at the AR, AA, and DA had strong significant negative correlations with the level of glycosylated hemoglobin (AA, AR, DA; r − 0.66, − 0.68, − 0.58, respectively) (P < 0.001). Conclusion: AD values at different points (AR, AA, and DA) were significantly lower in prediabetic and metabolic syndrome patients than in controls. These values also showed a significant negative correlation with the levels of HBA1C.

The aim of this study was to evaluate the left ventricular (LV) function by conventional two-dimensional speckle tracking echocardiography (2D STE) to detect subclinical LV systolic dysfunction in patients with dipper and nondipper hypertension.Methods One hundred consecutive patients with hypertension were included in our study. Clinical evaluation, baseline laboratory investigations, 24 ambulatory blood pressure monitoring 2D echocardiographic examination and 2D STE were performed for all patients. Patients were classified as dippers and nondippers according to their nighttime MAP (mean arterial blood pressure) reduction rate of ≥10 or <10%, respectively. ResultsOf 100 patients, 71% were nondippers while 29% were dippers. Nondippers had a significantly lower global longitudinal strain (LS) value (−22.45 ± 3.26 vs. −18.2 ± 3.3, P < 0.001), global circumferential strain (CS) value (−24.23 ± 3.56 vs. −19.16 ± 8.25, P < 0.001) and global radial strain (RS) value (35.04 ± 11.16 vs. 29.58 ± 8.44, P = 0.009). It was found that nondipper status was associated with worsening of LS by 2.737, (P = 0.001), CS by 3.446, (P = 0.002), RS by −3.256, (P = 0.158) and DM also was found associated with worsening of LS by 1.849, (P = 0.062), CS by 3.284 (P = 0.018), RS by −2.499 (P = 0.381). ConclusionThe nondipping hypertension pattern is associated with subclinical LV systolic dysfunction as shown by the impaired global myocardial strain in all three directions.

Background The management of hypertensive disorders of pregnancy (HDP) during hospitalization requires an accurate blood pressure (BP) measurement, mainly by invasive intra-arterial reading. Nevertheless, little is known about the precision of non-invasive (NI) central BP measurements in HDP. We aimed to assess the accuracy of NI central BP assessment in comparison to invasive BP measurement in HDP. This cross-sectional study included all patients with HDP that were admitted to university hospitals for high BP control, from December 2018 till December 2019, and 10 healthy matched non-hypertensive controls. Patients were compared for demographic, anthropometric, and echocardiographic data. In all subjects, invasive BP assessment was done by radial arterial cannulation and NI assessment of BP was performed by an oscillometric automated device (Mobil-O-Graph); the comparison was done after initial control of BP. Results One hundred patients were included and divided into 3 groups (pre-existing hypertension (HTN), gestational HTN, and pre-eclampsia). There was no statistically significant difference between NI central and invasive methods in measuring both systolic BP (SBP) (126.39 ± 14.5 vs 127.43 ± 15.3, p = 0.5) and diastolic BP (82.41 ± 9.0 vs 83.78 ± 8.9, p = 0.14) among the total studied population. A strong positive correlation was found between NI central and invasive SBP (r = 0.96, p < 0.001). HDP was associated with an increase in arterial stiffness, left ventricular diastolic dysfunction, and complications. Conclusion Non-invasive measurement of BP using oscillometric automated devices is as accurate as the invasive method, and it is a practical safe method in pregnant women with hypertensive disorders (CTR no. = NCT04303871).

Key clinical messageThe risk of rupture of LV pseudaneurysm is still not well understood, and ischemic cardiomyopathy with heart failure is a common consequence. Simple investigations like chest X‐ray can give clue to such a serious diagnosis.

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Objective Hypertensive pulmonary edema is a fatal condition unless early and properly diagnosed and managed. Central blood pressure (cBP) has been proven to be more associated with adverse cardiovascular events. We aimed to study the correlation between cBP and heart damage in patients with Hypertensive pulmonary edema. Methods We included 50 patients admitted to the emergency department in a university hospital for hypertensive pulmonary edema, 27 women and 23 men aged 50 to 70 years. We excluded patients with suspected acute coronary syndrome, significant valvular heart disease, and pericardial diseases. We measured cBP non-invasively from pulse wave analysis of the brachial artery. Brain natriuretic peptide (BNP) and cBP were repeatedly measured for every patient. Results The median BNP levels of patients significantly decreased from 284 pg/ml (232–352.5) to 31.5 pg/ml (24–54) on discharge, P < 0.001. We found a significant correlation between admission BNP and central SBP (cSBP), urea, creatinine, arterial blood gases parameters, and left ventricular end-diastolic diameter (LVEDD). Concurrently, BNP at discharge was correlated with age, central DBP (cDBP), urea, creatinine, LVEDD, partial oxygen pressure (pO2), and oxygen saturation (SO2). Delta BNP was correlated with cSBP, peripheral SBP, urea, creatinine, pO2, and SO2. Linear regression analysis revealed that creatinine, and cSBP, were independent predictors of admission BNP, while urea and cDBP were the independent predictors of discharge BNP. Conclusion This simple, noninvasive method of cBP measurement was significantly associated with the extent of myocardial damage in patients presenting with hypertensive pulmonary edema.

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