Theodoros Gialernios

Relationship between low-grade inflammation and arterial stiffness in patients with essential hypertension.

Background Arterial stiffness is an independent cardiovascular risk factor in hypertensive individuals. Inflammation is associated with increased arterial stiffness and is implicated in the pathogenesis of hypertension. Objectives To examine whether low-grade inflammation contributes to arterial stiffness and wave reflections independently of blood pressure, in patients with essential hypertension and in controls. Methods We studied 235 consecutive patients with uncomplicated, never-treated essential hypertension and 103 sex- and age-matched controls. The level of inflammation was evaluated with high-sensitivity C-reactive protein (hsCRP) and serum amyloid A (SAA). Arterial stiffness was assessed with carotid–femoral (c-f) and carotid–radial (c-r) pulse wave velocity (PWV), and wave reflections with augmentation index (AIx). Results In the hypertensive group, in multiple regression analysis, both PWVc-f and PWVc-r were independently correlated with log hsCRP (β = 0.56, P = 0.006 and β = 0.45, P = 0.016, respectively), whereas no correlation was found between PWV and log SAA (P = NS). No significant correlation was observed between heart-rate-corrected AIx and log hsCRP (P = NS) and log SAA (P = 0.07) in the same group. Similarly, in the control group, an independent association was observed between PWVc-f and PWVc-r with log hsCRP (β = 0.68, P = 0.05 and β = 0.74, P = 0.05 respectively), but not with log SAA (P = NS). Furthermore, no significant association was shown between heart-rate-corrected AIx and log hsCRP or log SAA (P = NS) in the control group. Conclusions In hypertensive individuals, hsCRP is related to PWV, a direct marker of arterial stiffness, but not to AIx, a measure of wave reflections. Whether inflammation might act as a pathogenetic or modulating factor in arterial stiffening in chronic hypertension has to be confirmed.

Primary prevention of sudden cardiac death in a nonischemic dilated cardiomyopathy population: reappraisal of the role of programmed ventricular stimulation.

Background— We considered the role of programmed ventricular stimulation in primary prevention of sudden cardiac death in an idiopathic dilated cardiomyopathy population. Methods and Results— One hundred fifty-eight patients with idiopathic dilated cardiomyopathy underwent programmed ventricular stimulation. Ventricular tachycardia/ventricular fibrillation was triggered in 44 patients (group I, 27.8%) versus 114 patients (group II), where ventricular tachycardia/ventricular fibrillation was not induced. Sixty-nine patients with idiopathic dilated cardiomyopathy underwent implantable cardioverter-defibrillator (ICD) implantation: 41/44 in group I and 28/114 in group II. The major end points of the study were overall mortality and appropriate ICD activation. Overall mortality during the 46.9 months of mean follow-up was not significantly different between the 2 groups. Patients with left ventricular ejection fraction ≤35% (n=119) demonstrated a higher overall mortality rate compared with the patients with left ventricular ejection fraction >35% (n=39; 16.8% versus 10.3%, log-rank P =0.025). Advanced New York Heart Association class (III and IV versus I and II) was the single independent and strongest prognostic factor of overall mortality (hazard ratio, 11.909; P <0.001; confidence interval, 3.106–45.65), as well as of cardiac mortality (hazard ratio, 14.787; P =0.001; confidence interval, 2.958–73.922). Among ICD recipients, ICD activation rate was significantly higher in group I compared with group II (30 of 41 patients–73.2% versus 5 of 28 patients–17.9%; log-rank P =0.001), either in the form of antitachycardia pacing (68.3% versus 17.9%; log-rank P =0.001) or in the shock delivery form (51.2% versus 17.9%; log-rank P =0.05). Induction of ventricular tachycardia/ventricular fibrillation during programmed ventricular stimulation in contrast to left ventricular ejection fraction was the single independent prognostic factor for future ICD activation (hazard ratio, 4.195; P =0.007; confidence interval, 1.467–11.994). Conclusions— Inducibility of ventricular tachycardia/ventricular fibrillation was associated with an increased likelihood of subsequent ICD activation and sudden cardiac death surrogate.Background—We considered the role of programmed ventricular stimulation in primary prevention of sudden cardiac death in an idiopathic dilated cardiomyopathy population. Methods and Results—One hundred fifty-eight patients with idiopathic dilated cardiomyopathy underwent programmed ventricular stimulation. Ventricular tachycardia/ventricular fibrillation was triggered in 44 patients (group I, 27.8%) versus 114 patients (group II), where ventricular tachycardia/ventricular fibrillation was not induced. Sixty-nine patients with idiopathic dilated cardiomyopathy underwent implantable cardioverter-defibrillator (ICD) implantation: 41/44 in group I and 28/114 in group II. The major end points of the study were overall mortality and appropriate ICD activation. Overall mortality during the 46.9 months of mean follow-up was not significantly different between the 2 groups. Patients with left ventricular ejection fraction ⩽35% (n=119) demonstrated a higher overall mortality rate compared with the patients with left ventricular ejection fraction >35% (n=39; 16.8% versus 10.3%, log-rank P=0.025). Advanced New York Heart Association class (III and IV versus I and II) was the single independent and strongest prognostic factor of overall mortality (hazard ratio, 11.909; P<0.001; confidence interval, 3.106–45.65), as well as of cardiac mortality (hazard ratio, 14.787; P=0.001; confidence interval, 2.958–73.922). Among ICD recipients, ICD activation rate was significantly higher in group I compared with group II (30 of 41 patients–73.2% versus 5 of 28 patients–17.9%; log-rank P=0.001), either in the form of antitachycardia pacing (68.3% versus 17.9%; log-rank P=0.001) or in the shock delivery form (51.2% versus 17.9%; log-rank P=0.05). Induction of ventricular tachycardia/ventricular fibrillation during programmed ventricular stimulation in contrast to left ventricular ejection fraction was the single independent prognostic factor for future ICD activation (hazard ratio, 4.195; P=0.007; confidence interval, 1.467–11.994). Conclusions—Inducibility of ventricular tachycardia/ventricular fibrillation was associated with an increased likelihood of subsequent ICD activation and sudden cardiac death surrogate.

