Giulio Geraci
University of Palermo
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Featured researches published by Giulio Geraci.
European Journal of Preventive Cardiology | 2015
Giulio Geraci; Giuseppe Mulè; Calogero Geraci; Manuela Mogavero; F. D’Ignoto; Massimiliano Morreale; Anna Carola Foraci; Santina Cottone
Background Recent data suggest that renal haemodynamic parameters obtained by duplex Doppler sonography, especially the intrarenal resistive index (RI), may be associated with systemic vascular changes. However, conflicting data exist about the independent relationship between aortic stiffness and RI. The aim of this study was to evaluate the relationship between RI and arterial stiffness, assessed by aortic pulse wave velocity (aPWV), in hypertensive patients. Design Cross-sectional study. Methods We enrolled 264 hypertensive subjects aged between 30 and 70 years. They were divided into two groups, either with normal renal function (n = 140) or with chronic kidney disease (CKD) (n = 124). Each patient underwent assessment of ultrasonographic renal RI and measurement of aPWV through oscillometric device. Results Patients with renal RI>0.7 showed higher values of aPWV, both in the overall population (p < 0.001) and in the subgroups with (p < 0.01) and without CKD (p < 0.01). Moreover, statistically significant correlations were observed between aPWV and RI in the whole population (r = 0.38, p < 0.001) and in the subgroups with (r = 0.35, p < 0.001) and without CKD (r = 0.31, p < 0.001). These correlations held even after adjustment for several confounding factors in multivariate analyses. Conclusions Our results seem to corroborate the concept that the RI may be considered as a marker of systemic vascular changes and therefore a predictor of cardiovascular risk.
Nutrition Metabolism and Cardiovascular Diseases | 2015
Giulio Geraci; Giuseppe Mulè; Manuela Mogavero; Calogero Geraci; D. D'Ignoti; Chiara Guglielmo; Santina Cottone
BACKGROUND AND AIM Renal resistance index (RRI), assessed by Duplex-Doppler sonography, has been classically considered as a mere expression of intrarenal vascular resistance. Recent studies, however, have showed that RRI is also influenced by upstream factors, especially arterial compliance, confirming its possible role as a marker of systemic vascular alterations. Several studies have shown that carotid intima-media thickness (cIMT) and carotid plaques (cP), assessed by ultrasonography, are documented markers of subclinical organ damage as well as expression of progressive atherosclerotic disease, and that they get worse with the progressive deterioration of renal function. The study was aimed to evaluate the relationship between RRI and severity of carotid atherosclerosis in hypertensive subjects with and without impaired renal function. METHODS AND RESULTS The study population, including 263 hypertensive patients (30-70 years), was split into 3 groups based on cIMT and presence of cP (cIMT ≤ 0.9 mm and no cP; cIMT > 0.9 mm and no cP; cP). All patients were also divided into 2 subgroups (normal renal function; CKD stage I-IV). A stepwise increase in RRI corresponding to the groups of progressive severity of carotid atherosclerosis was observed (respectively 0.61 ± 0.07, 0.65 ± 0.06, 0.68 ± 0.06; p < 0.001). A strong positive correlation was observed between RRI and cIMT in the whole population (r = 0.43; p < 0.001) and in the subgroups with (r = 0.42; p < 0.001) and without (r = 0.39; p < 0.001) CKD. These associations remained statistically significant even after adjustment for various confounding factors. CONCLUSION Showing a close association between RRI and severity of carotid atherosclerosis, our results strengthen the concept that RRI is a marker of systemic vascular changes.
Hypertension Research | 2015
Giuseppe Mulè; Emilio Nardi; Laura Guarino; Valentina Cacciatore; Giulio Geraci; Ilenia Calcaterra; Bruno Oddo; Francesco Vaccaro; Santina Cottone
Plasma aldosterone concentrations (PACs) are often increased in the advanced stages of chronic kidney disease (CKD); however, PAC has not been fully investigated in early CKD. Moreover, little is known about the relationship between aldosteronemia and left ventricular (LV) mass in subjects with mild-to-moderate CKD. The study objectives were to analyze PAC, LV mass (LVM), LV geometry and their relationships, in a group of hypertensive patients with stage I–III CKD. One hundred ninety-five hypertensive patients with stage I–III CKD were enrolled and compared with a control group of 82 hypertensive patients without renal dysfunction. LVM was higher in subjects with CKD than in the control group and increased progressively with advancing stages of CKD (P=0.004). A similar trend was observed for PAC (P<0.0001), in which PAC was greater in CKD subjects with LV concentric geometry than in those with eccentric LV hypertrophy (P=0.01). Furthermore, in CKD patients, PAC was directly and significantly correlated with LVM (r=0.29; P<0.0001) and with relative wall thickness (RWT; r=0.36; P<0.0001). These associations remained significant even after adjustment for various confounding factors in multiple regression analyses (P<0.001). In summary, the results demonstrated that in CKD hypertensive patients, LVM, RWT and PAC are increased and related to each other from the earliest stages of renal dysfunction. Furthermore, it seems biologically plausible to speculate that aldosterone may promote a concentric geometry of the left ventricle and increase LVM in hypertensive patients with early CKD.
