Chrysa Arvaniti

Cognitive Impairment Is Related to Increased Arterial Stiffness and Microvascular Damage in Patients With Never-Treated Essential Hypertension

BACKGROUND It is known that essential hypertension may be implicated in the development of cognitive impairment that is associated to microvascular disease of the brain. It has been hypothesized that increased arterial stiffness of the large arteries may lead to microvascular changes due to increased pulsatile flow. Our study tests the hypothesis that large artery stiffness and microvascular damage are related to brain microcirculation changes as reflected by impaired cognitive function. METHODS We studied 110 nondiabetic patients aged 40-80 years (mean age 53.8 +/- 11.2 years, 57 men) with recently diagnosed stage I-II essential hypertension. Mini-Mental State Examination (MMSE) was used as a screening test for global cognitive impairment. We performed both 2-D echocardiography and carotid-femoral pulse wave velocity (PWV) in order to evaluate arterial stiffness. Twenty-four hour urine microalbumin excretion was measured as a marker of microvascular damage. RESULTS In the entire population, MMSE was negatively correlated with age (r = -0.42, P < 0.001), 24-h pulse pressure (PP) (r = -0.18, P < 0.05), and PWV (r = -0.3, P = 0.003). Additionally, MMSE was not independently correlated with microalbuminuria in patients aged over 65 years (r = -0.58, P = 0.003). CONCLUSIONS Impaired cognitive function is associated with increased large artery stiffness and microalbumin excretion in newly diagnosed, untreated hypertensive patients. These findings support the hypothesis that cognitive impairment induced by impaired microcirculation is linked to large artery stiffness and microvascular damage.

Association of Target Organ Damage With Three Arterial Stiffness Indexes According to Blood Pressure Dipping Status in Untreated Hypertensive Patients

BACKGROUND Subclinical organ damage represents an intermediate stage in the continuum of vascular disease and a determinant of overall cardiovascular risk. We investigated the associations of pulse wave velocity (PWV), ambulatory arterial stiffness index (AASI), and office pulse pressure (PP) with several target organ damages (TODs) in newly diagnosed and never-treated patients with essential hypertension with respect to their dipping profile. METHODS One hundred sixty-eight hypertensive patients with recently diagnosed and never-treated stage I-II essential hypertension were evaluated with respect to the relationship of PWV, AASI, and office PP with TOD including microalbumin (MAU) levels, cognitive function, intima-media thickness (IMT), coronary flow reserve (CFR), left ventricular mass (LVM), left ventricular filling pressures, diastolic dysfunction, and left atrium (LA) enlargement. RESULTS Simultaneous estimation of AASI, PWV, and office PP independently associated with the following: (i) CFR (P < 0.01), 24-h urine albumin excretion rates (P < 0.05), left ventricular diastolic dysfunction (P < 0.01), and LA enlargement (P < 0.01) in never-treated hypertensive patients; (ii) CFR (P < 0.05), IMT (P < 0.01), left ventricular diastolic dysfunction (P < 0.05), and LA enlargement (P < 0.05) in dippers; and (iii) CFR (P < 0.05) and LA enlargement (P < 0.01) in nondippers. Nonindependent relationships revealed between (i) AASI and left ventricular filling pressures and (ii) PWV and cognitive dysfunction in never-treated hypertensive patients. CONCLUSIONS The simultaneous estimation of three noninvasive indexes of arterial stiffness leads to valuable information regarding their association with TOD including CFR, MAU levels, IMT, left ventricular diastolic dysfunction, and LA enlargement in never-treated hypertensive patients regarding their dipping status.

Acute effects of unilateral temporary stellate ganglion block on human atrial electrophysiological properties and atrial fibrillation inducibility

BACKGROUND In experimental models, stellate ganglion block (SGB) reduces the induction of atrial fibrillation (AF), while data in humans are limited. OBJECTIVE The aim of this study was to assess the effect of unilateral SGB on atrial electrophysiological properties and AF induction in patients with paroxysmal AF. METHODS Thirty-six patients with paroxysmal AF were randomized in a 2:1 order to temporary, transcutaneous, pharmaceutical SGB with lidocaine or placebo before pulmonary vein isolation. Lidocaine was 1:1 randomly infused to the right or left ganglion. Before and after randomization, atrial effective refractory period (ERP) of each atrium, difference between right and left atrial ERP, intra- and interatrial conduction time, AF inducibility, and AF duration were assessed. RESULTS After SGB, right atrial ERP was prolonged from a median (1st-3rd quartile) of 240 (220-268) ms to 260 (240-300) ms (P < .01) and left atrial ERP from 235 (220-260) ms to 245 (240-280) ms (P < .01). AF was induced by atrial pacing in all 24 patients before SGB, but only in 13 patients (54%) after the intervention (P < .01). AF duration was shorter after SGB: 1.5 (0.0-5.8) minutes from 5.5 (3.0-12.0) minutes (P < .01). Intra- and interatrial conduction time was not significantly prolonged. No significant differences were observed between right and left SGB. No changes were observed in the placebo group. CONCLUSION Unilateral temporary SGB prolonged atrial ERP, reduced AF inducibility, and decreased AF duration. An equivalent effect of right and left SGB on both atria was observed. These findings may have a clinical implication in the prevention of drug refractory and postsurgery AF and deserve further clinical investigation.

Incidental aneurysms of aorta and basilar artery in patients with coronary artery ectasia. A magnetic resonance angiography study.