Correlation of Noninvasive Electrocardiography with Invasive Electrophysiology in Syncope of Unknown Origin: Implications from a Large Syncope Database

Background: The evaluation of syncope can be expensive, unfocussed, and unrevealing yet, failure to diagnose an arrhythmic cause of syncope is a major problem. We investigate the utility of noninvasive electrocardiographic evaluation (12‐lead ECG and 24‐hour ambulatory electrocardiographic recordings) to predict electrophysiology study results in patients with undiagnosed syncope.

Assessment of cardiac function with Doppler tissue imaging in asymptomatic HIV-infected patients

Doppler tissue imaging (DTI) is a useful tool for the detection of subtle systolic function abnormalities related to the longitudinal contraction. We assessed left ventricular (LV) systolic function with DTI in 45 human immunodeficiency virus (HIV)-infected patients without any heart-related symptoms and in 30 healthy control subjects. Although conventional echocardiography showed no differences between groups, DTI revealed lower peak systolic velocities in group A patients when compared with group B ones (Sms: 8.84 ± 0.94 cm/s vs. 9.42 ± 0.84 cm/s, respectively, P < 0.001 and Sml: 9.58 ± 1.86 cm/s vs. 10.78 ± 2.07 cm/s P = 0.003). In group A patients, both peak systolic myocardial velocities at the septal (Sms) and lateral mitral annulus (Sml) correlated with CD4 lymphocyte count (P = 0.034 and 0.009, respectively). We conclude that pulse wave DTI reveals subtle and non-otherwise detectable abnormalities of the longitudinal LV contractile function in asymptomatic patients with positive HIV serology. DTI study should potentially be expanded in the population of HIV-infected patients, aiming at an early identification of LV systolic dysfunction.

Beneficial effects of angiotensin II type 1 receptor blocker antihypertensive treatment on inflammation indices: the effect of smoking.

