Agata Milewska

Noninvasively assessed pulsatility of ascending aortic pressure waveform is associated with the presence of coronary artery narrowing

Several hemodynamic indices, measured invasively in the ascending aorta during routine angiography, are related to the presence and severity of coronary atherosclerosis. Radial artery tonometry, when combined with a validated transfer function, offers the possibility of noninvasive assessment of central arterial pressure. We aim to evaluate the association between noninvasive indices of aortic or radial pressure waveforms and the presence of a significant coronary stenosis. Patients who underwent elective coronary angiography were studied (110 men, 91 women, mean age 53 ± 0.9 years). Noninvasive measurement of their central hemodynamics was performed by analysis of the aortic pressure waveform derived from the radial artery. An increase in aortic fractional pulse pressure was associated with coronary artery narrowing or previous myocardial infarction. After multivariate adjustment, the odds ratio and confidence intervals (CI) of having a significant coronary aortic stenosis was 1.72 (95% CI, 1.1–2.7) and of previous myocardial infarction 1.6 (95% CI, 1.1–2.2). An increase in noninvasively assessed aortic fractional pulse pressure, but not of the peripheral index is significantly associated with the presence of coronary artery disease.

J-wave formation in patients with acute intracranial hypertension

Various electrocardiographic changes are found in patients with increased intracranial pressure. The most common findings are sinus bradycardia, QT prolongation, ST-segment changes, and T- or U-wave abnormalities. The presence of J wave is reported rarely. We describe 3 patients with increased intracranial pressure caused by different cerebral pathologies accompanied by the dynamic formation of J waves in time.

Add-On Therapy with a Nighttime Dose of Doxazosin in Patients with Uncontrolled Hypertension: Effects on Autonomic Modulation of the Cardiovascular System

This study was designed to determine whether or not the addition of a single nighttime dose of doxazosin in extended-release form (GITS; gastrointestinal therapeutic system) would affect the autonomic modulation of the cardiovascular system in patients with uncontrolled hypertension treated with a multi-drug regimen. Resting 5-min noninvasive finger blood pressure and ECG signals, as well as 24-h Holter ECGs, were recorded in 30 patients with uncontrolled hypertension on multi-drug treatment before and after 16-week add-on therapy with doxazosin GITS. Cardiovascular autonomic modulation was evaluated by spectral analysis of heart rate variability (HRV) and a cross-correlation method for spontaneous baroreflex sensitivity (BRS) in 5-min resting recordings, and by the analysis of Poincaré plots and phase-rectified signal averaging of the duration of cardiac cycles in 24-h ECG recordings. This combined therapy significantly reduced systolic pressure (19.4±3.5 mmHg; p<0.0001), diastolic blood pressure (9.4±2.0 mmHg; p=0.0003), and pulse pressure (10.0±2.8 mmHg; p=0.0021). Concomitantly, there was a significant increase in resting spontaneous BRS (p=0.0191) and increases in 24-h short-term (p=0.0129) and total (p=0.0153) HRV, but with no significant change in heart rate or other measures of HRV. The improvements in HRV and BRS were observed mainly in patients already treated with thiazide diuretics. There was a significant association (r=0.49; p=0.0065) between the degree of change in diastolic blood pressure and short-term HRV caused by the combined treatment. The addition of 4 mg doxazosin GITS to multi-drug antihypertensive therapy is associated with an improvement in cardiovascular autonomic control.

Aortic excess pressure and arterial stiffness in subjects with subclinical white matter lesions

a Department of Radiology, University School of Medicine, 49 Przybyszewskiego, 60-355 Poznan, Poland b Department of Cardiology-Intensive Therapy, University School of Medicine, 49 Przybyszewskiego, 60-355 Poznan, Poland c Institute of Physics, University of Zielona Gora, 4a Szafrana, 65-516 Zielona Gora, Poland d Department of Surgery, University School of Medicine, 49 Przybyszewskiego, 60-355 Poznan, Poland

Contribution of arterial excess pressure and arterial stiffness to central augmentation pressure in healthy subjects.

pressure in healthy subjects J. Piskorski , T. Krauze , K. Katulska , M. Wykretowicz , A. Milewska , D. Przymuszala , H. Wysocki , A. Wykretowicz ⁎, P. Guzik b a Institute of Physics, University of Zielona Gora, 4a Szafrana, 65-516 Zielona Gora, Poland b Department of Cardiology-Intensive Therapy, University School of Medicine, 49 Przybyszewskiego, 60-355 Poznan, Poland c Department of Radiology, University School of Medicine, 49 Przybyszewskiego, 60-355 Poznan, Poland

Prognosis after acute coronary syndrome in relation with ventricular-arterial coupling and left ventricular strain.

