Katalin Farkas

Comparison of Tissue Doppler Velocities Obtained by Different Types of Echocardiography Systems: Are They Compatible?

Background: Both systolic and diastolic tissue Doppler (TD) velocities have an important diagnostic and prognostic role in cardiology. We aimed to compare TD velocities between two different echocardiography systems. Patients: Thirty‐one consecutive patients (mean age: 65.2 ± 17.5 years; 12 males) were enrolled. Methods: Systolic (Sa), early (Ea), and late (Aa) diastolic velocities were measured by TD at the lateral mitral annulus by a Sonos 2000 (Hewlett‐Packard, Andover, MA, USA) and a Philips iE33 system. The E/Ea ratio was calculated. Results: Ea, Aa, and Sa velocities were higher when measured by the Sonos system (Ea: 13.2 ± 4.1 cm/s vs. 8.3 ± 3.6 cm/s; Aa: 14.8 ± 3.8 cm/s vs. 9.3 ± 2.3 cm/s; Sa: 15.2 ± 3.6 cm/s vs. 8.4 ± 2.0 cm/s; P < 0.0001 all). A significant correlation was found in Ea and in Ea/Aa (r = 0.84 and r = 0.85 resp; P < 0.0001 for both), and a weaker in Aa (r = 0.43; P = 0.02) between the machines. The Bland‐Altman analysis showed broad limits of agreement between the measurements for Ea, Aa, and Sa (mean difference: 4.95 cm/s; 5.52 cm/s; 6.73 cm/s, respectively; limits: 0.64–9.25 cm/s; −1.39–12.39 cm/s; −0.37–13.83 cm/s, respectively). An E/Ea ratio >5.6 by the Sonos system showed 75% sensitivity and 79% specificity for elevated left ventricular filling pressure, defined as E/Ea >10 by the reference Philips system. Conclusions: Although diastolic TD velocities had excellent correlations between the two machines, there was a systematic overestimation by the Sonos system. Since the limits of agreement do not allow replacing the measurements, we suggest using the same echocardiographic equipment at patient follow‐up. (Echocardiography 2010;27:230‐235)

Intracardiac calcification is a marker of generalized atherosclerosis

Aortic valve calcification (AVC) and carotid artery calcification (CAC) are considered to be markers of generalized atherosclerosis. However, the role of intracardiac calcification (ICC) (valvular and perivalvular calcification) is unclear. The objective of this retrospective study was to analyze the relationship between ICC and CAC, risk factors, and clinical atherosclerotic disease. Risk factors included age, sex, diabetes mellitus, hypercholesterolemia, and hypertension; clinical atherosclerosis comprised stroke, coronary artery disease, and peripheral artery disease. Between January 1, 2001, and January 1, 2004, all consecutive patients were enrolled into the study who underwent both carotid ultrasonography and transthoracic echocardiography examinations within 2 months. Patients with renal failure, substantial aortic stenosis, and carotid artery occlusion were excluded. There were 320 patients (104 men; mean ± SEM age, 66.6 ± 0.76 years). Positive results on carotid ultrasonography are defined as any CAC. Patients were categorized as having mild, moderate, or severe CAC. Positive results on transthoracic echocardiography were defined as any ICC; AVC was defined as mitral anulus calcification (MAC) or both. Intracardiac calcification was found in 181 patients, AVC in 51 patients, MAC in 48 patients, and calcification of both structures in 82 patients. Using multiple logistic regression analysis, ICC (odds ratio, 1.9), age (10-year periods) (odds ratio, 2.0), and the presence of peripheral artery disease (odds ratio, 1.7) were independent predictors of CAC. Carotid ultrasonography results were positive in 227 patients. For CAC, the sensitivities of AVC, MAC, both, and any ICC were 52.4%, 52.0%, 33.5%, and 71.2%, respectively, and the specificities were 84.9%, 87.1%, 92.5%, and 78.5%, respectively. The extension of ICC as 0, 1 location (AVC or MAC) , or 2 locations (AVC and MAC) was associated with the severity of CAC (P < .001, τ = 0.42). There was no difference between patients with AVC vs patients with MAC in the presence of different stages of CAC (P = .62). Intracardiac calcification (MAC or AVC) is an independent predictor of CAC as a marker of atherosclerosis, although the lack of ICC does not rule out atherosclerosis. Intracardiac calcification is related to CAC, with high specificity. The extension of ICC is related to the severity of atherosclerosis. Based on our results, antiatherothrombotic therapy should be considered in patients with ICC even before obtaining a positive carotid ultrasonography result.

High prevalence of peripheral arterial disease in hypertensive patients: the Evaluation of Ankle-Brachial Index in Hungarian Hypertensives screening program.

