Higher Diastolic Pressure Research Articles

Risk Factors for Early Bioprosthetic Heart Valve Degeneration in Patients with Rheumatic Fever

Background: Rheumatic Fever (RF) is an immunological disorder related to exposure to group a streptococcus and rheumatic heart disease is an important cause of valve replacement. Bioprosthetic valves tend to degenerate faster in rheumatic patients, presumably due to immune mechanisms. Objectives: The study sought to assess whether classic risk factors for cardiovascular disease are related to Early Valve Degeneration (EVD) in patients with RF. Design: Case-control study. Methods: Patients with RF and EVD or Late Valve Degeneration (LVD) were selected. The cutoff point was 9 years for a second valve surgery. Data regarding cardiovascular risk of the two groups were obtained and compared. A data imputation analysis was used to deal with missing data. Results: Twenty valves were included in the primary outcome analysis and 33 were used for data imputation. The mean age for the first valve replacement was 40.6 (±6.2) years for the EVD group and 31.1 (±12.3) years for the LVD group, (p = 0.03), which remained significant after data imputation. For blood pressure, there was a non-statistically significant trend towards higher diastolic pressure in patients with EVD in relation to LVD (86.8 (±7.2) and 79 (±10.9) mmHg, respectively, p = 0.08), which after data imputation was statistically higher than that of the LVD group (88 [85.4-88.8] and 77 [73-84.5] mmHg, respectively, p = 0.001). Lipid profile was also worse on the EVD group. Conclusions: The data suggest that EVD may result more from aging and cardiovascular factors than from immunological mechanisms, suggesting stricter targets for cardiovascular disease in these patients.

Implication of noise exposure on hearing with emphasis to hOGG1 and GPx-1 polymorphisms and HO-1 protein among textile workers

Noise exposure is a health hazard in the textile industry. In cochlear hair cells, DNA damage caused by 8-oxoguanine (8-oxo G) can result in noise-induced hearing loss. Human 8-hydroxyguanine glycosylase (hOGG1) is a DNA repair enzyme that excises (8-oxo G) in the DNA and repairs DNA damage. Glutathione peroxidase-1 (GPx) is a crucial antioxidant enzyme that aids in limiting cochlear damages. Heme oxygenase-1 (HO-1) is a stress-inducible protein with a high fold change in the hair cells of the cochlea. The study aimed to investigate the association of either hOGG1 and GPx-1 polymorphisms with audiometric notches and HO-1 protein among textile workers. hOGG1 and GPx genotypes were analyzed by PCR–RFLP, and HO-1 levels were measured by ELISA in 115 male textile workers. Blood pressure and audiogram were performed. Results recorded the relation between audiometric notches and ear complaints among workers. Older age workers showed audiometric notches at > 25 dB with a significant decrease in HO-1 levels and higher levels in workers with normal audiogram. Ser/Cys genotype of hOGG1 gene was associated with age and work duration while CC genotype of GPx is associated with HO-1 levels and diastolic pressure. Ser/Cys genotype of hOGG1 gene was associated with age while Cys/Cys genotype was associated with work duration among workers. CC genotype of GPx gene was associated with higher HO-1 levels and TT genotype was associated with high diastolic pressure. Finally, hearing impairment was dependent on the duration of exposure to noise, older age, and the presence of heterozygote TC genotype of GPx gene among textile workers.

20 years on – the measurement of blood pressure and detection of hypertension in children and adolescents: a national descriptive survey

In 1997 a survey identified a general lack of standardisation of blood pressure (BP) measurement and little consensus on the criteria for diagnosing hypertension amongst paediatricians. We have conducted a new online survey in 2021, to compare clinical practice between the two time periods. A national quality improvement survey was approved by the GAPRUKI committee and then circulated to consultant-grade general paediatricians. 125 analysable replies from 34 different sites were received and compared with the 1997 data. 106 (84.8%) reported clinic nurse involvement in BP measurement, more than twice than reported previously (40.6%). Most paediatricians (53.6%) now rely on oscillometric devices, whereas the mercury sphygmomanometer was favoured previously (82.7%). If assessing BP manually (n = 89), most (79.8%) now use Korotkoff phase V as the auscultatory endpoint for diastolic BP (phase IV was previously used (52.1%)). Diagnostic criteria of hypertension, the criteria (≥95th centile for gender, age and height) were constant, and 100% of paediatricians diagnosed it using systolic BP, but only 43 (34.4%) used diastolic BP, a decrease from 79.4% previously. Ambulatory BP Monitoring was six times more available than in 1997 (81.6% vs 13.6%). Similar to previous findings, only 12 (9.6%) paediatricians would manage hypertensive patients themselves, however 82 (72.6%) would keep general paediatric input. There have been important changes in the assessment of BP in children, including increased nurse involvement and greater use of technology. However, fewer paediatricians are responding to high diastolic pressures than twenty years ago.

