How to Identify Hypertensive Patients at High Cardiovascular Risk? The Role of Echocardiography

Cuspidi, Cesare; Tadić, Marijana; Sala, Carla

doi:10.1007/s40292-015-0079-2

Cited by 5 publications

(2 citation statements)

References 45 publications

(39 reference statements)

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“…Subclinical organ damage is detectable at cardiac site and various vascular districts focusing various parameters including coronary calcifications, carotid intima-media thickness, microalbuminuria, retinal vascular changes and is associate with increased cardiovascular risk in hypertension [11, 12]. In particular, the cardiac chamber morpho-functional changes are early signs of potentially evolving ouvert cardiac failure and atrial fibrillation and ultrasound evaluation allows to identify individuals at high risk due to presence of subclinical cardiac alterations in front of mild to moderate BP elevations [13].…”

Section: Introductionmentioning

confidence: 99%

sRAGE and early signs of cardiac target organ damage in mild hypertensives

Maresca

Guasti

Beigrezaei

et al. 2019

Cardiovasc Diabetol

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BackgroundSoluble Receptor for Advanced Glycation End Products (sRAGE) may be considered a marker inversely related to inflammation and its participation has been established in patients with advanced atherosclerotic vascular diseases. However, it is still unknown whether sRAGE reduction could be early metabolic change in the first stage of hypertension and initial hypertension-associated cardiac damage. We sought to determine the sRAGE values in otherwise healthy, untreated and recently diagnosed mild hypertensives and evaluate their association with blood pressure (BP) values, metabolic parameters, and with subclinical initial signs of cardiac target organ damage (TOD).MethodssRAGE were measured in 100 hypertensive and 100 normotensive subjects matched for age, gender and body mass index (BMI), submitted to a clinic visit and both ambulatory BP monitoring and echocardiography to determine the presence of initial cardiac TOD (presence of signs of left ventricular hypertrophy: left ventricular mass indexed for height2.7 (LVMi) > 48 g/m2.7 for men and > 44 g/m2.7 for women and/or increased left atrial volume 4-chamber indexed for body surface area (LAVi) > 34 ml/m2).ResultssRAGE levels were similar between hypertensive and normotensive subjects and were not significantly correlated with office and 24-h BPs values. However, when subgrouping the hypertensive patients in Hyp-TOD and Hyp-withoutTOD, sRAGE was found to be different among the three groups (p = 0.030), being lower in the Hyp-TOD group than the values of both Hyp-withoutTOD (p = 0.038) and normotensives (p = 0.038). In hypertensive patients sRAGE was negatively related with both LVMi (r = − 0.239, p = 0.034) and LAVi (r = − 0.315, p = 0.005) and was independently related to cardiac TOD also in multivariable analysis.ConclusionsIn this population of mild hypertensives, low circulating sRAGE may be a very early marker of initial TOD, suggesting the possible participation of oxidative stress in initial cardiac changes in human hypertension.Electronic supplementary materialThe online version of this article (10.1186/s12933-019-0821-5) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

sRAGE and early signs of cardiac target organ damage in mild hypertensives

Maresca

Guasti

Beigrezaei

et al. 2019

Cardiovasc Diabetol

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“…In the evaluation of CV risk in high-risk categories of patients, new techniques can be used to detect early CV alterations in clinical studies ( 10 ). Considering that small artery remodeling (i.e., thickened arterial wall) is the earliest form of target organ damage in arterial hypertension, and it has a role in increasing vascular resistance, the evaluation of microvascular alterations might provide clinically useful information extending the determination of traditional Framingham risk factors ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

Retinal microvascular alterations in patients with active rheumatoid arthritis without cardiovascular risk factors: the potential effects of T cell co-stimulation blockade

Piantoni,

Regola,

Angeli

et al. 2024

Front. Med.

