L. Ryliskyte

Arterial wall dysfunction in systemic lupus erythematosus

Carotid-radial pulse wave velocity (PWV), aortic augmentation index (AIx) and endothelium-dependent flow-mediated dilatation (FMD) have been repeatedly showed to be related to premature atherosclerosis and cardiovascular diseases in different settings of population. The increased arterial stiffness and endothelium dysfunction may add to premature aging of the arteries in systemic lupus erythematosus (SLE) patients. Still data about arterial stiffness and endothelium function in inflammatory rheumatic diseases are not well described. The aim of this study was to determine the PWV, its derivate marker AIx and FMD and factors possibly influencing them in young SLE women without significant organ damage. Thirty women between 23 and 55 years with an established SLE diagnosis and 66 healthy women were consequently included in the study and both groups were comparable according to age, body mass index (BMI), serum lipid profile and creatinine. PWV was determined by measuring carotid-radial pulse wave transit time with the help of applanation tonometry and AIx, its derivate marker, was calculated as a difference between two waveform peaks expressed as a percentage of the pulse pressure. The FMD was performed by obtaining the repeated scans of the brachial artery at rest and during reactive hyperemia. In SLE women, PWV and AIx were significantly higher and FMD was not different from controls. In linear multiple stepwise regression analysis if patients and controls were both considered, PWV was weakly related to mean blood pressure (MBP), AIx was mostly predicted by age and MBP and FMD was predicted by the diameter of blood vessel, BMI, high density lipoproteins. If the sole SLE setting was analyzed, PWV was not related to any of the pending parameters, AIx turned out to be related to organ damage measured by Systemic Lupus International collaborative Clinics (SLICC) index and age, and FMD obtained strong and significant relation with vessel diameter, and BMI, and disease duration. Regardless of the small number of study group patients, we can state that controlling for MBP and taking measures towards organ damage prevention can partially slow down the process of early atherosclerosis in SLE patients.

Non-invasive evaluation of myocardial reperfusion by transthoracic Doppler echocardiography and single-photon emission computed tomography in patients with anterior acute myocardial infarction

BackgroundThe study was designed to evaluate whether the preserved coronary flow reserve (CFR) 72 hours after reperfused acute myocardial infarction (AMI) is associated with less microvascular dysfunction and is predictive of left ventricular (LV) functional recovery and the final infarct size at follow-up.MethodsIn our study, CFR was assessed by transthoracic Doppler echocardiography (TDE) in 44 patients after the successful percutaneous coronary intervention during the acute AMI phase. CFR was correlated with contractile reserve assessed by low-dose dobutamine echocardiography and with the total perfusion defect measured by single-photon emission computed tomography 72 hours after reperfusion and at 5 months follow-up. The ROC analysis was performed to determine test sensitivity and specificity based on CFR. Categorical data were compared by an χ2 analysis, continuous variables were analysed with the independent Students t test. In order to analyse correlation between CFR and the parameters of LV function and perfusion, the Pearson correlation analysis was conducted. The linear regression analysis was used to assess the relationship between CFR and myocardial contractility as well as the final infarct size.ResultsWe estimated the CFR cut-off value of 1.75 as providing the maximal accuracy to distinguish between patients with preserved and impaired CFR during the acute AMI phase (sensitivity 91.7%, specificity 75%). Wall motion score index was better in the subgroup with preserved CFR as compared to the subgroup with reduced CFR: 1.74 (0.29) vs. 1.89 (0.17) (p < 0.001) during the acute phase and 1.47 (0.30) vs. 1.81 (0.20) (p < 0.001) at follow-up, respectively. LV ejection fraction was 47.78% (8.99) in preserved CFR group vs. 40.79% (7.25) in impaired CFR group (p = 0.007) 72 hours after reperfusion and 49.78% (8.70) vs. 40.36% (7.90) (p = 0.001) after 5 months at follow-up, respectively. The final infarct size was smaller in patients with preserved as compared to patients with reduced CFR: 5.26% (6.14) vs. 23.28% (12.19) (p < 0.001) at follow-up.ConclusionThe early measurement of CFR by TDE can be of high value for the assessment of successful reperfusion in AMI and can be used to predict LV functional recovery, myocardial viability and the final infarct size.