BACKGROUND The value of modern non-invasive indices of the left ventricle (LV) and arterial system function, and their interaction for determining prognosis in contemporarily treated patients with acute coronary syndrome (ACS) is not well established. The study aimed to determine the association of ventricular-arterial (VA) coupling, LV global longitudinal peak systolic strain (GLPSS), global strain rate (GSR) and end-diastolic volume at end-diastolic pressure 30mmHg (V30) with long-term clinical outcomes in patients with ACS. METHODS Echocardiography was applied in 569 ACS patients followed up for >12months after hospitalization. Univariate Cox proportional hazard regression models adjusted to various clinical factors, including reduced LV ejection fraction <40%, were used to compare patients between the first and third tertiles of various indices of LV and arterial systems function and their interaction for the prediction of a combined end-point (defined as either stroke, myocardial infarction or death). Results are presented as hazard ratio (HR) with 95% confidence interval (CI). RESULTS There were 57 clinical outcomes during a median follow-up of 625days. Increased VA coupling >1.68 (HR 2.4; 95% CI: 1.04-5.6); V30>107mL (HR 4.5; 95% CI: 1.9-10.6), GLPSS > -12.8% (HR 2.4; 95% CI: 1.02-5.7), GSR > -0.96 1/s (HR 3.8; 95% CI: 1.6-9.1) were robustly associated with increased hazard. CONCLUSIONS With a sample of contemporarily treated ACS patients, abnormal values of non-invasive indices of LV function and their interaction with arterial system, predict adverse clinical outcomes, independently of LV ejection fraction.

Left Ventricular Mass: Correlation with Fatness, Hemodynamics and Renal Morphology

Summary Background Left ventricular mass (LVM) is correlated with body composition and central hemodynamics as well as kidney function. Recently, fat-free mass has been considered to be more strongly correlated with LVM in comparison to other descriptors of fatness. We therefore address the question of whether comprehensive descriptors of fatness, central hemodynamics and renal characteristics demonstrate the association with left ventricular mass in healthy non-obese population. Material/Methods 119 healthy non-obese subjects (53 females, 66 males, mean age 50 yrs) were evaluated. Central hemodynamics was measured by Pulse Wave Analysis, left ventricular mass was assessed by echocardiography, fatness was evaluated by anthropometry, bioimpedance, and ultrasound. Results Left ventricular mass index (LVMI) correlated to the same extent with central and peripheral blood pressure but not with descriptors of wave reflection. Fat-free mass as well as intraabdominal fat correlated to a similar extent with LVMI. Kidney morphological characteristics indexed to body surface area were associated inversely and independently with LVMI. Conclusions Comprehensive assessment of fatness reinforced the concept that intraabdominal fat compartment is strongly correlated with left ventricular mass. Descriptors of wave reflection are not associated with left ventricular mass. The interrelationsh between kidney morphology and LVMI indicates that such associations may be a biologically plausible phenomenon.

Arterial stiffness, body fat compartments, central hemodynamics, renal function and left atrial size

Abstract Background. Left atrial (LA) size is an important predictor of stroke, death, and atrial fibrillation. It was demonstrated recently that body fat, arterial stiffness and renal functions are associated with LA diameter. However, data are lacking for comprehensive assessments of all these risk factors in a single population. Therefore, the aim of the present study was to investigate the association between LA size and different fat descriptors, central hemodynamics, arterial stiffness, and renal function in healthy subjects. Methods. To this end, body fat percentage, abdominal, subcutaneous fat, and general descriptors of body fat were estimated in 162 healthy subjects (mean age 51 years). Echocardiography was performed to assess LA diameter. Arterial stiffness and peripheral and central hemodynamics were estimated by digital volume pulse analysis and pulse wave analysis. Glomerular filtration rate was estimated by MDRD formula. Results. There were significant (p < 0.05) bivariate correlations between LA diameter and all descriptors of body fat (except subcutaneous fat). Arterial stiffness and estimated glomerular filtration rate (eGFR) were also significantly correlated with LA size. Multiple regression analysis including all significant confounders, such as sex, mean arterial pressure, arterial stiffness, eGFR and body fat descriptors, explained 35% of variance in LA diameter. Conclusions. In conclusion, the present study reveals significant, independent relationships between body fat, arterial stiffness, and LA size.

Renal morphology assessed by ultrasound in relation to central haemodynamics and body fat

There is a correlation between renal function and the morphological characteristics of the kidney. However, little is known about the association between renal morphology and other important predictors of the risk of cardiovascular diseases, such as central haemodynamics or body fat. Thus, in the present study we investigated correlations between renal morphology, body fat and central haemodynamics. Renal morphology and intra‐abdominal and subcutaneous fat were assessed by ultrasound, whereas central haemodynamics were evaluated by pulse wave analysis, in 93 healthy, non‐obese subjects (mean (±SEM) age 52 ± 1 years; 43 men, 50 women). Significant correlations were found for indices of body fat (waist : hip ratio, body mass index and intra‐abdominal fat) and renal morphology (kidney length, width and volume). Significant inverse correlations were found between central augmentation pressure (cAP) and kidney length (r = −0.33; P = 0.0009), width (r = −0.24; P = 0.01) and volume (r = −0.27; P = 0.007). In addition, significant negative correlations were found between the central augmentation index (cAIx) and kidney length (r = −0.36; P = 0.0003), width (r = −0.29; P = 0.003) and volume (r = −0.33; P = 0.0008). Multiple linear regression analysis revealed independent associations between kidney length and both cAP and cAIx. In conclusion, common morphometric characteristics of the kidney, as assessed by ultrasound, are associated with measures of body fat and descriptors of central haemodynamics. The relationships demonstrated in the present study indicate that these associations may be a biologically plausible phenomenon.