Florin Mitu

Defining left ventricular hypertrophy in children on peritoneal dialysis.

BACKGROUND AND OBJECTIVES Left ventricular hypertrophy (LVH) is an important end point of dialysis-associated cardiovascular disease. The objective of this study was to evaluate the effect of different pediatric reference systems on the estimated prevalence of LVH in children on chronic peritoneal dialysis (CPD). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Echocardiographic studies in 507 pediatric CPD patients from neonatal age to 19 years were collected in 55 pediatric dialysis units around the globe. We compared the prevalence of LVH on the basis of the traditional cutoff of left ventricular mass (LVM) index (>38.5 g/m(2.7)) with three novel definitions of LVH that were recently established in healthy pediatric cohorts. RESULTS Application of the new reference systems eliminated the apparently increased prevalence of LVH in young children obtained by the traditional fixed LVM index cutoff currently still recommended by consensus guidelines. However, substantial differences of LVM distribution between the new reference charts resulted in a marked discrepancy in estimated LVH prevalence ranging between 27.4% and 51.7%. CONCLUSIONS Although our understanding of the anthropometric determinants of heart size during childhood is improving, more consistent normative echocardiographic data from large populations of healthy children are required for cardiovascular diagnostics and research.

Vascular aging and subclinical atherosclerosis: why such a “never ending” and challenging story in cardiology?

The true onset of atherosclerosis remains one of the biggest challenges for cardiologists. Is atheroma plaque development considered the earliest step of vascular aging? If so, when it starts? Before or after birth? If it starts before birth or early during childhood, it seems that Thomas Sydenham was right: “A man is as old as his arteries.” Except disorganization of elastic fibers, less is known about the morphology of vascular aging and also about the molecular events influencing the age of arteries, arterial stiffness, and their role in the appearance of future complications. Cellular and molecular events responsible for the switch from physiologic to pathologic aging of human arteries are less known. Epigenetic, genetic, and environmental influences at the onset of early vascular aging (EVA) should specifically influence the process. This paper briefly reviews the controversial data regarding vascular aging with an emphasis on the less known facts about the morphology of EVA.

The predictors of cholelithiasis in female patients with metabolic syndrome

Cholesterol gallstone disease is often associated with the metabolic syndrome. Female gender is an unmodifiable risk factor for cholelithiasis and, in its turn, the metabolic syndrome features a sexual dimorphism which warns that a global approach might overlook important discrimination. We carried out a retrospective analytical case-control study in order to perform a comparative analysis between two groups of female patients with metabolic syndrome and gallstones (n=60) or without gallstones (n=65). All the patients were investigated by abdominal ultrasound and met at least three criteria for the diagnosis of metabolic syndrome. Cases and controls were compared regarding anthropometric measurements, a complex lipid profile, and liver function tests. The risks associated with the likelihood of gallstones were estimated by means of cross-tabulation. In order to rank the significant variables we developed a binary logistic regression model which identified lean body weight ≤ 46.44 kg (OR 0.165; 95% CI 0.045–0.611; P = 0.007), total cholesterol ≥ 4.9 mmol/L (OR 15.948; 95% CI 2.700–94.205; P = 0.002), and direct bilirubin > 5.1 µmol/L (OR 0.056; 95% CI 0.013–0.235; P < 0.001), as variables with significant probability of association with the risk of gallstones in women with metabolic syndrome.

