Idiopathic Arterial Hypertension Research Articles

The state of cardiorespiratory system in female students with idiopathic arterial hypertension under treadmill training

Annotation. One of the most widespread pathogenic condition, among young women, is idiopathic arterial hypertension which significantly worsen the life condition, learning abilities and in future can lead to the development of arterial hypertension, ischemic heart disease, complicate course of the pregnancy and delivery. The aim of the research was to examine the functional state of cardiorespiratory system in female students of 1-3rd year of high school with the signs of idiopathic arterial hypertension under the fixed stress- test. The main group consisted of 32 female students of 1-3rd year of high school with idiopathic arterial hypertension. The control group was formed from almost healthy female students from the same years of study. The treadmill (Biomedical Systems), due to Bruce protocol, was used for estimating the level of tolerance to physical pressure. To assess the degree of reliability of the results of the study used a variational-statistical method of analysis of the results using a package of statistical programs Statistica V. 10 (USA) and the recommendations of O. Yu. Rebrova (2002). Under the treadmill test it was revealed the decrease of tolerance to physical pressure in female students from the main group on 31,24% (р<0,05), in comparison to the MET numbers got in the control group (37,11±2,16) ml/kg/min. Under stress-test reliable increase of heart rate in control group was observed after 6-8 minutes of training, in female students from control group the same reaction was observed after 3-5 min of training without its further increase. The increase of SBP in the main group at the peak of training was (20,88±3,12)%, in the control group – this index was completely higher (27,88±3,36)% (р<0,01). After the finishing of the stress test in the female students of the main group the duration of their heart rhythm and arterial pressure reviving was (9,85±1,22) min., that overcame the result got in control group (6,24±0,67) min. Thus, the treadmill test allows exactly reveal the level of cardiorespiratory system adaptation to physical pressure, aerobic capacity in young women with the signs of idiopathic arterial hypertension.

Microarray profiling of long noncoding RNAs associated with idiopathic pulmonary arterial hypertension.

[This retracts the article DOI: 10.3892/etm.2017.4355.].

New echocardiographic indexes for evaluating cardiac function in idiopathic pulmonary arterial hypertension using three-dimensional echocardiography.

Purpose Noninvasive real-time three-dimensional echocardiography (RT3DE) was utilized to explore new indexes for evaluating cardiac function in patients with idiopathic pulmonary arterial hypertens...

Clinical features and prognostic factors in children with idiopathic pulmonary arterial hypertension

Objective To investigate the clinical features and prognostic factors in children with idiopathic pulmonary arterial hypertension(IPAH). Methods The data of children with IPAH diagnosed in Beijing Children's Hospital from January 2006 to December 2015 were collected.The cases were divided into survival group and death group according to the prognosis.The risk factors influencing prognosis in children with IPAH were identified by Logistic regression analysis. Results Total 26 patients were enrolled in this study, and 17 of them survived and 9 of them were dead.IPAH was found to be more common in school-age children.The average age of the patients was(6.6±3.6)years and the male to female ratio was 1.17∶1.All of the children had the symptoms with decreased activity tolerance and fatigue.The incidence of syncope and dyspnea and edema of lower extremity were 34.6%, 23.1%.Accentuated pulmonic second sound(P2) was detected in 92.3% of patients during physical examination, which was also the most common sign.About 50.0% patients were functional class Ⅲ-Ⅳ.Echocardiography showed that all childrens' mean pulmonary artery systolic pressure(PASP) was(79.0±20.3) mmHg(1 mmHg=0.133 kPa) and 16 of them with right ventricular dilatation.Electrocardiogram with ST-T changes and right ventricular high voltage were common.The average plasma level of brain natriuretic peptide(BNP) in all cases was(870.4±720.9) pg/ml.The single factor analysis illustrated that syncope(OR=26.25, 95%CI 3.04-226.60, P=0.003), heart functional class Ⅲ-Ⅳ(OR=19.199, 95%CI 1.88-196.53, P=0.0128), PASP≥70 mmHg(OR=9.936, 95%CI 1.81-∞, P=0.005), BNP≥850 pg/ml(OR=59.991, 95%CI 4.69-767.62, P=0.002) indicated the worse outcome. Conclusion IPAH in children is rare and the prognosis is poor.Syncope, cardiac function grade, PASP and the levels of BNP are the main important factors affecting the prognosis of children with IPAH.BNP has important clinical significance for the evaluation of IPAH and the prognosis of the disease. Key words: Idiopathic pulmonary arterial hypertension; Clinical features; Prognosis; Children