Age-specific differences in hypertension combination management and associated factors influencing treatment choice.

The current hypertension guideline emphasizes combination therapy, especially single-pill combination therapy (SPC). However, few studies compared the prevalence and factors associated with initial therapy choice across heterogeneous age groups in a current population. First, the authors consecutively identified 964 treatment naïve hypertensive patients in a large academic hospital from 01/31/2019 to 01/31/2020. All patients were grouped into (1) young aged, age<55; (2) middle-aged, 55≤age<65; and (3) older aged, age ≥65. The multivariable regression model examined the factors associated with the combination therapy by age group. Overall, 80 (8.3%) were young, 191 (19.8%) were middle, and 693 (71.9%) were older aged. Compared with older age, younger patients were more likely to be male, highly educated, regularly exercised, have metabolic syndrome, and less likely to have cardiovascular-related comorbidities, with a lower systolic but higher diastolic pressure. Only one in five patients used SPC, and the prevalence decreased with age. Besides hypertension grade, young patients without catheterization or echo test were less likely to receive multiple therapies, while older patients who were male with lower weight and lower risk levels were less likely to receive multiple therapies. In conclusion, combination therapy, especially SPC, was underused in the targeted hypertensive population. Our contemporary population study showed that young patients (<55) without a history of catheterization or echo examination and male older-aged (≥65) patients with low-risk classification were the population most likely to be neglected. Such information can help triage medical care resources in improving SPC use.

Assessment of the psychophysiological state of management staff of different ages and the risks of health disorders

The main reason for the low life expectancy of the population and the deterioration of the demographic situation in the Russian Federation is the high mortality of employees of working age. One of the significant directions in the problem of ensuring the preservation of the health of workers is to ensure the preservation of labor longevity.&#x0D; The study aims to analyze the features of labor activity in a daily cycle during the week and the functional state of employees of the management staff of industrial enterprises, depending on age characteristics, to develop measures to prevent the development of unfavorable functional conditions, occupational pathology.&#x0D; The object of the study are employees of neuropsychiatric mental labor, including 140 employees of the management staff at the two television enterprises, men aged 25 to 65±1.15 years, with work experience in a managerial position from 3 to 20±0.99 years. Physiological studies included assessment of the functional state of the central nervous system (CNS) and the cardiovascular system by conventional methods.&#x0D; Scientists presented a scientific justification of the problem of ensuring professional performance depending on gender and age characteristics, which are based on insufficiently identified physiological features of the formation of fatigue, fatigue, the development of overstrain of the functional systems of the body of workers in modern forms of labor, to predict possible changes in the health of workers in order to prolong working longevity.&#x0D; As a result of the analysis of data on changes in the functional state of workers, we found: a significant spread of arterial hypertension in the groups of 30–39 and 40–49 years, low representation of the "weak" type of nervous system and high diastolic pressure in people with arterial hypertension, with a "strong" type of nervous system, a tendency to affect rigidity in the group of employees with arterial hypertension.&#x0D; Limitations. There are quantitative restrictions related to the volume of the questionnaire survey.&#x0D; Ethics. All studies were conducted in accordance with the principles of biomedical ethics and approved by the Local Ethics Committee of Izmerov Research Institute of Occupational Health, Moscow (Protocol No. 4 of 04/14/2021). Informed consent. Each participant of the study submitted a voluntary written informed consent signed by him after explaining to him the potential risks and benefits, as well as the nature of the upcoming study.