Methods of Paraclinic Diagnosis of Catecholamine Secreting Tumours, Especially of Pheochromocytoma

Summary Catecholamine tumoral syndrome is caused by lesions of the medulosuprarenal cromafin tissue (pheochromocytoma or pheochromocytoblastoma) or of the neural crest (paraganglioma), from the ganglionar cells (ganglioneurinoma or ganglioneuroblastoma) or from the sympathetic nervous cells (sympathogonia – sympathoblastoma and sympathoblasts – neuroblastoma), tumors that excessively secrete cathecolamines (adrenaline and noradrenaline), but also neuropeptides. Indications for testing are associated with the clinical context. Because the pheochromocytoma means a heterogeneous group of secretory tumours, there is no analysis achieving the 100% accuracy. The diagnosis can be established by hormonal dosages for basal determinations and by dynamic tests or through nonspecific tests. Imagistic explorations like computer tomography, abdominal and pelvic MRI can localise the tumour. Plasma and urinary metanephrines dosage are the first intention tests because have a higher accuracy compared to catecholamines or other metabolites. Considering the low prevalence of catecholamine secreting tumours, we considered it necessary to systematise diagnostic possibilities.

Subclinical cardiovascular disease assessment and its relationship with cardiovascular risk SCORE in a healthy adult population: A cross-sectional community-based study

INTRODUCTION The aim of this study is to evaluate the relationship and the accuracy of SCORE (Systematic Coronary Risk Evaluation Project) risk correlated to multiple methods for determining subclinical cardiovascular disease (CVD) in a healthy population. MATERIAL AND METHODS This cross-sectional study included 120 completely asymptomatic subjects, with an age range 35-75 years, and randomly selected from the general population. The individuals were evaluated clinically and biochemical, and the SCORE risk was computed. Subclinical atherosclerosis was assessed by various methods: carotid ultrasound for intima-media thickness (cIMT) and plaque detection; aortic pulse wave velocity (aPWV); echocardiography - left ventricular mass index (LVMI) and aortic atheromatosis (AA); ankle-brachial index (ABI). RESULTS SCORE mean value was 2.95±2.71, with 76% of subjects having SCORE <5. Sixty-four percent of all subjects have had increased subclinical CVD changes, and SCORE risk score was correlated positively with all markers, except for ABI. In the multivariate analysis, increased cIMT and aPWV were significantly associated with high value of SCORE risk (OR 4.14, 95% CI: 1.42-12.15, p=0.009; respectively OR 1.41, 95% CI: 1.01-1.96, p=0.039). A positive linear relationship was observed between 3 territories of subclinical CVD (cIMT, LVMI, aPWV) and SCORE risk (p<0.0001). There was evidence of subclinical CVD in 60% of subjects with a SCORE value <5. CONCLUSIONS As most subjects with a SCORE value <5 have subclinical CVD abnormalities, a more tailored subclinical CVD primary prevention program should be encouraged.

Increased Type 2 Diabetes Mellitus Risk (Assessed by Findrisc Score) is Associated with Subclinical Atherosclerotic Markers in Asymptomatic Adult Population

Abstract Background and Aims. Risk score questionnaires for the screening of type 2 diabetes mellitus (DM) present high accuracy, especially the Finnish Diabetes Risk Score (FINDRISC). The aim of the study was to assess the FINDRISC score and its correlations with multiple markers of subclinical atherosclerosis in an asymptomatic urban population. Material and Methods. In the current prospective study, 111 randomized asymptomatic subjects, aged 35-75, were evaluated. FINDRISC score, the cardiovascular and metabolic risk profile were evaluated. Multiple markers of subclinical atherosclerosis were assessed including carotid intima-media thickness (IMT), ankle-brachial index (ABI), pulse wave velocity (PWV) and left ventricular mass index (LVMI). Results. Mean age was 51.87 ± 10.64 years while FINDRISC score was 10.53 ± 4.53. 77% of the subjects were overweight and all parameters of obesity were well associated with FINDRISC score (p<0.001). This asymptomatic population was dyslipidemic (total cholesterol 212.79±44.99 mg/dl). DM risk correlated with age, blood pressure, fasting plasma glucose and glomerular filtration rate. Increased FINDRISC was associated with IMT (r=0.24, p=0.01), PWV (r=0.26, p=0.008) or LVMI (r=0.23, p=0.01). Conclusions. This asymptomatic population was metabolically uncontrolled. Easily administered type 2 DM screening questionnaires should be routinely performed as increased risk score values are associated with subclinical atherosclerosis.