Prevalence of comorbidities according to predominant phenotype and severity of chronic obstructive pulmonary disease.

BackgroundIn addition to lung involvement, several other diseases and syndromes coexist in patients with chronic obstructive pulmonary disease (COPD). Our purpose was to investigate the prevalence of idiopathic arterial hypertension (IAH), ischemic heart disease, heart failure, peripheral vascular disease (PVD), diabetes, osteoporosis, and anxious depressive syndrome in a clinical setting of COPD outpatients whose phenotypes (predominant airway disease and predominant emphysema) and severity (mild and severe diseases) were determined by clinical and functional parameters.MethodsA total of 412 outpatients with COPD were assigned either a predominant airway disease or a predominant emphysema phenotype of mild or severe degree according to predictive models based on pulmonary functions (forced expiratory volume in 1 second/vital capacity; total lung capacity %; functional residual capacity %; and diffusing capacity of lung for carbon monoxide %) and sputum characteristics. Comorbidities were assessed by objective medical records.ResultsEighty-four percent of patients suffered from at least one comorbidity and 75% from at least one cardiovascular comorbidity, with IAH and PVD being the most prevalent ones (62% and 28%, respectively). IAH prevailed significantly in predominant airway disease, osteoporosis prevailed significantly in predominant emphysema, and ischemic heart disease and PVD prevailed in mild COPD. All cardiovascular comorbidities prevailed significantly in predominant airway phenotype of COPD and mild COPD severity.ConclusionSpecific comorbidities prevail in different phenotypes of COPD; this fact may be relevant to identify patients at risk for specific, phenotype-related comorbidities. The highest prevalence of comorbidities in patients with mild disease indicates that these patients should be investigated for coexisting diseases or syndromes even in the less severe, pauci-symptomatic stages of COPD. The simple method employed to phenotype and score COPD allows these results to be translated easily into daily clinical practice.

The application of peripartum use of pulmonary artery catheter in pregnant patients with pulmonary hypertension

To investigate the application and value of pulmonary artery catheterization (PAC) in pregnant patients with pulmonary hypertension (PH). The clinical data of pregnant patients with PH who were treated between 2006 and 2014 in surgical intensive care unit (SICU) at Capital Medical University affiliated Beijing Anzhen Hospital were retrospectively analysed. The differences of the clinical characteristics and outcome between PAC inserted patients and PAC not inserted patients were compared. The systolic pulmonary artery pressure (sPAP) measured by preoperative echocardiography has no significant difference between the PAC inserted patients [(103.0 ± 24.1) mmHg (1 mmHg = 0.133 kPa)] and PAC not inserted patients [(96.4 ± 27.3) mmHg; P = 0.175]. SPAP may be overestimated or underestimated by echocardiography compared with PAC with a gap from -38.4 mmHg to 49.5 mmHg. The rates of idiopathic pulmonary arterial hypertension (20.0% vs 3.2%) and continuous use of epidural anesthesia (89.1% vs 65.1%) were higher in PAC inserted patients compared with PAC not inserted patients. Norepinephrine, dobutamine, sildenafil, alprostadil, iloprost and low molecular weight heparin were more widely used in PAC inserted patients. The mortality rate and the rates of low birth weight (63.9% vs 30.6%) and very low birth weight infants (19.4% vs 13.9%) were all higher in PAC inserted patients, while the rate of induced abortion was lower in this group (5.5% vs 17.5%). The length of stay in surgical intensive care unit [6.0 (5.0) d vs 1.0 (3.0) d], postoperative length of stay [8.0 (6.0) d vs 8.0 (4.0) d] and total hospital costs [43 999.22 (38 267.27) RMB vs 14 878.24 (10 564.47) RMB] were all higher in PAC inserted patients. The incidence rate of PAC related complications was 7.3%. In moderate or severe PH pregnant patients with severe clinical symptoms, perioperative insertion of PAC helps to monitor the perinatal pulmonary arterial pressure(PAP) and guide treatment, potentially improving clinical outcomes and lowering the short term mortality. PAC can't be replaced by echocardiography in measuring PAP.