Usefulness of pretransplant aortic arch calcification evaluation for kidney transplant outcome prediction in one year follow-up

Abstract Vascular calcification (VC) is linked to post-transplant cardiovascular events and hypercalcemia which may influence kidney graft function in the long term. We aimed to evaluate whether pretransplant aortic arch calcification (AoAC) can predict post-transplant cardiovascular or cerebrovascular events (CVEs), and to assess its association with post-transplant plasma calcium levels and renal function in one-year follow-up. Our single-center observational prospective study enrolled 37 kidney transplant recipients (KTR) without previous history of vascular events. Two radiologists evaluated pretransplant AoAC on chest X-ray as suggested by Ogawa et al. in 2009. Cohen’s kappa coefficient was 0.71. The mismatching results were repeatedly reviewed and resulted in consensus. Carotid-femoral (cfPWV) and carotid-radial pulse wave velocity (crPWV) was measured using applanation tonometry before and one year after transplantation. Patient clinical, biochemical data, and cardiovascular/CVE rate were monitored within 1 year. We found out that eGFR1year correlated with eGFRdischarge and calcium based on hospital discharge data (β = 0.563, p = .004 and β = 51.360, p = .026, respectively). Multivariate linear regression revealed that donor age, donor gender, and recipient eGFRdischarge (R-squared 0.65, p = .002) better predict eGFR1year than AoAC combined with recipient eGFRdischarge (R-squared 0.35, p = .006). During 1-year follow-up, four (10.81%) patients experienced cardiovascular events, which were predicted by PWV ratio (HR 7.549, p = .045), but not related to AoAC score (HR 1.044, p = .158). In conclusion, KTR without previous vascular events have quite low cardiovascular/CVE rate within 1-year follow-up. VC evaluated as AoAC on pretransplant chest X-ray together with recipient eGFRdischarge could be related to kidney function in one-year follow-up.

[LB.01.16] FACTORS RELATED TO LEFT VENTRICULAR HYPERTROPHY IN ONE YEAR FOLLOW-UP OF HEMODIALYSIS PATIENTS

Objective: The phenomenon of cardiac remodeling in dialysis population which leads to high prevalence of cardiovascular disease is every day burden for nephrologists. We aimed to analyze which factors could better indicate the presence of left ventricular hypertrophy in dialysis population. Design and method: 60 stable hemodialysis patients were screened for a prospective study. 45 patients had all data and met the inclusion criteria (no previous cardiovascular events, no cerebrovascular events). The calculated effect size for this population is 0.4052 (&agr; 0.05, &bgr; 0.90). Blood tests (including beta2-microglobulin, cystatin C), carotid femoral pulse wave velocity (cfPWV), left ventricular mass (LVM) and index, left ventricular end diastolic diameter, relative wall thickness, mean wall thickness and left ventricular ejection fraction were evaluated twice, average 1 year apart was also tested. Results: LVM and LVM index correlated with cystatin C level (r = 0.5141, p = 0.0085 and r = 0.4381, p = 0.0284 respectively), beta2-microglobulin concentration (r = 0.5759, p = 0.0025 and r = 0.5136, p = 0.0086 respectively). Change in LVM and LVM index within one year follow-up correlated with change in cfPWV (r = 0.5201, p = 0.0468 and r = 0.5518, p = 0.0266 respectively). Left ventricular end diastolic diameter, and MWT also strongly correlated with beta2-microglobulin and cystatinC. The strongest relationship revealed by linear regression indicated that for an increase of 1 m/s in cfPWV the expected increase in LVM index is 5.505 g/m2 (r-squared 0.3695, p = 0.3244, 95%CI [1.38;9.62]). During one year follow up the reverse cardiac remodeling was observed in some patients. Conclusions: Change in carotid-femoral pulse wave velocity within 1 year in dialysis population without previous cardiovascular or cerebrovascular events is associated with change in LVM index and has better descriptive value than cystatin C or beta2-microglobulin.