The effect of long‐term angiotensin II type 1 receptor blocker (ARB) therapy on inflammation indices has not been fully investigated in a hypertensive population. The authors evaluated 323 consecutive nondiabetic patients (mean age, 57 years; 176 men; 92 smokers) with high renin activity and uncomplicated essential hypertension whose blood pressure levels normalized (from 163.9/100.7 mm Hg to 131.6/82.8 mm Hg) after 4 weeks of ARB or ARB/diuretic treatment. All patients underwent full laboratory evaluation (routine examination of blood and urine, liver, kidney, thyroid function, and lipid and glucose profiles), including measurement of high‐sensitivity C‐reactive protein and serum amyloid A levels, at drug‐free baseline, which was repeated after 6 months of ARB or ARB/diuretic treatment. A significant (P<.001) overall decrease was noted in both high‐sensitivity C‐reactive protein (−0.41±1.56 mg/dL) and serum amyloid A (−0.62±2.03 mg/dL), but a smaller decrease in high‐sensitivity C‐reactive protein and serum amyloid A change was seen in the smoker subgroup compared with nonsmokers (P<.05), indicating that the ARB or ARB/diuretic anti‐inflammatory effect may be adversely affected by smoking status.

Deceleration Capacity of Heart Rate Predicts Arrhythmic and Total Mortality in Heart Failure Patients

Deceleration capacity (DC) of heart rate proved an independent mortality predictor in postmyocardial infarction patients. The original method (DCorig) may produce negative values (9% in our analyzed sample). We aimed to improve the method and to investigate if DC also predicts the arrhythmic mortality.

Microalbuminuria and global myocardial function in patients with essential hypertensive

INTRODUCTION The myocardial performance index, Tei index, is a relatively new echocardiography indice which is related to parameters which express both the systolic and diastolic myocardial function. The purpose of the present study was to investigate the possible correlation of Tei index to microalbuminuria, which is an indice of kidney target-organ damage in hypertensive patients. MATERIALS AND METHODS We evaluated 9680 consecutive patients (mean age 55.2 years, 5144 male and 4536 female) with chronic uncomplicated essential hypertension and the correlation between Tei index, defined as the sum of the isovolumetric relaxation and contraction time divided by the ejection time, and kidney target damage (microalbuminuria) was evaluated. RESULTS In univariate analysis we noticed a positive correlation of Tei index with microalbuminuria (r=0.353 p<0.001). Furthermore, a significant difference was found in each Tei quartile for microalbumin levels (p<0.001). In multivariate analysis with Tei index as a dependent variable (high versus low quartile) and independent variables gender, age, body mass index, plasma glucose, heart rate, blood pressure, kidney function indices and lipids, the independent prognostic correlation to microalbuminuria was noticed (OR: 1.002 p<0.001). CONCLUSIONS In the present study we found that Tei index correlates with microalbuminuria in essential hypertensive patients. Thus we can assume that this index could be used not only for the evaluation of the global myocardial performance of hypertensive patients but also for the assessment of the cardiovascular risk in arterial hypertension since it correlates with kidney damage.

Aggravation of left ventricular diastolic dysfunction in hypertensives with coronary artery disease

We investigated the combined effects of hypertension and coronary artery disease (CAD) on left ventricular (LV) diastolic function. We examined 118 consecutive hypertensives who underwent diagnostic coronary angiography. All patients underwent a complete echocardiographic study within 24 h of catheterization by operators blind to their condition. The study participants were divided into two groups according to the presence of CAD: group A, with the disease (n=72); and group B, without (n=46). Patients with CAD exhibited lower LV fractional shortening and ejection fraction (P=0.002 and P=0.001). Hypertensives with CAD had significantly prolonged isovolumic relaxation time (IVRT) compared to those without CAD (P<0.001). Most interestingly, CAD patients had significantly worse Ema/Ama, Vp (flow propagation velocity), E/Vp and Vp/IVRT (all P<0.05). In addition, after adjusting for confounders, univariate and multivariate logistic regression analyses revealed that IVRT increases were associated with greater odds of CAD, whereas decreases in Vp or Vp/IVRT were associated with lower odds of CAD (all P⩽0.001). In hypertensives, the early recognition of LV diastolic performance alteration may be associated with the presence of significant CAD, indicating the need for more aggressive approaches both in terms of pharmacological treatment and interventional evaluation.

