G. Rubagotti

Vascular alterations in apolipoprotein A-I amyloidosis (Leu75Pro). A case–control study

Abstract Background: Among hereditary amyloidoses, apolipoprotein A-I (APO A-I) amyloidosis (Leu75Pro) is a rare, autosomal dominant condition in which renal, hepatic, and testicular involvement has been demonstrated. Objective: To investigate vascular structural as well as functional alterations. Methods: In 131 carriers of the amyloidogenic Leu75Pro APO A-I mutation (mean age 52 + 16 years, 56 women) and in 131 subjects matched for age, sex, body mass index and clinic blood pressure (BP), arterial stiffness (pulse wave velocity, PWV) and carotid intima-media thickness (IMT) were measured. Results: By definition no differences for age, sex, body mass index, and BP were observed. Meanmax IMT (Mmax–IMT) in the common (CC), bifurcation (BIF) and internal (ICA) carotid artery were comparable in the two groups. After adjustment for high-density lipoprotein cholesterol and renal function differences between the two groups, a lower meanmax–IMT was observed in APO A-I Leu75Pro mutation carriers than in controls (CC Mmax–IMT 0.87 ± 0.21 versus 0.93 ± 0.2 mm, p = 0.07; BIF Mmax–IMT 1.19 ± 0.48 versus 1.36 ± 0.46 mm, p = 0.025; ICA Mmax–IMT 0.9 ± 0.37 versus 1.02 ± 0.35 mm, p = 0.028). On the other hand, aortic stiffness was significantly greater in patients with APO A-I amyloidosis than controls (PWV 11.5 ± 2.9 and 10.7 ± 2.3 m/s, p < 0.05), even after adjusting for confounders. Conclusions: In carriers of the amyloidogenic Leu75Pro APO A-I mutation, a significant increase in arterial stiffness is observed; on the contrary, carotid artery IMT is comparable to that of control subjects. These results may add significant information to the clinical features of this rare genetic disorder.

[BP.09.01] ASSESSMENT OF LEFT VENTRICULAR SYSTOLIC FUNCTION IN MASKED AND ISOLATED OFFICE HYPERTENSION IN A GENERAL POPULATION IN NORTHERN ITALY: THE VOBARNO STUDY

Objective: Previous studies have demonstrated that ambulatory blood pressure monitoring (ABPM) provides useful information in hypertensive patients and in the general population. Few data are available on LV function according to BP categories as defined by clinic and 24 hours BP measurement. The aim of our study was to evaluate indices of left ventricular (LV) function in normotensive subjects (NT), in patients with isolated office hypertension (IOH), with masked hypertension (MHT) and with sustained hypertension (HT) defined according to clinic and 24 hours blood pressure (BP) monitoring. Design and method: Out of 585 subjects, we identified 294 untreated subjects (mean age 56 ± 9 years, 45% males) participating in our ongoing population study (Vobarno study). All subjects underwent standard laboratory examinations and clinic and 24 hours blood pressure measurement. Standard echocardiography was performed in all patients, and indices of systolic function were calculated. Furthermore in all patients, myocardial mechanoenergetic efficiency (MEE) was calculated as stroke volume/heart rate and indexed to LV mass (MEEi = MEE/LVM)(de Simone et al, 2016). Results: 39.5% of subjects were classified as NT, 17% as IOH, 18.5% as MH and 25% as HT. MEEi was significantly lower in IOH, MH and HT as compared to NT (0.52 ± 0.12, 0.54 ± 0.13,0.51 ± 12 vs 0.67 ± 0.16 ANOVA p < 0.05). The difference between groups remained statistically significant after adjusting for all possible confounders. Midwall fractional shortening (absolute value and % of predicted), was significantly lower in IOH, MH and EH as compared to NT, while no differences in fractional shortening and ejection fraction were observed among the four groups of subjects. Conclusions: Left ventricular myocardial mechanoenergetic efficiency and midwall function are depressed not only in patients with sustained hypertension, but also in patients with isolated office and masked hypertension.