[PP.LB03.11] CAN ARTERIAL STIFFNESS PREDICT LARGE ARTERY DAMAGE IN SHORT TERM IN PATIENTS ON DIALYSIS?

Objective: To study a short term aortic pulse wave velocity measurement value for predicting cerebrovascular and cardiovascular events in patients on dialysis. Design and method: 26 stable dialysis patients (mean age 57.27 ± 13.97) without previous large artery damage were prospectively studied. Blood tests within 6 month were accomplished. All patients underwent two carotid-femoral pulse wave velocity measurements at the beginning of the study and after 6 months. Carotid-femoral PWV assessment was performed on the non dialysis day. We collected data about cerebrovascular and cardiovascular events during 6 month follow-up and according this divided patients into two groups (with and without events). Statistical analysis was performed using R Statistical Software. Results: During a 6 month follow-up, 2 non cardiovascular deaths, 7 cardiovascular events (atrial fibrillation, myocardial infarction) and 1 cerebrovascular (stroke) event were registered. Cerebrovascular and cardiovascular pathology was associated with an increase in beta2-microglobulin concentration (46.91 vs 33.51, 46.91, p = 0.0626) and in carotid-femoral PWV at the beginning of the study (11.4 vs 10.9, p = 0.6707) and during follow-up (12.55 vs 10.00, p = 0.0369). There was no difference between groups while comparing other laboratory parameters (albumin, cholesterol, parathyroid hormone concentration, CRP, hemoglobin concentration, calcium and phosphate level) and no correlation between carotid-femoral PWV and beta2-microglobulin values. Patients with carotid-femoral PWV >10 m/s had 2,6 higher event risk. Conclusions: Carotid-femoral PWV even in a short term follow-up helps indicate patients with higher cerebrovascular and cardiovascular risk.

753 THE INFLUENCE OF AGEs ON KIDNEY FUNCTION AMONG PATIENTS WITH METABOLIC SYNDROME

Objectives: The aim of this study was to evaluate the impact of advanced glycation end-products (AGEs) on kidney function among patients with metabolic syndrome. Methods: The retrospective cohort study included 249 patients, who were investigated in a tertiary medical centre from 2011-08-01 till 2011-12-01 and matched NCEP metabolic syndrome criterions. Kidney function was evaluated by albuminuria and glomerular filtration rate, calculated by MDRD formula. AGEs were measured using non-invasive device, the skin autofluorescence reader. AGEs were classified into three groups: 1st-from 0.9 to 1.6 (n = 70), 2nd-from 1.7 to 1.9 (n = 82), 3rd-from 2.0 to 4.0 (n = 97). The kidney function was compared to the amount of AGEs. The data was analysed by using SPSS 19.0 programs. Results: Among 249 patients, there were 159 (63.9%) women and 90 (36.1%) men. Mean age was 53.88 ± 6.18. According to the amount of albumins in urine, specimens were ascribed as normoabuminuria (89.16%), microalbuminuria (10.04%) and macroalbuminuria (0.80%). Analysing albuminuria with AGEs groups, there was no correlation found (p > 0.05). According to GFR, we distributed three groups: GFR >90mls/min/1.73m2, or normal GFR (63.14%), 60-89mls/min/1.73m2, or slightly declined GFR (35.59%), 30–59mls/min/1.73m2, or stage 3 chronic kidney disease (1.27%). We found a negative correlation between GFR and AGEs rates (Pearson correlation coefficient r = 0.232, p < 0.0001). When comparing the distribution of GFR among AGEs’ groups, we found a statistically significant difference between 1st and 3rd groups (p = 0.013). Conclusions: The quantity of AGEs is not associated with the amount of albumins in urine, but higher amount of AGEs do correlate with decreased GFR.