Association of Sedentary Time With Cardiocerebral Deaths: A Prospective Cohort Study

Abstract Background To explore the association of sedentary time with cardiocerebral deaths. Methods A total of 12,608 community residents aged 35 years or above in Jiangxi Province who took part in “the study on prevalence of major cardiovascular diseases and key techniques in China” during 2013–2014 were enrolled in this prospective, observational cohort study. Sedentary time was obtained through baseline questionnaire, and all death events were collected by telephone follow-up, information report from the departments of public health in township health centers and village doctors, and death surveillance system of Jiangxi Center for Disease Control and Prevention. Cox proportional hazard regression model was used to evaluate the association of sedentary time with cardiocerebral deaths. Results A total of 11,744 participants were included in final analysis. During an average 5.4 years of follow-up (63,298 person-year), 796 all-cause deaths occurred, including 373 cardiocerebral deaths. The difference of cardiocerebral death rate was statistically significant in 3 groups of &amp;lt;6 h/d (2.9%), 6–8 h/d (3.9%), and &amp;gt;8 h/d (5.4%). Kaplan–Meier curve showed that there was a significant difference in the cumulative mortality among the 3 groups (log rank χ2 = 17.27, P &amp;lt; 0.01). Cox regression analysis showed that after adjusting for relevant confounding factors, older age, high diastolic pressure and body mass index, male, country of residence, unemployment, and long sedentary time were risk factors for cardiocerebral deaths. Compared with the &amp;lt;6 h/d group, the risk of cardiocerebral deaths increased by 68.3% (HR = 1.683, 95% CI: 1.186–2.388) for participants with sedentary time of &amp;gt;8 h/d. Conclusions Long sedentary time independently increases the risk of cardiocerebral deaths.

Abstract 10899: Excessive Right Ventricular Afterload in Pulmonary Arterial Hypertension: Effects on Diastolic Function and the Left Ventricle

Introduction: Right ventricular (RV) diastolic dysfunction in pulmonary arterial hypertension (PAH) remains poorly understood. In this study, we used RV pressure-volume (PV) loops to assess RV diastology as a function of afterload in PAH. Methods: RV PV loops were prospectively measured in control (n=9) and PAH (n=39) patients at rest and during supine bike exercise. PAH patients were stratified by effective arterial elastance (Ea), a lumped measure of total afterload, into two groups: high afterload (HA, n=20) and severe afterload (SA, n=19). Results: PAH groups were matched with respect to age, sex, and PAH medication usage. Ea at rest and exercise was higher in SA PAH (1.8 vs. 0.6 mmHg/ml, P &lt;0.0001 at rest; 2.3 vs 0.8 mmHg/ml, P &lt; 0.0001 with exercise). In the SA group, RV end-diastolic pressure (RVEDP) was higher at rest (13.3 vs 7.6 mmHg, P = 0.0017) and rose markedly with exertion (23.4 vs 13.1 mmHg, P=0.0001). Because RV volumes changed similarly in both groups, SA patients exhibited stiffer RVs (dP/dV 0.30 vs 0.11 mmHg/mL, P=.024). To understand pericardial-interventricular interactions, we calculated the RVEDP-to-pulmonary capillary wedge pressure (PCWP) ratio and the left ventricular (LV) transmural filling pressure (LVTMFP). RVEDP/PCWP was substantially higher in SA (2.1 vs 1.0, P=.005). Therefore, even though PCWP rose considerably in SA (mean 16 mmHg), exercise LVTMFP was significantly reduced in SA vs HA PAH (-7.5 vs 2.55 mmHg, P=0.002). Along with reduced LV size seen by concomitant echo, we thus revealed blunted LV filling specifically in SA PAH. Accordingly, exercise cardiac index, stroke volume index, and LV stroke work index were all markedly reduced in SA PAH. Conclusions: Severe afterload in PAH results in high RV diastolic pressures and RV stiffening, which in turn blunt LV filling and LV output with exertion. Due to ventricular interactions, exercise PCWP may rise considerably in PAH, thus reducing its ability to differentiate from left heart disease.