[OP.7C.11] RELATIONSHIP BETWEEN DIMENSIONS OF THE ASCENDING AORTA AND CLINIC AND 24 HOURS BLOOD PRESSURE IN A GENERAL POPULATION IN NORTHERN ITALY

Objective: Epidemiological studies have suggested that even mild enlargement of the ascending aorta may have independent prognostic significance for cardiovascular events. Therefore, some Authors have proposed that dilatation of the ascending aorta could be considered as a form of preclinical vascular damage in hypertensive patients. Aim of our study: was to assess the correlation between clinic and 24 hours BP values and the dimensions of the aorta, measured at level of the sinuses of Valsalva (Val), at the left ventricular outflow tract (LVOT), and at the level of the proximal ascending aorta (AscAO) in subjects from a general population. Design and method: 250 subjects (43% males, mean age 56 ± 4 years, 42% hypertensives-HT) underwent laboratory examinations, clinic and 24 hours BP measurement, cardiac and carotid ultrasound, carotid-femoral pulse wave velocity measurement (AoPWV). Results: Aortic diameters were greater HT as compared to NT (Val: 3.41 ± 0.54 vs 3.25 ± 0.41 cm, LVOT 2.10 ± 0.28 vs 2.04 ± 0.26, AscAo 3.39 ± 0.45 vs 3.18 ± 0.38, all p < 0.05). Aortic diameters were all correlated to clinic and 24 hours BP values. The coefficients of correlation were greater for 24 hours BP (Tab). Val, AscAo, LVOT were also significantly correlated with left ventricular mass (r = 0.61, r = 0.48, and r = 0.43, all p < 0.001), meanmax intima media thickness (r = 0.13, r = 0.24, and r = 0.13, all p < 0.05) and with AoPWV (r = 0.16, p < 0.05, r = 0.28 p < 0.001, r = 0.08 p = ns). Figure. No caption available. Conclusions: The dimensions of the proximal ascending aorta are significantly related to BP values in normotensive subjects and in hypertensive patients. Aortic dimension are more strictly related to twenty-four hours BP values than to clinic BP values. In this sample of general population a significant correlation between aortic dimensions and measures of cardiac and vascular organ damage was also observed, confirming the parallelism between different forms of organ damage

[OP.7C.04] ARTERIAL STIFFNESS IS INDEPENDENTLY CORRELATED WITH MYOCARDIAL MECHANOENERGETIC EFFICIENCY IN A GENERAL POPULATION IN NORTHERN ITALY: THE VOBARNO STUDY

Objective: A non-invasive approach for the estimation of mechanical efficiency through the calculation of the ratio between stroke work and HR–pressure product has been recently proposed by de Simone et al. This index, which expresses the amount of blood pumped in a single beat in 1 second by the heart, may be easily obtained by echocardiography. The aim of our study was to evaluate the determinants of myocardial mechanoenergetic efficiency index (MEEi), calculated as as stroke volume/heart rate and indexed to LV mass (MEEi = MEE/LVM) in a large general population sample in Northern Italy. Design and method: We evaluated 478 subjects participating in a general population study in Northern Italy (Studio Vobarno). All subjects underwent a physical examination with measurement of clinic blood pressure (BP). In all subjects laboratory examinations, 24 hours blood pressure measurement, echocardiography, and assessment of carotid-femoral pulse wave velocity (PWV) were performed. Results: Subjects had a mean age of 58 ± 10 years, a BMI of 26 ± 4, 44% were males, 69% had arterial hypertension (55% treated). MEEi was lower in males and in patients with increased PWV. MEEi was inversely correlated with age, BMI, waist circumference, clinic and 24 hours BP, glucose, uric acid, triglycerides and directly correlated with HDL. MEEI was also inversely correlated with relative wall thickness (RWT) and PWV. At linear regression multivariate (?) analysis MEEi remained independently related to male gender (&bgr; = 0.16, p < 0.001), BMI (&bgr; = −0.13, p < 0.005), RWT (&bgr; = −0.56, p < 0.001) and PWV (&bgr; = −0.10, p < 0.05). Conclusions: In a large sample of general population in Northern Italy myocardial mechanoenergetic efficiency was inversely correlated with arterial stiffness, independently of multiple possible confounders.

Myocardial mechanoenergetic efficiency index (MMEI) and arterial stiffness: Association in a general population in norther Italy

To cite this article: Fabio Bertacchini, Massimo Salvetti, Anna Paini, Giulia Rubagotti, Deborah Stassaldi, Carlo Aggiusti, Giulia Maruelli, Chiara Arnoldi, Giovanni Saccà, Enrico Agabiti Rosei, Maria Lorenza Muiesan (2017) P41: MYOCARDIAL MECHANOENERGETIC EFFICIENCY INDEX (MMEI) AND ARTERIAL STIFFNESS: ASSOCIATION IN A GENERAL POPULATION IN NORTHER ITALY, Artery Research 20:C, 67–67, DOI: https://doi.org/10.1016/j.artres.2017.10.071

MPS 16-04 EVALUATION OF LOCAL CAROTID STIFFNESS AND WALL-TO-LUMEN RATIO OF RETINAL ARTERIOLES IN NORMOTENSIVE SUBJECTS AND HYPERTENSIVE PATIENTS