Primary Prevention of Sudden Cardiac Death in a Nonischemic Dilated Cardiomyopathy PopulationClinical Perspective: Reappraisal of the Role of Programmed Ventricular Stimulation

Background— We considered the role of programmed ventricular stimulation in primary prevention of sudden cardiac death in an idiopathic dilated cardiomyopathy population. Methods and Results— One hundred fifty-eight patients with idiopathic dilated cardiomyopathy underwent programmed ventricular stimulation. Ventricular tachycardia/ventricular fibrillation was triggered in 44 patients (group I, 27.8%) versus 114 patients (group II), where ventricular tachycardia/ventricular fibrillation was not induced. Sixty-nine patients with idiopathic dilated cardiomyopathy underwent implantable cardioverter-defibrillator (ICD) implantation: 41/44 in group I and 28/114 in group II. The major end points of the study were overall mortality and appropriate ICD activation. Overall mortality during the 46.9 months of mean follow-up was not significantly different between the 2 groups. Patients with left ventricular ejection fraction ≤35% (n=119) demonstrated a higher overall mortality rate compared with the patients with left ventricular ejection fraction >35% (n=39; 16.8% versus 10.3%, log-rank P =0.025). Advanced New York Heart Association class (III and IV versus I and II) was the single independent and strongest prognostic factor of overall mortality (hazard ratio, 11.909; P <0.001; confidence interval, 3.106–45.65), as well as of cardiac mortality (hazard ratio, 14.787; P =0.001; confidence interval, 2.958–73.922). Among ICD recipients, ICD activation rate was significantly higher in group I compared with group II (30 of 41 patients–73.2% versus 5 of 28 patients–17.9%; log-rank P =0.001), either in the form of antitachycardia pacing (68.3% versus 17.9%; log-rank P =0.001) or in the shock delivery form (51.2% versus 17.9%; log-rank P =0.05). Induction of ventricular tachycardia/ventricular fibrillation during programmed ventricular stimulation in contrast to left ventricular ejection fraction was the single independent prognostic factor for future ICD activation (hazard ratio, 4.195; P =0.007; confidence interval, 1.467–11.994). Conclusions— Inducibility of ventricular tachycardia/ventricular fibrillation was associated with an increased likelihood of subsequent ICD activation and sudden cardiac death surrogate.Background—We considered the role of programmed ventricular stimulation in primary prevention of sudden cardiac death in an idiopathic dilated cardiomyopathy population. Methods and Results—One hundred fifty-eight patients with idiopathic dilated cardiomyopathy underwent programmed ventricular stimulation. Ventricular tachycardia/ventricular fibrillation was triggered in 44 patients (group I, 27.8%) versus 114 patients (group II), where ventricular tachycardia/ventricular fibrillation was not induced. Sixty-nine patients with idiopathic dilated cardiomyopathy underwent implantable cardioverter-defibrillator (ICD) implantation: 41/44 in group I and 28/114 in group II. The major end points of the study were overall mortality and appropriate ICD activation. Overall mortality during the 46.9 months of mean follow-up was not significantly different between the 2 groups. Patients with left ventricular ejection fraction ⩽35% (n=119) demonstrated a higher overall mortality rate compared with the patients with left ventricular ejection fraction >35% (n=39; 16.8% versus 10.3%, log-rank P=0.025). Advanced New York Heart Association class (III and IV versus I and II) was the single independent and strongest prognostic factor of overall mortality (hazard ratio, 11.909; P<0.001; confidence interval, 3.106–45.65), as well as of cardiac mortality (hazard ratio, 14.787; P=0.001; confidence interval, 2.958–73.922). Among ICD recipients, ICD activation rate was significantly higher in group I compared with group II (30 of 41 patients–73.2% versus 5 of 28 patients–17.9%; log-rank P=0.001), either in the form of antitachycardia pacing (68.3% versus 17.9%; log-rank P=0.001) or in the shock delivery form (51.2% versus 17.9%; log-rank P=0.05). Induction of ventricular tachycardia/ventricular fibrillation during programmed ventricular stimulation in contrast to left ventricular ejection fraction was the single independent prognostic factor for future ICD activation (hazard ratio, 4.195; P=0.007; confidence interval, 1.467–11.994). Conclusions—Inducibility of ventricular tachycardia/ventricular fibrillation was associated with an increased likelihood of subsequent ICD activation and sudden cardiac death surrogate.