Short-term efficacy of atrial septostomy in the treatment of idiopathic pulmonary arterial hypertension patients complicating with right heart failure

To evaluate the efficacy of atrial septostomy in idiopathic pulmonary arterial hypertension (IPAH) patients complicating right ventricular failure. This retrospective analysis included 5 IPAH patients (3 males, (29.3±15.2) years old) with right ventricular failure which were refractory to conventional and target-specific medication in Shanghai Chest Hospital from March to July 2014. Graded balloon dilation septostomy procedures were performed in all 5 patients. Successful atrial septostomy was achieved in 5 attempts with no procedure-related complications. Immediately post procedure, the mean systemic oxygen saturation decreased from (98.0±1.8)% to (86.4±3.2)% (P = 0.002), while the mean right atrial pressure decreased from (18.9±1.7) mmHg (1 mmHg = 0.133 kPa) to (16.0±1.3) mmHg (P = 0.039) and the mean cardiac index increased from (2.1±0.3) L · min(-1) · m(-2) to (2.7±0.5) L · min(-1) · m(-2) (P = 0.029). Mean follow-up was (6.2 ±1.8) months. Cardiac functional class (WHO) was 3 in 3 patients and 4 in 2 patients before the procedure, and increased 1 class in all patients during follow-up (P = 0.062). Exercise endurance (6-min walk test) also improved from (289.2±16.9) m to (320.4±19.6) m (P = 0.019), while B-type natriuretic peptide (BNP) level declined from (550.0±35.7) ng/L to (218.0±36.2) ng/L (P < 0.001). Except one patient developed spontaneous closure of created defect, right to left shunt at atrial septal level was evidenced by echocardiography during follow-up in the rest 4 patients. Atrial septostomy is safe and can improve hemodynamics and heart function in selected IPAH patients with right heart failure. Atrial septostomy can be used as a palliative treatment for IPAH and further study is warranted to evaluate the long-term efficacy of this procedure.

Clinical features and misdiagnosis of connective tissue disease plus pulmonary embolism

To evaluate the clinical features and reasons of misdiagnosis of connective tissue disease plus pulmonary embolism (PE). The clinical data were reviewed retrospectively for 22 hospitalized patients with connective tissue disease and PE from February 2006 to March 2014. And the features of onset, clinical and laboratory characteristics, imaging tests and causes of misdiagnosis were analyzed. There were 12 males and 10 females with an average age of (36.2 ± 14.2) years. And 12 (54.5%) PE patients had concurrent deep venous thrombosis. Antiphospholipid syndrome and Behcet's disease were the major causes of connective tissue disease. Chest distress, palpitation and extremity swelling were initial symptoms. There were elevated erythrocyte sedimentation rate (n = 11, 50.0%), elevated C-reactive protein (n = 8, 36.4%) and abnormal autoantibody (n = 15, 68.2%) respectively. Computed tomography showed pulmonary arteries stenosis, occlusion and aneurismal dilation. Eighteen (81.8%) patients had pulmonary hypertension with a systolic pulmonary pressure of (72 ± 20) mmHg (1 mmHg = 0.133 kPa). And 3 of them presented severity of pulmonary pressure non-matched to the degree of pulmonary vascular involvement. And 18 (81.8%) patients with connective tissue disease were missed due to a lack of typical symptoms and physician understanding of disease before admission. Three (13.6%) patients had a misdiagnosis of idiopathic pulmonary arterial hypertension. The median time of diagnosis was 12 months. Connective tissue disease may develop PE as the initial symptom. And some patients lack typical clinical manifestations of connective tissue disease. It should raise an alert with the physicians.