Journal of Clinical Hypertension | 2016
Giulio Geraci; Giuseppe Mulè; Manuela Mogavero; Calogero Geraci; Emilio Nardi; Santina Cottone
The role of vascular renal changes in mediating the association between serum uric acid (SUA) and renal damage is unclear. The purposes of this study were to investigate the relationship between SUA and renal resistive index (RRI), assessed by duplex Doppler ultrasonography, and to assess whether hemodynamic renal changes may explain the association between SUA and renal damage in hypertensive patients. A total of 530 hypertensive patients with and without chronic kidney disease were enrolled and divided into SUA tertiles based on sex‐specific cutoff values. RRI and albuminuria were greater and glomerular filtration rate (GFR) was lower in the uppermost SUA tertile patients when compared with those in the lowest tertiles (all P<.001). Moreover, SUA strongly correlated with RRI (P<.001) in all patients. However, RRI did not seem to explain the relationship between SUA and renal damage, and GFR significantly related with SUA in the overall population (P<.001) even after adjustment for RRI.
American Journal of Hypertension | 2016
Giulio Geraci; Giuseppe Mulè; Giuseppa Costanza; Manuela Mogavero; Calogero Geraci; Santina Cottone
BACKGROUND Structural atherosclerotic damage, arterial stiffness, pulse pressure (PP), and renal hemodynamics may interact and influence each other. Renal resistance index (RRI) appears as a good indicator of systemic vascular changes. The aim of our study was to assess the independent relationships of carotid intima-media thickness (cIMT), aortic pulse wave velocity (aPWV), and peripheral PP with RRI in hypertensives with various degrees of renal function. METHODS We enrolled 463 hypertensive patients (30-70 years) with normal renal function (group 0; n = 280) and with chronic kidney disease (groups I-V; n = 183). All subjects underwent ultrasonographic examination of intrarenal and carotid vasculature, as well as a 24-h ambulatory blood pressure monitoring. RESULTS A statistically significant difference in RRI, cIMT, aPWV, and clinic PP was observed in the different 6 groups (all P < 0.001), even after adjustment for age. RRI correlated with cIMT (r = 0.460, P < 0.001), aPWV (r = 0.386, P < 0.001), clinic PP (r = 0.279, P < 0.001), and 24-h PP (r = 0.229, P < 0.001) in the entire study population. These correlations were similar in subjects with and without renal dysfunction. In the overall study population, the association between RRI, cIMT, and clinic PP remained statistically significant even after adjustment for various confounding factors, whereas the relationship between RRI and aPWV was lost in multivariate analysis. CONCLUSIONS cIMT and clinic PP rather than directly aPWV are associated with intrarenal hemodynamics. Our results confirm that in hypertensives RRI not only detects derangement of intrarenal circulation but may also be considered as a sensor of systemic vascular changes, independently of level of renal function.
Journal of Clinical Hypertension | 2015
Giuseppe Mulè; Ilenia Calcaterra; Miriam Costanzo; Giulio Geraci; Laura Guarino; Anna Carola Foraci; Maria G. Vario; Giovanni Cerasola; Santina Cottone
The authors aimed to analyze the relationship between subclinical renal damage, defined as the presence of microalbuminuria or an estimated glomerular filtration rate (eGFR) between 30 mL/min/1.73 m2 and 60 mL/min/1.73 m2 and short‐term blood pressure (BP) variability, assessed as average real variability (ARV), weighted standard deviation (SD) of 24‐hour BP, and SD of daytime and nighttime BP. A total of 328 hypertensive patients underwent 24‐hour ambulatory BP monitoring, 24‐hour albumin excretion rate determination, and eGFR calculation using the Chronic Kidney Disease Epidemiology Collaboration equation. ARV of 24‐hour systolic BP (SBP) was significantly higher in patients with subclinical renal damage (P=.001). This association held (P=.04) after adjustment for potential confounders. In patients with microalbuminuria, ARV of 24‐hour SBP, weighted SD of 24‐hour SBP, and SD of daytime SBP were also independently and inversely related to eGFR. These results seem to suggest that in essential hypertension, short‐term BP variability is independently associated with early renal abnormalities.