Biomass using tribal women exhibited respiratory symptoms, hypertensive risks and abnormal pulmonary function

In rural areas of developing countries, solid fuels are still widely used for cooking, heating, and lighting purposes. This study investigates the effects of household air pollutants (HAPs) exposure on the occurrence of respiratory symptoms, blood pressure, and lung function. In this study, we randomly selected 123 (83 biomass and 40 clean fuel user) subjects to assess the impact of smoke generated from solid biomass fuel by assessing their health status along with the ventilation pattern of the kitchens and living rooms. HAPs (PM10, PM2.5, and CO) and different health parameters were measured along with monitoring of self-reported health symptoms for a consecutive period of eight months. Results revealed that the concentration of CO, PM2.5, and PM10 were found highest in biomass using households. Higher odds of the upper respiratory symptoms, runny nose (OR: 4.08, 95% CI: 1.22–22.14, p < 0.03), nasal congestion (OR: 9.07, 95% CI: 1.39–97.89, p < 0.01) and the odds of the lower respiratory symptoms like wheezing (OR: 1.62, 95% CI: 1.23–10.94, p < 0.01), breathlessness (OR: 4.44, 95% CI: 1.3–14.75, p < 0.01), chest tightness (OR: 4.89, 95% CI: 1.23–22.14, p < 0.03) and dry cough (OR: 3.661, 95% CI: 1.05–12.25, p < 0.04) were significantly higher in biomass fuel user. Similarly higher systolic (+11.41 mmHg), higher diastolic pressure (+3.3 mmHg), higher pulse pressure (+8.11 mmHg), and a 6 mmHg higher mean arterial pressure among biomass fuel using tribal women. The risk of hypertension was significantly (p < 0.03) higher (OR: 3.04; 95% CI: 1.18–7.89) among solid biomass fuel users. The lung abnormality was recorded 28.91% (OR: 5.02, 95% CI: 1.50 to 16.56, p < 0.01) among biomass fuel user. Finally, it is suggested that the use of efficient cookstoves, increase in cross ventilation, and cleaner fuel are urgently needed to curb the pollution load.

Non-invasive diagnostics of blockage growth in the descending aorta-computational approach

Atherosclerosis causes blockages to the main arteries such as the aorta preventing blood flow from delivering oxygen to the organs. Non-invasive diagnosis of these blockages is difficult, particularly in primary healthcare. In this paper, the effect of arterial blockage development and growth is investigated at the descending aorta on some possible non-invasive assessment parameters including the blood pressure waveform, wall shear stress (WSS), time-average WSS (TAWSS) and the oscillation shear index (OSI). Blockage severity growth is introduced in a simulation model as 25%, 35%, 50% and 65% stenosis at the descending aorta based on specific healthy control aorta data clinically obtained. A 3D aorta model with invasive pulsatile waveforms (blood flow and pressure) is used in the CFD simulation. Blockage severity is assessed by using blood pressure measurements at the left subclavian artery. An arterial blockage growth more than 35% of the lumen diameter significantly affects the pressure. A strong correlation is also observed between the ascending aorta pressure values, pressure at the left subclavian artery and the relative residence time (RRT). An increase of RRT downstream from the stenosis indicates a 35% stenosis at the descending aorta which results in high systolic and diastolic pressure readings. The findings of this study could be further extended by transferring the waveform reading from the left subclavian artery to the brachial artery.Graphical abstract

Functional and structural efficacy of a novel combinational therapy of aflibercept and timely focal/grid photocoagulation in diabetic macular oedema: do clinical study results compare favourably with a standard-of-care treated real-world population?

To evaluate treatment efficacy in diabetic macular oedema (DME) comparing a study population receiving combined intravitreal vascular endothelial growth factor (VEGF) inhibition and focal/grid photocoagulation with a matched, real-world population receiving standard of care treatment. In an exploratory study, we included 43 eyes from 32 patients from a previously published study as well as 46 eyes from 38 standard-of-care patients. The study population had received a loading dose of three monthly aflibercept injections followed by focal/grid photocoagulation and additional aflibercept pro re nata. Principal measurements at 12 months were numbers of intravitreal injections, best corrected visual acuity (BCVA) and central retinal thickness (CRT). At baseline, there were no differences between groups regarding age, sex, body mass index, haemoglobin A1 C, systolic pressure or type of diabetes, but the study population had a higher diastolic pressure (81.6 versus 72.1 mmHg, p = 0.03) and a lower duration of diabetes (12.3 versus 23.2 years, p = 0.03). At month 12, patients in the study group had a higher visual acuity (79.6 versus 74.3 ETDRS letters, p = 0.03), despite having received fewer aflibercept injections (4.4 versus 5.9, p < 0.01) with a higher likelihood of having only received the three mandatory injections in the loading phase (39.5% versus 13.0%, p = 0.01). In comparison to a matched, real-world DME-population, patients in combined treatment with intravitreal aflibercept and postloading focal/grid photocoagulation obtained a better functional outcome despite having received fewer intravitreal injections. Future randomized studies are needed to evaluate the long-term efficacy of this combined treatment regimen.