Initial experience with macitentan in contemporary patient cohort

Aims:To establish the effect of idiopathic arterial hypertension (HT) on LV function, geometry and remodelling in the setting of aortic stenosis (AS) and its impact on prognosis and outcomes. In addition we evaluated the efficacy and safety of anti-HT agents in patients with moderate to severe AS. Methods: A search was performed in the Cochrane, Pubmed and Embase databases using the MESH or Entree terms “aortic valve stenosis”, “hypertension”, “blood pressure”, “ventricular function”, “ventricular dysfunction”, “prognosis”, “mortality” and “symptoms”, and 1156 articles were reviewed. Key demographics and outcomes of patients in 82 suitable studies were performed. Results: Patients with concurrent AS and arterial HT had worse degrees of LV hypertrophy effect size 0.33 p value= 0.05 and systolic function effect size 0.0 p= 0.01 using Cohen’s method compared to their normotensive counterparts. They experienced more rapid development of symptoms effect size 0.076 p> 0.05 and greater degrees of diastolic dysfunction effect size 0.28 p=0.05. HT post aortic valve replacement impaired reverse LV remodelling and is associated with a poorer outcome. Appropriate antihypertensive agents are well tolerated and beneficial in the setting of AS. Conclusion: HT in moderate to severe AS resulted in worsening LV hypertrophy and more rapid development of symptoms.

Hypertension in aortic stenosis: a systematic review

Aims:To establish the effect of idiopathic arterial hypertension (HT) on LV function, geometry and remodelling in the setting of aortic stenosis (AS) and its impact on prognosis and outcomes. In addition we evaluated the efficacy and safety of anti-HT agents in patients with moderate to severe AS. Methods: A search was performed in the Cochrane, Pubmed and Embase databases using the MESH or Entree terms “aortic valve stenosis”, “hypertension”, “blood pressure”, “ventricular function”, “ventricular dysfunction”, “prognosis”, “mortality” and “symptoms”, and 1156 articles were reviewed. Key demographics and outcomes of patients in 82 suitable studies were performed. Results: Patients with concurrent AS and arterial HT had worse degrees of LV hypertrophy effect size 0.33 p value= 0.05 and systolic function effect size 0.0 p= 0.01 using Cohen’s method compared to their normotensive counterparts. They experienced more rapid development of symptoms effect size 0.076 p> 0.05 and greater degrees of diastolic dysfunction effect size 0.28 p=0.05. HT post aortic valve replacement impaired reverse LV remodelling and is associated with a poorer outcome. Appropriate antihypertensive agents are well tolerated and beneficial in the setting of AS. Conclusion: HT in moderate to severe AS resulted in worsening LV hypertrophy and more rapid development of symptoms.

Analysis of factors related to pulmonary hypertensive crisis in patients with idiopathic pulmonary arterial hypertension