Primary Prevention of Sudden Cardiac Death in a Nonischemic Dilated Cardiomyopathy PopulationClinical Perspective

Background— We considered the role of programmed ventricular stimulation in primary prevention of sudden cardiac death in an idiopathic dilated cardiomyopathy population. Methods and Results— One hundred fifty-eight patients with idiopathic dilated cardiomyopathy underwent programmed ventricular stimulation. Ventricular tachycardia/ventricular fibrillation was triggered in 44 patients (group I, 27.8%) versus 114 patients (group II), where ventricular tachycardia/ventricular fibrillation was not induced. Sixty-nine patients with idiopathic dilated cardiomyopathy underwent implantable cardioverter-defibrillator (ICD) implantation: 41/44 in group I and 28/114 in group II. The major end points of the study were overall mortality and appropriate ICD activation. Overall mortality during the 46.9 months of mean follow-up was not significantly different between the 2 groups. Patients with left ventricular ejection fraction ≤35% (n=119) demonstrated a higher overall mortality rate compared with the patients with left ventricular ejection fraction >35% (n=39; 16.8% versus 10.3%, log-rank P =0.025). Advanced New York Heart Association class (III and IV versus I and II) was the single independent and strongest prognostic factor of overall mortality (hazard ratio, 11.909; P <0.001; confidence interval, 3.106–45.65), as well as of cardiac mortality (hazard ratio, 14.787; P =0.001; confidence interval, 2.958–73.922). Among ICD recipients, ICD activation rate was significantly higher in group I compared with group II (30 of 41 patients–73.2% versus 5 of 28 patients–17.9%; log-rank P =0.001), either in the form of antitachycardia pacing (68.3% versus 17.9%; log-rank P =0.001) or in the shock delivery form (51.2% versus 17.9%; log-rank P =0.05). Induction of ventricular tachycardia/ventricular fibrillation during programmed ventricular stimulation in contrast to left ventricular ejection fraction was the single independent prognostic factor for future ICD activation (hazard ratio, 4.195; P =0.007; confidence interval, 1.467–11.994). Conclusions— Inducibility of ventricular tachycardia/ventricular fibrillation was associated with an increased likelihood of subsequent ICD activation and sudden cardiac death surrogate.Background—We considered the role of programmed ventricular stimulation in primary prevention of sudden cardiac death in an idiopathic dilated cardiomyopathy population. Methods and Results—One hundred fifty-eight patients with idiopathic dilated cardiomyopathy underwent programmed ventricular stimulation. Ventricular tachycardia/ventricular fibrillation was triggered in 44 patients (group I, 27.8%) versus 114 patients (group II), where ventricular tachycardia/ventricular fibrillation was not induced. Sixty-nine patients with idiopathic dilated cardiomyopathy underwent implantable cardioverter-defibrillator (ICD) implantation: 41/44 in group I and 28/114 in group II. The major end points of the study were overall mortality and appropriate ICD activation. Overall mortality during the 46.9 months of mean follow-up was not significantly different between the 2 groups. Patients with left ventricular ejection fraction ⩽35% (n=119) demonstrated a higher overall mortality rate compared with the patients with left ventricular ejection fraction >35% (n=39; 16.8% versus 10.3%, log-rank P=0.025). Advanced New York Heart Association class (III and IV versus I and II) was the single independent and strongest prognostic factor of overall mortality (hazard ratio, 11.909; P<0.001; confidence interval, 3.106–45.65), as well as of cardiac mortality (hazard ratio, 14.787; P=0.001; confidence interval, 2.958–73.922). Among ICD recipients, ICD activation rate was significantly higher in group I compared with group II (30 of 41 patients–73.2% versus 5 of 28 patients–17.9%; log-rank P=0.001), either in the form of antitachycardia pacing (68.3% versus 17.9%; log-rank P=0.001) or in the shock delivery form (51.2% versus 17.9%; log-rank P=0.05). Induction of ventricular tachycardia/ventricular fibrillation during programmed ventricular stimulation in contrast to left ventricular ejection fraction was the single independent prognostic factor for future ICD activation (hazard ratio, 4.195; P=0.007; confidence interval, 1.467–11.994). Conclusions—Inducibility of ventricular tachycardia/ventricular fibrillation was associated with an increased likelihood of subsequent ICD activation and sudden cardiac death surrogate.