Aims: Peripheral arterial disease (PAD) can be diagnosed in asymptomatic stage, measuring ankle-brachial index (ABI). Low ABI is an indicator of increased cardiovascular risk and its inclusion to traditional risk factors can improve risk prediction. The objective of the present cross-sectional part of our large-scale, multicenter, observational study was to evaluate the prevalence of PAD in a large cohort of hypertensive patients. Methods and results: A total of 21 892 hypertensive men and women (9162 men; mean age 61.45 years) were included in our prospective study in hypertension clinics. Clinical history, physical examination, and blood analysis were taken, and the ABI was measured with the Doppler method in all patients. The prevalence of PAD (ABI ⩽0.9) was 14.4%. In 15.6% of the patients an ABI of 0.91–0.99, and in 9.4% of the patients high ABI (>1.3) was measured. In the low, moderate, high, and very high Systematic Coronary Risk Evaluation risk groups, the prevalence of low ABI was 8.1, 11.1, 16.3, and 26%, respectively. The prevalence of PAD was lower in hypertensive patients achieving their blood pressure target (9.6 vs. 16.8%; P < 0.001). Conclusions: Asymptomatic PAD was highly prevalent in the studied hypertensive population. The use of ABI screening may improve cardiovascular risk prediction. Optimal blood pressure goal values in PAD patients and cardiovascular morbidity/mortality data will be evaluated after the 5-year long prospective phase of the Evaluation of Ankle-Brachial Index in Hungarian Hypertensives program.

Quinapril improves endothelial function in postmenopausal hypertensive patients.

Background/Aim: Hypertension is one of the main cardiovascular risk factors, and it may be responsible for the excess morbidity and mortality in postmenopausal women. Endothelium-dependent dilation of conduit arteries is reduced in women after menopause, as shown by the reduced flow-mediated dilation (FMD) of the brachial artery. The aim of this study was to evaluate changes in FMD during and following a 6-month-long treatment with increasing doses (10, 20 and 40 mg) of quinapril in hypertensive postmenopausal patients. Methods: A multicenter, open-label, non-comparative, baseline control study in 61 postmenopausal outpatients. Results:The mean baseline FMD (% ± SD) of the 53 patients in the intent-to-treat population (patients with at least one FMD evaluation) was 2.83 ± 1.24%; FMD of the 51 subjects on 10 mg quinapril daily was 5.58 ± 2.179%; FMD of the 52 patients on 20 mg quinapril was 7.06 ± 2.31%, and FMD of the 53 subjects on 40 mg daily was 8.07 ± 2.57% (p < 0.001 for each dose, compared to baseline). Conclusion: Ourresults confirmed that quinapril improves endothelial function at all examined doses as measured by FMD. Modulation of the renin-angiotensin system may act as a target for reducing cardiovascular risk in postmenopausal hypertensive women.

MORTALITY RATES IN HYPERTENSIVE SUBJECTS WITH PERIPHERAL ARTERIAL DISEASE: DETECTION OF A J-CURVE PHENOMENON

Objective: Determination of asymptomatic organ damage is important in cardiovascular risk stratification, and has a great impact on the treatment of hypertension. The measurement of the ankle-brachial index (ABI) is an accepted method for the detection of asymptomatic peripheral arterial disease (PAD). Abnormal ABI is accepted as a marker of cardiovascular risk that predicts adverse cardiovascular outcomes. Purpose: The assessment of mortality rates during the follow-up period of the ERV program in hypertensive patients with ABI < = 0.9. Design and method: The Hungarian ERV program is a large-scale, multicenter, observational study with a cross-sectional and a longitudinal part. The first period of the study was conducted from April 2007 to September 2008 in 55 hypertension outpatient clinics in Hungary and the prospective phase was ended in April 2014. In all patients ABI was measured and cardiovascular outcomes were collected in the 5 years follow-up period. Results: In the 21892 enrolled hypertensive patients (50–75 years of age), the prevalence of PAD (ABI < = 0.9) was 14.4 %. In 9.4% of the subjects high ABI (>1.3) was measured. Among these hypertensive subjects the five years cumulative death ratio in both gender was twice as high in PAD patients compared to those without PAD (17.4% vs 7.4% in men, p < 0.001; 9.8% vs 4.2% in women, p < 0.001). The cumulative death ratio was significantly higher in patients with high ABI, as well. The relative risk of cumulative death was higher in case of low ABI compared to patients with normal ABI values both in men (RR:2.32; p < 0.001) and in women (RR:2.32; p < 0.001). In hypertensive PAD patients mortality increased in both genders in patients with systolic blood pressure below 120 mmHg and above 160 mmHg compared to systolic blood pressure 130–139 mmHg (p < 0.001and p < 0,01) and in men below diastolic pressure 70 mmHg and above 90 mmHg compared to diastolic blood pressure 80–89 mmHg (p < 0.001 and p < 0.01). Conclusions: Low ABI is a strong predictor of mortality in hypertensive patients. In hypertensive PAD patients, the J-curve shape phenomenon between blood pressure and mortality was firstly described in our analysis.