Pathophysiological, haemodynamic and prognostic implications of left atrial dysfunction in cardiac amyloidosis and other cardiomyopathies with hypertrophic phenotype

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND &amp; PURPOSE. Left atrial function (LAF) is a determinant of clinical status and outcome in many cardiac disorders, including cardiac amyloidosis (CA). Aim of this study is to explores the LAF in CA and other cardiomyopathies with hypertrophic phenotype, and its consequences on cardiovascular haemodynamics, right ventricular function and survival. METHODS. We enrolled 50 patients with CA (26 AL and 24 wtATTR) and 75 with hypertrophic phenotype (LVH group) [25 hypertrophic cardiomyopathy (HCM) pts, 25 hypertensive pts (HypCM), and 25 pts with aortic stenosis (AS)]. LAF was analysed using the phasic method [LAEI as reservoir, LAPEF as conduit, LAAEF as active pump and TLAEF as total emptying function; see figure 1] by LA volumes determination. RESULTS. ATTR patients showed higher LA dimensions and impaired reservoir and total LA emptying function (TLAEF) compared to AL without differences LAF. Compared to the LVH group, CA patients showed higher LA dimension with impaired LAF in all phasic parameters, higher LV filling pressures and reduced biventricular function. We further divided CA and LVH patients into four subgroups based on the presence or absence of LA dysfunction (LADys+ for TLAEF values below the median: &amp;lt;50.2%; range 9.3-70.9%]. Among the groups, patients with CA/LADys+ showed worst clinical status, higher pulmonary pressures (sPAP) and lower TAPSE and TAPSE/sPAP ratio values. After a median follow-up of 24 months, 19 patients died from cardiovascular (CV) causes (15 in CA/LADys+ group and 4 in LVH/LADys+). The overall survival free of CV death was 64% in CA/LADys+ and 85% in LVH/LADys+ (4/26) group [log-rank χ2 29.6; p &amp;lt; 0.0001]. A sequential multivariate model was employed to assess whether LAF could predict CV deaths: TLAEF was entered together with established clinical and echocardiographic parameters (NYHA functional class, LAVI, E/Em, sPAP, TAPSE and TAPSE/sPAP ratio). At the final backward analysis, LAVI, TAPSE/sPAP and TLAEF were independent prognosticators of CV death. CONCLUSIONS. LAF is significantly more impaired in CA than LVH group and is associated with worst clinical status, RV dysfunction and higher LV filling and pulmonary pressure. Moreover, LADys is a frequent feature of CA and significantly associated with higher CV mortality. We suggests that LADys in LVH group could results from chronic pressure overload due to LA"s exposure to high LV diastolic pressure (impaired LV compliance). In CA, LADys could also be determined by direct LA infiltration. The pathophysiological result is a progressive LA remodelling with increased LA pressure, consequent backward transmission to the pulmonary venous system and, ultimately, RV dysfunction. TLAEF is parameter of LAF that correlates with increased pulmonary vascular resistance (measured elsewhere with cardiac catheterisation) and RV dysfunction. In CA, it seems promising as marker of the haemodynamic consequences of LADys and CV mortality. Abstract Figure 1 Abstract Figure 2

Impaired Diastolic Function Predicts Improved Ischemic Myocardial Flow by Mechanical Left Ventricular Unloading in a Swine Model of Ischemic Heart Failure.