Objective: Wall-to-lumen ratio of retinal arterioles (W/L) might serve as an in-vivo parameter of microvascular damage. Few data are available on the correlation between local stiffness, evaluated at carotid artery level, and the presence of retinal abnormalities, assessed by arteriolar/venular ratio. Aim of the study was to analyse the correlation between carotid stiffness (CS) and W/L of retinal arterioles. Design and Method: Methods: 227 subjects (56% female, age 55 ± 4 years, 48% hypertensives, 30% treated) underwent laboratory examinations, clinic BP measurement, carotid-femoral pulse wave velocity (aoPWV) and W/L ratio measurement. CS was determined from the relative stroke change in diameter (measured with a high-resolution echotracking system) and carotid pulse pressure (measured with applanation tonometry). Results: both W/L and CS were significantly related with clinic SBP (r = 0.17, p < 0.05 and r = 0.50, p < 0.001), clinic PP (r = 0.22, p < 0.001 and r = 0.55, p < 0.001), carotid SBP (r = 0.18, p < 0.05 and r = 0.51, p < 0.001) and with carotid PP (r = 0.24, p < 0.001 and r = 0.56, p < 0.001). W/L was not significantly related with age and laboratory data while a positive correlation was observed between W/L and CS (r = 0.18, p < 0.005). At multivariate analysis CS, but not aoPWV, remained independently associated with W/L. Conclusions: In this large group of hypertensives and normotensives local carotid stiffness represents the main determinant of wall to lumen ratio of retinal arterioles.

[OP.4B.09] CARDIAC ORGAN DAMAGE IN HYPERTENSIVE PATIENTS ACCORDING TO ON-TREATMENT BLOOD PRESSURE VALUES.

Objective: The recent results of the SPRINT study suggest that “intensive” reduction of systolic blood pressure (BP) (to less than 120 mmHg) might provide greater cardiovascular protection as compared to less intensive (<140 mmHg) reduction of BP, at least in some subsets of patients. Only few studies, have investigated the possible effect of tight blood pressure control on indices of left ventricular hypertrophy, and have been mainly based on electrocardiography. Aim of our study: was to evaluate cardiac organ damage according to “on treatment” blood pressure values in a large cohort of hypertensive patients undergoing echocardiography (2D, M-mode with conventional and tissue Doppler analysis) at the echo-lab of an ESH Excellence Centre in Italy. Design and method: The analysis included 976 treated hypertensive patients (43% female, age 59 ± 12 yrs, age range 15–90). Patients were subdivided in three groups according to BP values at the time of the echocardiogram, defined as follows: uncontrolled (UC; SBP >or equal to 140 mmHg), controlled <140 (C140; SBP between 139 and 120 mmHg) and controlled <120 (C120; SBP <120 mmHg). Results: In 407 patients (42%) SBP values were >140 mmHg, 449 patients (46%) had SBP was between 139 and 120 mmHg (C140) and in 120 (12%) SBP was <120 mmHg (C120). Left ventricular mass (LVM) and LVM index (LVMI) were progressively lower in UC, C140 and C120 (LVM: 162 ± 51, 159 ± 47 and 149 ± 44 gr respectively, p for trend <0,001; LVMI: 40 ± 11,38 ± 10 and 35 ± 9 gr/m2.7 respectively, p for trend <0,001). No significant difference was observed for relative wall thickness. Left atrial volume (LAV) and LAV/BSA were progressively lower in UC, C140 and C120 (LAV/BSA: 25.6 ± 7.6, 23.7 ± 7.9, 22.7 ± 8.5, respectively, p for trend <0,001). These differences remained significant even after adjusting for possible confounders. Conclusions: Lower achieved BP targets are associated with a progressive lower left ventricular mass, left ventricular mass index and left atrial volumes. These findings are in line with previous results indicating a favorable effect of tight BP control on electrocardiographic indices of LV hypertrophy. Prospective studies are needed to confirm the possible favorable effect of tight BP control on echocardiographic indices of LVH, and their relation to CV events.

OS 14-02 ON TREATMENT BLOOD PRESSURE VALUES AND CARDIAC ORGAN DAMAGE IN HYPERTENSIVE PATIENTS.