To explore the risk and protective factors for pulmonary hypertensive crisis (PHC) in patients with idiopathic pulmonary arterial hypertension (IPAH). A retrospective study was performed for 65 patients with a diagnosis of IPAH between January 2010 and December 2013. According to clinical manifestations, they were divided into two groups of susceptibility and non-susceptibility to PHC. Clinical and hemodynamic parameters were analyzed in univariate and multivariate manners. Among them, there were 32 males and 33 females with a mean age of (14.4 ± 12.3) (10/12-47.3) years. Twenty-three patients had typical manifestations of PHC and 18 of them were induced by exercises.Univariate analysis revealed that the proportion of patients with World Health Organization (WHO) functional class III-IV in PHC-susceptible group was significantly higher than PHC-nonsusceptible group (60.9% vs 23.8%, P = 0.003) while the percentage of patent foramen ovale in PHC-susceptible group was significantly lower than PHC-nonsusceptible group (8.7% vs 45.2%, P = 0.003).In patients with WHO functional classI-II, hemodynamic variables including the decline of pulmonary arterial pressure and positive rate in vasoreactivity testing in PHC-susceptible group were significantly higher than PHC-nonsusceptible group.In patients with WHO functional class III-IV, baseline pulmonary arterial pressure and mean right atrial pressure in PHC-susceptible group were significantly higher than those in PHC-nonsusceptible group. Multivariate Logistic regression analysis revealed that, for those with WHO functional class III-IV (OR = 23.45, 95%CI: 2.85-193.09) and the decline of systolic pulmonary arterial pressure in vasoreactivity testing (OR = 1.12, 95%CI: 1.04-1.22) were independent risk factors for PHC in IPAH patients while patent foramen ovale (OR = 0.01, 95%CI: 0.00-0.52) was a protective factor. PHC in IPAH patients is correlated with WHO functional class, pulmonary vascular reactivity, baseline pulmonary arterial pressure and patent foramen ovale. And exercise is the most common stimulus to PHC.

Clinical observation of cardiopulmonary exercise test in patients with idiopathic pulmonary arterial hypertension

To explore the exercise characteristics of patients with idiopathic pulmonary arterial hypertension (IPAH). From November 2010 to September 2012 , 76 consecutive IPAH patients and 24 healthy controls from Fuwai Cardiovascular Hospital were enrolled to undergo cardiopulmonary exercise testing. The exercise parameters were compared. Correlations among peak oxygen consumption, anaerobic threshold, peak oxygen pulse, New York Heart Association (NYHA) class, N-terminal pro-brain natriuretic peptide (NT-proBNP), 6-minute walking distance (6 MWD) and cardiac index are analyzed in IPAH. There were 21 males and 55 females in IPAH and 8 males and 16 females in controls. Their mean ages were (31.5 ± 10.6) and (35.5 ± 6.4) years respectively. Significant differences (P = 0.000) existed between two groups in peak oxygen consumption ((12.7 ± 3.3) vs (25.6 ± 5.8) ml·min(-1)·kg(-1)), anaerobic threshold ((9.8 ± 2.5) vs (16.7 ± 3.9) ml·min(-1)·kg(-1)), peak oxygen pulse ((5.3 ± 1.6) vs (9.9 ± 2.5) ml/bpm) and ventilator efficiency (slope of minute ventilation in relation to CO2 produced) ((42.6 ± 2.0) vs (25.5 ± 3.5)). In IPAH, peak oxygen consumption was significantly correlated with NYHA class (r = -0.509, P = 0.000), 6 MWD (r = 0.443, P = 0.002) and NT-proBNP levels (r = -0.423, P = 0.011). And anaerobic threshold was significantly correlated with NYHA class (r = -0.362, P = 0.002), 6MWD (r = 0.343, P = 0.004) and NT-proBNP levels (r = -0.275, P = 0.017). Peak oxygen pulse and ventilator efficiency were both correlated well with total pulmonary vascular resistance. Partial correlation analysis demonstrated that there were significant correlations among peak oxygen consumption, anaerobic threshold, NYHA class, NT-proBNP levels and 6MWD after adjusting for age, gender and weight. Peak oxygen consumption and anaerobic threshold decrease ventilator efficiency in IPAH patients. Cardiopulmonary exercise testing is an invasive tool of assessing safely the function of IPAH patients.

