Athanasios Angelis

Cardiovascular effects of high-intensity interval aerobic training combined with strength exercise in patients with chronic heart failure. A randomized phase III clinical trial

BACKGROUND The aim of this work was to evaluate the effect of high-intensity interval exercise (i.e., 30s at 100% of max workload, followed by 30s at rest, 45 min 3 days/week working-out schedule for 12 weeks) on left ventricular function and aortic elastic properties among chronic heart failure (CHF) patients. METHODS This study is a phase III clinical trial. Of the 100 consecutive CHF patients (NYHA classes II-IV, ejection fraction<50%) that were randomly allocated, 72 completed the study (exercise training group, n=33, 63 ± 9 years, 88% men, and control group, n=39, 56 ± 11 years, 82% men). All patients underwent cardiopulmonary stress test, non-invasive high-fidelity tonometry of the radial artery, pulse wave velocity measurement using a SphygmoCor device and echocardiography before and after the completion of the training program. RESULTS Both groups reported similar medical characteristics and physical activity status. General mixed effects models revealed that the intervention group reduced pulse wave velocity by 9% (p=0.05); Emv/Vp by 14% (p=0.06); E to A ratio by 24% (p=0.004), E to Emv ratio by 8% (p=0.05), MLHFQ score by 66% (p=0.003) and the depression score by 19% (p=0.5); increased augmentation index by 29%; VTI by 4% (p=0.05), 6-minute-walk distance up to 13% (p=0.05), peak oxygen uptake by 28% (p=0.001) and peak power by 25% (p=0.005). There were no significant changes in the control group. CONCLUSION Interval high-intensity aerobic training, combined with strength exercise, seems to benefit aortic dilatation capacity and augmented systolic pressure in parallel with improvement in left ventricular diastolic function and quality of life.

Dynamic penile peak systolic velocity predicts major adverse cardiovascular events in hypertensive patients with erectile dysfunction.

Objective: Hypertension is associated with an abnormal penile blood flow. Reduced dynamic penile peak systolic velocity (D-PSV) correlates with adverse cardiovascular outcomes. The aim of this study is to investigate whether abnormal penile blood flow predicts major adverse cardiovascular events (MACE) in hypertensive men. Methods: In total, 298 hypertensive men (55 ± 9 y/o) without known cardiovascular disease or diabetes were evaluated for cavernous vascular disease severity by dynamic penile Doppler ultrasound. The whole population was divided into tertiles according to D-PSV reduction (low tertile <25 cm/s; middle tertile 25–35 cm/s; and high tertile >35 cm/s). Predictive performance was evaluated with calibration, discrimination, and reclassification. Results: During the mean follow-up period of 4.9 years, a total of 22 (7%) MACE occurred. D-PSV level was associated with MACE and the differences between the tertiles were significant (Mantel log-rank test: 6.54; P < 0.01). A Cox proportional hazard model showed that study participants in the lowest D-PSV tertile (<25 cm/s) had an approximately 3.5-fold higher MACE risk compared with those in the highest D-PSV tertile (>35 cm/s) after adjustment for age, systolic pressure, metabolic parameters, smoking, C-reactive protein, and testosterone levels. Low D-PSV did not significantly improve the C-statistic model (0.774 vs. 0.767; P = 0.44), whereas the calibration was satisfactory (Hosmer–Lemeshow X2 = 8.73, P = 0.30). When only intermediate-risk patients were evaluated, the risk reclassification beyond traditional risk factors resulted in a clinical net reclassification index of 9.2% that was marginally significant (P = 0.07). The integrated discrimination improvement index showed better performance of the model that included D-PSV compared with the reference model in identifying MACE (improvement index: 0.047, P = 0.038). Conclusion: Low-penile blood flow predicts MACE in hypertensive patients free of clinical atherosclerosis. This predictive ability is independent of the severity of hypertension and decreased testosterone that is often present in such patients.

Deceleration Capacity of Heart Rate Predicts Arrhythmic and Total Mortality in Heart Failure Patients

Deceleration capacity (DC) of heart rate proved an independent mortality predictor in postmyocardial infarction patients. The original method (DCorig) may produce negative values (9% in our analyzed sample). We aimed to improve the method and to investigate if DC also predicts the arrhythmic mortality.

BLOOD PRESSURE AND HEART RATE VARIABILITY IN ERECTILE DYSFUNCTION

Objective: Cardiac autonomic dysfunction is associated with increased cardiovascular mortality. No data on sympathovagal balance is available in patients with erectile dysfunction (ED), in whom cardiovascular risk is high. The aim of the study was to assess blood pressure variability (BPV) and heart rate variability (HRV) in patients with hypertension and erectile dysfunction. Design and method: We studied 215 untreated hypertensives (104 diagnosed with ED, mean age 53.9 ± 10.3 and 111 controls, mean age 48.3 ± 11.8). Cardiac autonomic function was evaluated by analysis of short-term BPV and HRV measures over 24-h, daytime, and nighttime using 24-h ambulatory blood pressure monitoring and the standard deviation of the measurements. Echocardiography was also performed and left ventricular mass index (LVMI) was estimated with the Demereux formula. ANCOVA was applied and the comparison between the two groups was adjusted for age, office pulse pressure, body-mass index, history of diabetes, smoking status, LDL and high sensitivity C-reactive protein. Results: In comparison with controls, patients with ED had higher daytime diastolic blood pressure variability (11.2mmHg vs. 10.7mmHg, p = 0.046) and daytime HRV (10.5 beats per minute vs. 10.3 beats per minute, p = 0.033). All other daytime, nighttime and 24 h measurements of BPV and HRV were not different between groups (p > 0.05). At echocardiography, hypertensives with ED had similar LVMI compared to hypertensives without ED (p < 0.05). Conclusions: Compared to controls, ED patients showed a daytime sympathovagal imbalance, characterized by a relatively increased sympathetic activity. Whether this autonomic alteration has a prognostic role in hypertensive ED patients for future cardiovascular events warrants further investigation in prospective studies.