Background: Impact of mechanical left ventricular (LV) unloading on myocardial tissue perfusion and its regulating factors remain unclear. This study was conducted to elucidate the predictors of regional blood flow (RBF) improvement by mechanical LV unloading.Materials and Methods: One to four weeks after percutaneous induction of myocardial infarction (MI), Yorkshire pigs (n = 15) underwent mechanical LV unloading using Impella CP. Hemodynamic parameters were collected prior to LV unloading. RBF in infarct, border and remote myocardium were measured by fluorescent microsphere injections before and 120 min after LV unloading.Results: RBF showed variable responses to mechanical LV unloading. While infarct RBF improved in general (0.33 ± 0.13 to 0.42 ± 0.19 mL/min/g, p = 0.06), there were a few pigs that showed little improvement. Meanwhile, there were no clear trends in the border (1.07 ± 0.47 to 1.02 ± 0.65 mL/min/g, p = 0.73) and remote myocardial RBF (1.25 ± 0.52 to 1.23 ± 0.68 mL/min/g, p = 0.85). In the simple linear regression analysis, cardiac output, mean pulmonary arterial wedge pressure, mean left atrial pressure, minimum LV pressure, end-diastolic LV pressure, maximum dP/dt, slope of end-diastolic pressure-volume relationship (EDPVR) and end-diastolic wall stress were significantly associated with % change of infarct RBF. In the multiple regression model, slope of EDPVR and maximum dP/dt remained as independent predictors of infarct RBF change.Conclusion: Steeper EDPVR and lower maximum dP/dt were associated with increased blood perfusion in the infarct area after LV unloading. Our data suggests mechanical LV unloading is more beneficial in post-MI patients with high diastolic pressure associated with increased LV stiffness and in those with worse cardiac contractility.

Coronary Flow and Unloading in Acute Myocardial Infarction Shock

In patients with cardiogenic shock that undergo successful coronary intervention, there are still factors complicating myocardial recovery. There is room for improvement in coronary flow using mechanical circulatory devices, specifically by left ventricular unloading. This idea was further explored in a research study using pigs. Results showed that subjects with acute myocardial infarction who have reduced cardiac contractility and/or high diastolic pressure would benefit from support strategies targeting left ventricular unloading.

Lung Ultrasound B-lines as a Surrogate Marker for High Left Ventricular Diastolic Pressures; a bed-side Diagnostic tool

Background: We studied the diagnostic accuracy of B-lines (comet-tail sign) on bedside lung US, NT-proBNP, E/e` on ECHO in differentiation of the causes of acute dyspnea in the emergency setting. Major advantages include bedside availability, no radiation, high feasibility and reproducibility, and cost efficiency. Methods: Our prospective study was performed at the alazhar university hospital, Cairo, Egypt, between July 2019 and March 2020. All patients underwent lung ultrasound examinations, along with TTE, laboratory testing, including rapid NT-proBNP testing. Results: The median E/e’ levels in patients with B-profile were 18, compared with a median of 7.4 in the subjects with A-profile (P =&lt; 0.0001 CI = -9.649 to -7.044). It was found that the sensitivity and the specificity of detecting B-profile on ultrasound is high when E/e’ &gt; 15.5 (95.0% and 83.0% consecutively), which concluded the high correlation between finding B profile on U/S chest and elevated left ventricle filling pressure in a patient presenting with picture of suggestive of heart failure Conclusion: Chest ultrasound can be used as screening test for the evaluation of patients with suspicion of heart failure with excellent sensitivity and good specificity.

COMPARISON OF ANXIETY LEVEL, BLOOD PRESSURE AND PULSE PARAMETERS OF PATIENTS WITH AND WITHOUT CORONARY ANGIOGRAPHY EXPERIENCE: A CROSS-SECTIONAL STUDY

Objective: The study aimed to compare state and trait anxiety, blood pressure, and heart rate of patients with and without coronary angiography experience who undergo coronary angiography intervention. Methodology: This study is cross-sectional comparative research. A total of 160 patients, including 80 patients undergo for the first time coronary angiography and 80 patients with at least one experience of coronary angiography were included in the sample of the study. In the study, data were collected using 'Patient Information Form' and 'State-Trait Anxiety Inventory', blood pressure measurement device, and pulse oximeter. Results: The mean of state anxiety scores of the patients with and without CA experience were 39.35±5.31 and 39.98±4.04, respectively; (p=0.395). The mean of trait anxiety scores of the patients with and without CA experience were 44.73±6.84 and 44.51±6.05, respectively (p=0.826). There was no statistically significant difference observed in state and trait anxiety between two groups. Before the CA procedure, the systolic and diastolic blood pressure average of the patients with CA experience were statistically higher than those without CA experience (p<0.05). Conclusion: The anxiety levels of the patients before the CA were observed to be similar and moderate, regardless of their CA experience. It was observed that patients with CA experience before CA procedure had higher systolic and diastolic blood pressures compared to the group without experience.