Objective — Incidental intracranial aneurysms have been revealed in 0.5-1% of adult patients undergoing cerebral angiography, while only 8% of those aneurysms are located in the basilar artery.Those aneurysms running usually symptomless, may lead to life-threatening situations due to rupture. Intracranial aneurysms could co-exist with abdominal aneurysms. Another dilating arterial lesion, coronary artery ectasia was linked in previous studies with aneurysms of the abdominal aorta.The aim of the present study is to investigate the coexistence of coronary artery ectasia with other aneurysms since dilating arterial lesions seem to share a similar pathogenesis, a thin or absent media of the arterial wall. Methods and results — Ten consecutive patients with coronary artery ectasia after coronary angiography underwent magnetic angiography (MRA) of the brain, thoracic and abdominal aorta. Three incidental aneurysms were revealed: one intracranial aneurysm located in the basilar artery, one extended thoracic/abdominal aneurysm and one abdominal aneurysm. Embolism was used for the management of the basilar artery aneurysm while the extended aneurysm of the descending thoracic and abdominal aorta was surgically repaired in part. Conclusions – Whether our results are just a coincidence or they announce a common pathogenesis is a subject of further screening studies of the population. Nevertheless, a high index of suspicion is expected for patients with coronary ectasia about the presence of other vascular defects at different locations, especially when non-typical symptoms are mentioned.

Infiltration of the sphenopalatine ganglion decreases blood pressure in newly diagnosed and never treated patients with essential hypertension

BACKGROUND Sphenopalatine ganglion (SPG), an extracranial structure, is connected with the central nervous system (CNS) through sympathetic and parasympathetic nerves. We hypothesized that SPG block through sympathetic nerves anesthesia might decrease blood pressure (BP) in recently diagnosed and never treated middle-aged patients with essential hypertension. METHODS We performed SBG block in 22 hypertensive patients (mean age 45±12years, 15 men). All patients have been subjected to 24hour ambulatory blood pressure monitoring a week prior the procedure as well as in a period of 21-30days after the SBG block in order to estimate differences in 24h average systolic (24h SBP) and diastolic blood pressure (24h DBP), daytime, nighttime, pre-awake and early morning SBP and DBP as well as BP load. RESULTS We found that 24h SBP (p=0.001) and 24h DBP (p<0.001), daytime SBP and DBP (p<0.001) as well as daytime SBP and DBP load (p=0.002 and p<0.001, respectively) were decreased in total population at 21-30days after SPG block. In 11/22 responders (24h SBP decrease ≥5mmHg), SBP and DBP were reduced during overall 24h and daytime (p<0.001) and nighttime periods (p=0.01 and p=0.06, respectively) while pre-awake SBP (p=0.09) along with daytime SBP and DBP load (p=0.07 and p=0.06, respectively) were also almost decreased. CONCLUSIONS SBG block might be a promising, non-invasive, safe, painless and easy to perform therapeutic option of BP decrease. As with renal denervation, SBG should be effective in those hypertensive patients with an activated SNS, so a period of patient selection should precede the application of this procedure.

Bilateral sphenopalatine ganglion block reduces blood pressure in never treated patients with essential hypertension. A randomized controlled single-blinded study

BACKGROUND Sympathetic fibers connect sphenopalatine ganglion (SPG) with the central nervous system. We aimed to study the effect of SPG block in blood pressure (BP) in never treated patients with stage I-II essential hypertension. METHODS We performed bilateral SPG block with lidocaine 2% in 33 hypertensive patients (mean age 48±12years, 24 men) and a sham operation with water for injection in 11 patients who served as the control group (mean age 51±12years, 8 men). All patients have been subjected to 24h ambulatory blood pressure monitoring prior and a month after the SBG block in order to estimate any differences in blood pressure parameters. We defined as responders to SBG block those patients with a 24h SBP decrease ≥5mmHg. RESULTS We found that 24h and daytime DBP (p=0.02) as well as daytime DBP load (p=0.03) were decreased in the study group a month after SPG block. In addition, a significant response was noted in 12/33 responders (36%) regarding: a. SBP and DBP during overall 24h and daytime (p<0.001) and night-time periods, b. pre-awake and early morning SBP and c. SBP (daytime and night-time) and DBP (daytime) load. No differences regarding BP were found in the sham operation group. CONCLUSIONS SPG block is a promising, minimally invasive option of BP decrease in hypertensives, probably through SNS modulation. Additionally, due to its anesthetic effect, SPG block might act as a method of selection for those hypertensive patients with an activated SNS before any other invasive antihypertensive procedure.

Erratum to: Racial disparities in early mortality in 1,134 young patients with acute stroke

Georgios Tsivgoulis • Jukka Putaala • Vijay K. Sharma • Clotilde Balucani • Sheryl Martin-Schild • Sotirios Giannopoulos • Lokesh Batala • Christos Krogias • Paola Palazzo • Reza Bavarsad Shahripour • Chrysa Arvaniti • Kristian Barlinn • Daniel Strbian • Elena Haapaniemi • Maria Flamouridou • Konstantinos Vadikolias • Ioannis Heliopoulos • Konstantinos Voumvourakis • Nikos Triantafyllou • Mahmoud Reza Azarpazhooh • Dimitrios Athanasiadis • Maria Kosmidou • Aristeidis H. Katsanos • Spyros N. Vasdekis • Leonidas Stefanis • Elefterios Stamboulis • Charitomeni Piperidou • Turgut Tatlisumak • Andrei V. Alexandrov

Bilateral adrenal hyperplasia complicated with severe ischemic stroke in a young patient.

A young patient suffered from acute right hemiparesis, facial weakness and Brocas aphasia with multiple brain lesions due to severe hypertension. His evaluation for secondary causes of hypertension revealed hyperaldosteronism due to bilateral adrenal hyperplasia. Treatment is based primarily on spironolactone and ACE inhibitors. Two years later he was in an outstanding clinical condition with few remained neurological symptoms and his blood pressure well controlled.