Journal of Hypertension | 2016
Giuseppe Mulè; Emilio Nardi; Massimiliano Morreale; S. D'Amico; Anna Carola Foraci; Chiara Nardi; Giulio Geraci; Giovanni Cerasola; Santina Cottone
Objective: Recent studies suggest that enlarged aortic root diameter (ARD) may predict cardiovascular events in absence of aneurysmatic alterations. Little is known about the influence of renal function on ARD. Our study was aimed to assess the relationships between glomerular filtration rate (GFR) and ARD in hypertensive subjects. Methods: We enrolled 611 hypertensive individuals (mean age: 52 ± 15 years; men 63%). ARD was measured by echocardiography at the level of Valsalvas sinuses using M-mode tracings. It was considered as absolute measure, normalized to body surface area (ARD/BSA) and indexed to height (ARD/H). GFR was estimated by the Chronic Kidney Disease Epidemiology Collaboration equation. The study population was categorized into seven groups: subjects without chronic kidney disease (no CKD) and subjects with increasing severity of CKD (1, 2, 3a, 3b, 4, 5), as proposed by the 2012 Kidney Disease: Improving Global Outcomes guidelines. Results: ARD/BSA and ARD/H showed a stepwise increase from the group with normal renal function to the groups with increasing severity of CKD. GFR correlated significantly with ARD (r = –0.17), ARD/BSA (r = –0.43) and ARD/H (r = –0.35; all P < 0.001). The associations of GFR with ARD/BSA (&bgr; = –0.26; P < 0.001) and ARD/H (&bgr; = –0.13; P = 0.01) held in linear multiple regression analyses, after adjustment for various confounding factors. Conclusion: Our study seems to suggest that a reduced renal function may adversely influence ARD. This may contribute to explain the enhanced cardiovascular risk associated with renal insufficiency.
Journal of Human Hypertension | 2016
Giuseppe Mulè; Ilenia Calcaterra; Miriam Costanzo; Massimiliano Morreale; Francesco D'Ignoto; Antonella Castiglia; Giulio Geraci; G Rabbiolo; Francesco Vaccaro; Santina Cottone
Limited and conflicting data are available about the association between short-term blood pressure (BP) variability and urinary albumin excretion rate (uAER). The objective of our study was to analyze the relationships between microalbuminuria (MAU), defined as an uAER between 20 and 200 μg min−1, and short-term BP variability (BPV), assessed as average real variability (ARV), weighted s.d. of 24-h BP and as s.d. of daytime and night-time BP. The study population consisted of 315 untreated essential hypertensives with normal estimated glomerular filtration rate (>60 ml min−1 per 1.73 m2), who underwent 24-h ambulatory BP monitoring and 24-h uAER determination. MAU was detected in 82 (26%) patients. ARV of 24-h systolic BP (SBP) was significantly higher in patients with MAU (9.8 (8.5–11.1) mm Hg) when compared with those without it (9.1 (8–10.2) mm Hg; P=0.007). This difference held (P=0.026) after adjustment for age, mean levels of BP and other potential confounders by analysis of covariance. A statistically significant correlation was also found between ARV of 24-h SBP and uAER (r=0.17; P=0.003). This association remained significant (β=0.15; P=0.01), also taking into account the effect of 24-h average systolic and diastolic BP, age, gender, diabetes, serum uric acid, triglycerides, estimated glomerular filtration rate in multiple regression analyses. All the other indices of short-term BPV tested were not independently associated with MAU. Our results seem to suggest that in essential hypertension, short-term BPV, only when estimated by ARV of 24-h SBP, is independently associated with MAU.