[PP.06.10] BLOOD PRESSURE VARIABILITY AND TARGET ORGAN DAMAGE IN HYPERTENSION

Objective: Hypertension is associated with several markers of subclinical target organ damage (TOD). Short-term blood pressure variability (SBPV) is a prognostic factor for cardiovascular events in hypertensives. We hypothesized that there is a relationship between SBPV and TOD in never-treated hypertensives. Design and method: We enrolled 943 consecutive essential hypertensives (mean age 53 ± 12 years, 497 males). Markers of subclinical TOD [left ventricular mass index (LVMI), pulse wave velocity (PWV), total arterial compliance (TAC), ankle-brachial index (ABI) and estimated glomerular filtration rate (eGFR)] and 24-h ambulatory blood pressure were evaluated in all patients. LVMI was assessed echocardiographically using the Devereux formula. Carotid-femoral PWV was estimated with the Complior. eGFR was calculated by the Cockcroft-Gault formula. ABI was calculated by dividing the highest ankle systolic blood pressure by the highest brachial systolic blood pressure. The ratio of stroke volume to pulse pressure was measured echocardiographically as a surrogate of TAC. SBPV was calculated as follows: 1) SD of 24-hour, daytime, or nighttime SBP and 2) weighted SD of 24-hour SBP. Results: In multivariable regression analysis, all four variables of SBPV exhibited significant association with LVMI (p = 0.014, p = 0.002, p = 0.002 and p < 0.001, respectively), PWV (p = 0.021, p = 0.015, p = 0.055 and p = 0.006, respectively) and TAC (p = 0.048, p = 0.020, p = 0.036 and p = 0.006, respectively). In multivariable analysis, ABI and eGFR were not associated with indices of SBPV. We assessed TOD based on 2013 European Guidelines for Hypertension [left ventricular hypertrophy (LVMI>115 g/m2 in men and >95 g/m2 in women), increased PWV (PWV>10m/s), decreased ABI (ABI<0.9) and decreased renal function (eGFR<60 ml/min)]. In multivariable logistic regression analysis, SBPV indices were not associated with markers of TOD (P > 0.05). Conclusions: Our findings support a complex relationship between SBPV and TOD in hypertension. Specifically, SBPV is more closely related to markers of ventricular and vascular compliance than other markers of TOD in hypertension.

LB-S&T-31 DYNAMIC PENILE PEAK SYSTOLIC VELOCITY IS RELATED TO MAJOR ADVERSE CARDIOVASCULAR EVENTS IN HYPERTENSIVE PATIENTS WITH ERECTILE DYSFUNCTION

RESULTS: All samples showed the 3D physical structure. The basic component of those samples were collagen fibers. All samples demonstrated the obviously heterogeneous between mucosa layer and other layers. The surfaces of mucosa were composed of dense interwoven nano-scaled fibers. Beneath the mucosal layers, all samples showed the typical porous structure. But, the high magnification of SEM revealed that the wall of those small pores were consist of interwoven nano-scaled fibers. Further comparison demonstrated that the decellularized urethra tissues posses the largest pore size (221.70 56.54 um). The pore size of decellularized ureter was significantly smaller than decellularized baldder. As to the diameter of nanofibers, the largest diameter of nanofibers was seen in the mucosa surface of decellularized ureter, which was 71 nm. The smallest diameter of nanofibers was seen in the mucosa surface of decellularized urethra (50 nm). CONCLUSIONS: When designing biomimetic scaffolds for urinary hollow organ tissue engineering, the following aspects should be considered: They must (1) mimic the nanofibrous collagen ECM; (2) be able to accommodate a large number of cells on one side and serve as a barrier on the opposite side, which is the asymmetric structure; and (3) be able to withstand mechanical stresses during tissue neogenesis.

Coronary artery disease topography in relation to rheology of the peripheral small arteries in middle aged erectile dysfunction men

Methods: 146 ED patients (46-61 y/o) with a coronary angiography documented single vessel CAD (> 50% of luminal narrowing) enrolled the study and divided into two subgroups according to the coronary lesions allocation. Patients with left main (LM), proximal or mid-left anterior descending artery (LAD) disease consisted Group 1. Group 2 included the rest of participants. All underwent carotid-femoral pulse wave velocity (PWV) augmentation index (AIx), carotid intimamedia thickness (IMT) and peak systolic penile Doppler velocity (PSV) evaluation. Low PSV (< 25cm/sec) implies an impaired physiology of the peripheral small arteries network.

Atheromatosis and endothelial response of the small peripheral arteries: a peritoneal dialysis versus hemodialysis patients mismatch

Methods 84 male ESRD patients, 46 on HD and the rest 38 on PD without apparent cardiovascular disease enrolled the study. The two groups did not differ statistically in age, (64,9 vs 64) prevalence of hypertension, diabetes mellitus, smoking and lipid profile. All underwent common carotid ultrasound intima –media thickness (cIMT) evaluation to uncover subclinical atheromatosis. Endothelial function was estimated by the SHIM-5 score (theoretical range 0-25) that grades erectile potency, a nitric oxide depended phenomenon based on vasodilator ability of the penile vasculature. Higher grading indicates a healthier endothelial vascular status.