BIOCHEMICAL DISORDER OBSERVED IN A DYSAUTONOMIC: ABOUT A CASE

The autonomic nervous system (SNA) innervates all the organs and ensures the homeostasis of the body, the disorder of the latter causes a pathology called dysautonomy in this work we will try to report the biochemical disorders observed in a dysautonomic patient. This is a 32-year-old patient who went back to the cardiology department of the 3rd military hospital of Laayoune for high Blood pressure and headaches a complete etiological assessment is done and who found hyperlipidemia and hyperglycemia echocardiography is normal, holter tensionel showed high diastolic arterial pressure exploration of the autonomic nervous system gave sympathetic hyperactivity. Biochemical disorders have defined the metabolic syndrome, which is strongly related to morbidity and cardiovascular mortality. The laboratory plays a valuable role in determining the criteria defining metabolic syndrome.

Effect of intimal flap motion on flow in acute type B aortic dissection by using fluid‐structure interaction

A monolithic, fully coupled fluid-structure interaction (FSI) computational framework was developed to account for dissection flap motion in acute type B aortic dissection (TBAD). Analysis of results included wall deformation, pressure, flow, wall shear stress (WSS), von Mises stress and comparison of hemodynamics between rigid wall and FSI models. Our FSI model mimicked realistic wall deformation that resulted in maximum compression of the distal true lumen (TL) by 21.4%. The substantial movement of intimal flap mostly affected flow conditions in the false lumen (FL). Flap motion facilitated more flow entering the FL at peak systole, with the TL to FL flow split changing from 88:12 in the rigid model to 83:17 in the FSI model. There was more disturbed flow in the FL during systole (5.8% FSI vs 5.2% rigid) and diastole (13.5% FSI vs 9.8% rigid), via a λ2 -criterion. The flap-induced disturbed flow near the tears in the FSI model caused an increase of local WSS by up to 70.0% during diastole. This resulted in a significant reduction in the size of low time-averaged WSS (TAWSS) regions in the FL (113.11 cm2 FSI vs 177.44 cm2 rigid). Moreover, the FSI model predicted lower systolic pressure, higher diastolic pressure, and hence lower pulse pressure. Our results provided new insights into the possible impact of flap motion on flow in aortic dissections, which are particularly important when evaluating hemodynamics of acute TBAD. NOVELTY STATEMENT: Our monolithic fully coupled FSI computational framework is able to reproduce experimentally measured range of flap deformation in aortic dissection, thereby providing novel insights into the influence of physiological flap motion on the flow and pressure distributions. The drastic flap movement increases the flow resistance in the true lumen and causes more disturbed flow in the false lumen, as visualized through the λ2 criterion. The flap-induced luminal pressure is dampened, thereby affecting pressure measures, which may serve as potential prognostic indicators for late complications in acute uncomplicated TBAD patients.

FACTORS ASSOCIATED WITH PREVALENT LENS OPACITIES IN CHINESE AMERICAN ADULTS: THE CHINESE AMERICAN EYE STUDY

ABSTRACT Purpose To identify risk factors associated with lens opacities in Chinese Americans. Methods A cross-sectional population-based study of 4,582 Chinese Americans ≥50 years residing in Monterey Park, California. Participants completed a comprehensive clinical examination with lens assessment using the Lens Opacities Classification System II, with lens opacities defined by a grade ≥2 in either eye. Participants were considered to have nuclear-only, cortical-only, or posterior subcapsular (PSC)-only if that was the only type of opacity present in both eyes. Results Cortical-only opacity was associated with older age, diabetes mellitus (OR 1.5, 95%CI 1.1–2.1), and family history of cataracts (OR 1.5, 95%CI 1.2–1.9). Nuclear-only opacity was associated with older age, diabetes mellitus (OR 1.4, 95%CI 1.1–1.9), greater waist-to-hip ratio (OR 1.2, 95%CI 1.1–1.4), and high-density lipoprotein (OR 1.1, 95%CI 1.02–1.2). Mixed-type opacities were associated with older age, greater waist-to-hip ratio (OR 1.3, 95%CI 1.1–1.6), and higher HbA1 c (OR 1.3, 95%CI 1.1–1.4). Taller height (OR 0.7, 95%CI 0.6–0.8), greater weight (OR 0.98, 95%CI 0.97–0.99), and higher diastolic pressure (OR 0.98, 95%CI 0.96–0.99) were protective. Conclusion CHES identified a strong, dose–response association between age and all types of prevalent lens opacities, which suggests an increasing cataract burden in Chinese Americans based on aging populations. CHES results demonstrate general consistency with previous population-based studies in regard to more sedentary lifestyle exposures (e.g., Westernized lifestyle) and prevalent cortical-only, nuclear-only, and mixed-type opacities, yet also identified further sedentary lifestyle exposures associated with prevalent lens opacities. Improved glycemic control and a more active lifestyle that minimizes factors contributing to metabolic syndrome may help reduce the burden of vision loss associated with lens opacities.