International Journal of Cardiology | 2017
Nardi E; Giuseppe Mulè; Chiara Nardi; Giulio Geraci; Maurizio Averna
BACKGROUND Some data support the concept that aortic root diameter (ARD) in hypertension may be regarded as a marker of subclinical organ damage. The impact of type 2 diabetes mellitus (DM) on cardiac structure and function is known, although the relationship between DM and ARD is not clear. The aim of our study was to evaluate the influence of DM on ARD in hypertensive patients. METHODS We enrolled 1693 hypertensive patients (aged 63.7±9.6years). The population was divided into two groups: the first one with DM (n=747) and the second one without DM (n=946). ARD was measured by echocardiography at level of Valsalvas sinuses using echocardiography M-mode tracings. It was considered as absolute measure and normalized to height (ARD/H) and body surface area (ARD/BSA). Left ventricular mass index (LVMI) and some parameters of systolic and diastolic function have been valued by means of echocardiography and tissue Doppler imaging. RESULTS The DM group was characterized by more elevated values of LVMI and a worst systolic and diastolic function. ARD value was significantly lower in DM group in comparison to patients without DM only when indexed for BSA (ARD/BSA=18.7±2.3mm/m2 vs 18.3±2.0mm/m2, p=0.01). This difference remained statistically significant, even after correction by age, sex and BMI (p=0.01). A multivariate linear regression analysis demonstrated an inverse relationship between DM and ARD/BSA after correction for potential confounders (β=0.10, p<0.001). CONCLUSIONS Our results confirm the hypothesis of a protective role of DM on aortic root dilatation.
Internal and Emergency Medicine | 2015
Giuseppe Mulè; Giulio Geraci; Calogero Geraci; Massimiliano Morreale; Santina Cottone
Progress in digital ultrasound technology and diffusion of Doppler ultrasound evaluation of the kidney enable a widespread non-invasive evaluation of renal haemodynamics. Initially most attention has been paid to the study of extraparenchymal renal arteries, mainly to detect renovascular disease. However, this approach has low reproducibility and accuracy. Therefore, interest has gradually moved towards the duplex evaluation of intrarenal anatomy, where the best and most reliable signals are obtained from the large segmental or interlobar arteries that run directly towards the transducer [1]. Among the sonographic parameters used in the last decade, great emphasis has been placed on the intrarenal resistive index (RRI), which is defined as the dimensionless ratio of the difference between maximum and minimum (end-diastolic) flow velocity to maximum flow velocity [1, 2]. It has been used for a long time for the diagnostic and prognostic assessment of renovascular disease [2, 3]. One of the earliest prospective uses of the RRI was in the prediction of kidney function outcomes following intervention for renal artery stenosis. In the pioneering study of Radermacher et al., an RRI[0.80 is associated with poorer outcomes, when surgery or angioplasty is used to correct renal artery stenosis [3]. Subsequently, RRI has been more widely used to detect changes in transplanted kidney perfusion, and to predict the rate of decline in renal function in chronic kidney diseases (CKD) of different etiologies [2, 4, 5]. Despite these promising data, most clinicians currently rely on measurements of traditional predictors of the progression of CKD (blood pressure, proteinuria, baseline renal function) rather than on ultrasound indices in individual patients. The current reluctance to use RRI as prognostic marker partly results from some uncertainty about the physiological factors that influence it. In the current issue of Internal and Emergency Medicine, Boddi and co-workers publish an exhaustive review of the literature on this topic, excellently summarizing the available information on the role or RRI in cardiovascular and renal medicine [6]. As discussed in this interesting paper, increased RRI may indicate remodelling of the microcirculation with a reduction of the cross-sectional area of vessels, and an increase of the total peripheral resistance of the kidney [2, 5, 6]. It is suggested that this index directly reflects intrarenal vascular resistance, which results in its denomination as ‘resistance index’. However, accumulating evidence indicates that the RRI provides important information about the systemic vasculature as well [2, 5– 10]. Indeed, recent data suggest that this parameter is not only an expression of parenchymal perfusion, but may also be influenced by upstream vascular factors, and indeed these factors appear to play a more important role than intrarenal resistance [2, 5–10]. In this regard, in a large group of hypertensive patients with and without impaired renal function, we describe a close and positive association between RRI and large arteries stiffness, determined by measuring aortic pulse wave velocity (aPWV), a strong independent predictor of cardiovascular morbidity and mortality [7, 11]. This close association remains statistically significant even after adjustment for age, blood pressure (BP) (either when & Giuseppe Mulè [email protected]