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BackgroundThe evaluation of microvascular alterations might provide clinically useful information for patients with an increased cardiovascular (CV) risk, such as those with rheumatoid arthritis (RA), being the small artery remodeling the earliest form of target organ damage in primary CV diseases, such as arterial hypertension. The evaluation of retinal arterioles is a non-invasive technique aimed to identify an early microvascular damage, represented by the increase of the wall-to-lumen ratio (WLR) index. Abatacept (ABA), a T-cell co-stimulator blocker, is used to treat RA. A CV protective action was hypothesized for its peculiar mechanism of action in the modulation of T-cells, potentially involved in the pathogenesis of CV comorbidity. The study aimed to non-invasively investigate morphological characteristics of retinal arterioles in a cohort of RA patients treated with ABA.Materials and methodsSeventeen RA patients [median (25th-75thpercentile) age = 58 (48–64) years, baseline 28-joint Disease Activity Score DAS28-C-reactive protein (DAS28-CRP) = 4.4 (3.9–4.6), body mass index (BMI) = 24.2 (23.4–26) kg/m2, rheumatoid factor positive:52.9%, anti-citrullinated peptide autoantibodies positive:76.5%] without known CV risk factors (arterial hypertension, diabetes, hypercholesterolemia, previous CV events, smoking) were evaluated by the adaptive optics imaging system of retinal arterioles before and every 6 months of therapy with ABA (T0, T6 and T12). Office blood pressure evaluation, 24-h ambulatory blood pressure monitoring and tissue-doppler echocardiography were also performed.ResultsA progressive significant reduction of the WLR of retinal arterioles was observed [T0 = 0.28 (0.25–0.30), T6 = 0.27 (0.24–0.31), T12 = 0.23 (0.23–0.26); p T0 vs. T6 = 0.414; p T6 vs. T12 = 0.02; p T0 vs. T12 = 0.009], without significant variations in other parameters. The T0-T12 reduction of WLR was correlated with that of DAS28-CRP (r:0.789; p = 0.005). Moreover, a significant reduction of diastolic office blood pressure and a trend for reduction of daily pressure measured by ambulatory monitoring were observed.ConclusionIn a cohort of RA patients without known CV risk factors, a reduction of retinal microvascular alterations was demonstrated after treatment for 12 months with ABA, in parallel with the reduction of disease activity. These results might suggest the possibility of microvascular abnormalities regression induced by the immune system modulation.

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Evaluation of aortic stiffness by a new simplified 2D speckle tracking analysis

Sabia

Avenatti

Cesareo

et al. 2018

Int J Cardiovasc Imaging

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Arterial stiffness is a marker of cardiovascular damage and an independent predictor of major cardiovascular events, usually assessed via Carotid-Femoral Pulse Wave Velocity (cfPWV). The aim of this study was to test the feasibility and usefulness of aortic strain analysis using a simplified transthoracic echocardiography (TTE) speckle-tracking (ST) based method. 60 consecutive patients with normal blood pressure and aortic dimensions underwent TTE and cfPWV evaluation. Strain analysis was performed on the largest section of the ascending aorta (aA) with a dedicated software; three couples of speckles were identified within the anterior and posterior aortic wall and transverse segments connecting each couple traced. Peak ascending Aorta Strain (PaAS) was defined as the averaged peak percentage deformation of these segments during the cardiac cycle; aortic stiffness index β was defined as 100 × Ln(SBP/DBP)/PaAS. 17 patients were excluded for suboptimal TTE images. In the 43 analyzed individuals (male 58%, age 63 years) PaAS was 5.5 [3.7-8.6] % with excellent inter and intra observer reproducibility (ICC 95% for both). PaAS showed significant correlation with age (r = - 0.64), aA diameter (r = - 0.45), cfPWV (r = - 0.41), stroke volume (r = - 0.41) and heart rate (r = - 0.49). Age remained the only independent determinant of PaAS in a multivariate analysis. β (10.8 [5.9-15.0]) showed significant direct correlation with age, Pulse pressure, aA diameter and cfPWV. A simplified strain analysis of the ascending aorta is technically feasible with good reproducibility; PaAS and β index correlate well with established parameters of arterial stiffness and might represent a new index in evaluating vascular biomechanics.

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How to Identify Hypertensive Patients at High Cardiovascular Risk? The Role of Echocardiography

Cited by 5 publications

References 45 publications

sRAGE and early signs of cardiac target organ damage in mild hypertensives

sRAGE and early signs of cardiac target organ damage in mild hypertensives

Retinal microvascular alterations in patients with active rheumatoid arthritis without cardiovascular risk factors: the potential effects of T cell co-stimulation blockade

Evaluation of aortic stiffness by a new simplified 2D speckle tracking analysis

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