Predictive factors of rapid linear renal progression and mortality in patients with chronic kidney disease

BackgroundRisk factors predictive of rapid linear chronic kidney disease (CKD) progression and its associations with end-stage renal disease (ESRD) and mortality requires further exploration, particularly as patients with linear estimated glomerular filtration rate (eGFR) trajectory represent a clear paradigm for understanding true CKD progression.MethodsA linear regression slope was applied to all outpatient eGFR values for patients in the Salford Kidney Study who had ≥2 years follow-up, ≥4 eGFR values and baseline CKD stages 3a-4. An eGFR slope (ΔeGFR) of ≤ − 4 ml/min/1.73m2/yr defined rapid progressors, whereas − 0.5 to + 0.5 ml/min/1.73m2/yr defined stable patients. Binary logistic regression was utilised to explore variables associated with rapid progression and Cox proportional hazards model to determine predictors for mortality prior to ESRD.ResultsThere were 157 rapid progressors (median ΔeGFR − 5.93 ml/min/1.73m2/yr) and 179 stable patients (median ΔeGFR − 0.03 ml/min/1.73m2/yr). Over 5 years, rapid progressors had an annual rate of mortality or ESRD of 47 per 100 patients compared with 6 per 100 stable patients. Factors associated with rapid progression included younger age, female gender, higher diastolic pressure, higher total cholesterol:high density lipoprotein ratio, lower albumin, lower haemoglobin and a urine protein:creatinine ratio of > 50 g/mol. The latter three factors were also predictive of mortality prior to ESRD, along with older age, smoking, peripheral vascular disease and heart failure.ConclusionsThere is a heterogenous interplay of risk factors associated with rapid linear CKD progression and mortality in patients with CKD. Furthermore, rapid progressors have high rates of adverse outcomes and require close specialist monitoring.

Neutrophil gelatinase-associated lipocalin is a predictor of complications in the early phase of ST-elevation myocardial infarction.

Aim To evaluate a correlation of serum level of neutrophil gelatinase-associated lipocalin (NGAL) to the risk of the occurrence of complications in patients with the early phase of ST-segment elevation myocardical infarction (STEMI) treated with fibrinolytic therapy prior to percutaneous coronary intervention (PCI). Methods A total of 54 patients with the diagnosis of STEMI treated with fibrinolytic therapy (alteplase) prior to PCI were included. Patients were admitted to the Intensive Care Unit (ICU) of Clinic for Heart, Blood Vessel and Rheumatic Diseases in the period January to March 2018. All patients underwent coronary angiography and PCI within the maximum of 48 hours delay after fibrinolysis, according to the hemodynamic and electrical stability and PCI availability. Blood samples were taken immediately after admission prior to fibrinolytic administration. Patients were divided into two groups according to NGAL values (less or more than 134.05 ng/mL). Results Higher values of NGAL have effect on a higher mean systolic and diastolic pressure (p=0.001 and p=0.003, respectively). Patients with higher NGAL values also have higher values of brain natriuretic peptide (p=0.0001) and highly sensitive troponin I (p=0.002). In that group relative risk (RR) for lethal outcome was 6.4 times significantly higher (p=0.002), for the development of heart failure 2.88 times (p=0.0002), for post-myocardial infarction angina pectoris 2.24 times (p=0.0158), and for ventricular rhythm disturbances (ventricular tachycardia, ventricular fibrillation) 1.96 times higher (p=0.0108). Conclusion Increased NGAL value is related to an unfavourable outcome of patients in the early phase of STEMI treated with fibrinolytic therapy prior to PCI.