Objective: The recent results of the SPRINT study suggest that “intensive” reduction of systolic blood pressure (BP) (to less than 120 mmHg) might provide greater cardiovascular protection as compared to less intensive (< 140 mmHg) reduction of BP, at least in some subsets of patients. Only few studies, have investigated the possible effect of tight blood pressure control on indices of left ventricular hypertrophy, and have been mainly based on electrocardiography. Aim of our study was to evaluate cardiac organ damage according to “on treatment” blood pressure values in a large cohort of hypertensive patients undergoing echocardiography (2D, M-mode with conventional and tissue Doppler analysis)at the echo-lab of an ESH Excellence Centre in Italy. Design and Method: The analysis included 976 treated hypertensive patients (43% female, age 59 ± 12 yrs, age range 15–90). Patients were subdivided in three groups according to BP values at the time of the echocardiogram, defined as follows: uncontrolled (UC; SBP >or equal to140 mmHg), controlled <140 (C140; SBP between 139 and 120 mmHg) and controlled <120 (C120; SBP <120 mmHg). Results: In 407 patients (42%) SBP values were>140 mmHg, 449 patients (46%) had SBP was between 139 and 120 mmHg (C140) and in 120 (12%) SBP was <120 mmHg (C120). Left ventricular mass (LVM) and LVM index (LVMI) were progressively lower in UC, C140 and C120 (LVM: 162 ± 51, 159 ± 47 and 149 ± 44 gr respectively, p for trend < 0,001; LVMI: 40 ± 11, 38 ± 10 and 35 ± 9 gr/m 2.7 respectively, p for trend < 0,001). No significant difference was observed for relative wall thickness. Left atrial volume (LAV) and LAV/BSA were progressively lower in UC, C140 and C120 (LAV/BSA: 25.6 ± 7.6, 23.7 ± 7.9, 22.7 ± 8.5, respectively, p for trend < 0,001). These differences remained significant even after adjusting for possible confounders. Conclusions: Lower achieved BP targets are associated with a progressive lower left ventricular mass, left ventricular mass index and left atrial volumes. These findings are in line with previous results indicating a favorable effect of tight BP control on electrocardiographic indices of LV hypertrophy. Prospective studies are needed to confirm the possible favorable effect of tight BP control on echocardiographic indices of LVH, and their relation to CV events.

Prevalence of electrocardiographic and echocardiographic LVH in a general population in northern italy. The vobarno study

Background: A large number of studies have demonstrated that left ventricular hypertrophy (LVH) detected with standard electroand echocardiography is an independent predictor of future cardiovascular complications in various subsets of patients. Due its low cost and wide availability electrocardiography represents the first line test for the assessment of cardiac organ damage in hypertensive patients. However a significant limitation is represented by its low sensitivity in detecting LVH. Aim of this study was to evaluate the prevalence of LVH detected by electroor echocardiography and the relationship between these two measures in a general population sample(Vobarno study). Methods: A total of 385 subjects (mean age 57 10years,44%males,64% hypertensives,44% overweight and 16%obese)underwent clinical examination with blood pressure measurement,standard laboratory examinations,a 12 leads electrocardiogram standard and standard echocardiography.EKGLVH was defined as the presence of a Sokolow-Lyon voltage 38 mm and/ or a Cornell voltage QRS duration product>2440 mm*msec and/or R in aVL;Echo-LVH was defined as LVM>50 g/m2.7 in men and 47g/m2.7 in women. Results: LVH prevalence was 5.1% and 16.3% with EKG and Echo,respectively.LVH was detected by both methods only in 2.0% of patients.The prevalence of EKG-LVH was 1.7% with Sokolow-Lyon voltage,4.2% with Cornell product and 5.1% with both EKG criteria.In hypertensives the prevalence of LVH was significantly greater than normotensives(6.8% vs 2.2% with EKG-LVH and 22.7% vs 9.6% with Echo).The concordance of the two techniques in identifying patients with LVH was only partial,and in particular,among patients with EKG-LVH a significant proportion(39%) did not have echo-LVH.However,patients with EKG-LVH but without Echo-LVH had greater LV mass index(39.9 vs 34.4 gr/m2.7,p<0.01) and worse systolic and diastolic function (midwall fractional shortening:17.3 vs 19.5; E/Em 10.6 vs 8.1,all p<0.01)as compared with those without both EKG and Echo-LVH.A positive correlation was observed between LVMI and Sokolow-Lyon voltage(r1⁄40.13,p<0.015),Cornell product(r1⁄40.22,p<0.001),Cornell voltage(r1⁄40.45,p<0.001)and R in aVL(r1⁄40.38,p<0.001). Conclusions: Our data confirm the greater sensibility of echocardiography examination for detection of LVH.The presence of EKG-LVH is associated with greater LVMI and worse systolic and diastolic function,even in the absence of clear-cut echo-LVH.Our results confirm the importance of identifying cardiac organ damage with both methods for a better stratification of cardiovascular risk.