Concentration of Natriuretic Peptides in Patients Suffering from Idiopathic Arterial Hypertension and Left Ventricular Diastolic Dysfunction Confirmed by Echocardiography

Concentration of natriuretic peptides (NPs) in arterial hypertension (AH) patients is higher than that in healthy people. One of the first symptoms of left ventricular hypertrophy (LVH) is left ventricular diastolic dysfunction (LVDD). The aim of this study was to examine whether determination of NPs in blood can be a useful indicator of LVDD detection in idiopathic AH patients. The study was conducted on three groups of patients: group Ia, 19 patients (average age 57 ± 3) with eccentric hypertrophy; group Ib, 13 patients (59 ± 4) with concentric hypertrophy; group II, 33 patients (58 ± 4) without AH or LVH. In all groups, mitral inflow profile was evaluated with Doppler test to detect LVDD, blood flow in upper right pulmonary vein, and concentration of atrial natriuretic peptide (ANP), N-terminal ANP (N-ANP), brain natriuretic peptide (BNP), and N-terminal BNP (N-BNP). In group Ia, significant correlations were observed between the following pairs: ratio of maximum early to late mitral inflow and ANP; deceleration time of early mitral inflow speed and ANP; atrial contraction (AR) and ANP; atrial contraction (AR) and N-ANP; similarly, in group Ib, significant correlations were observed between the following: relative wall thickness and BNP; isovolumic relaxation time and BNP; AR and BNP; relative wall thickness and N-BNP; isovolumic relaxation time and N-BNP; AR and N-BNP.

The clinical efficay of bosentan for idiopathic pulmonary arterial hypertension

Objective To explore the efficacy of bosentan in the treatment of idiopathic pulmonary arterial hypertension ( IPAH ).Methods 45 patients with IPAH were randomly assigned to study group ( 23 patients ) or control group ( 22 patients ).Both groups received conventional therapies and the study group was administered oral bosentan additionally.The efficacy was then analyzed in the two groups.Results 14 days after treatment,levels of PaO2 and 6MWD were higher whereas levels of PaCO2 and PAP were lower in the study group than in the control group [( 81 ± 3.7 )mmHg ( 1 mm Hg=0.133 kPa ) vs.( 57.0 ± 3.9 ) mm Hg and ( 331.0 ± 81.2 ) m vs.( 263.0 ± 58.9 ) m,and ( 43.0 ± 5.9 ) mmHg vs.( 66.0 ± 7.2 ) mm Hg and ( 63.0 ± 17.1 )mm Hg vs.( 78.0 ± 16.7 ) mm Hg; P ＜ 0.05 for all comparisons].Conclusions Oral bosentan is efficacious in the treatment of idiopathic pulmonary arterial hypertension,significantly reducing high pressure of pulmonary artery. Key words: Bosentan; Idiopathic pulmonary arterial hypertension

Dynamic pulmonary perfusion imaging in patients with idiopathic pulmonary arterial hypertension

Objective To investigate the value of dynamic PPI in patients with IPAH.Methods Twenty consecutive patients with IPAH underwent dynamic PPI and right ventricular catheterization.Ten healthy volunteers were also recruited in this study as control.Total lung ROI was drawn to calculate time-activity curves from dynamic PPI.Lung equilibrium time (LET),the duration from 99Tcm-MAA entering the lungs to equilibrium,was measured.Comparisons between two groups were carried out using t-test.Correlations between LET and hemodynamic parameters were determined by Pearson correlation analysis.Results LET was significantly prolonged in IPAH patients over the control group ( (33.9 ± 15.5) s vs ( 14.4 ± 3.7) s,t =5.340,P ＜0.001).Significant correlations were found between LET and mPAP(r =0.566,P ＜0.01) and between LET and total pulmonary resistance (TPR) measured by right heart catheterization (r =0.688,P ＜0.05).LET had a negative linear relationship with CI (r=-0.480,P ＜0.05).Conclusion Dynamic PPI is a practical and noninvasive method for evaluating the haemodynamic function of right heart in patients with IPAH. Key words: Hypertension, pulmonary; Radionuclide imaging; MAA

Role of circulating microRNA-22 in pathogenesis of idiopathic pulmonary arterial hypertension

Objective To investigate the value of plasma miR-22 in diagnosis of idiopathic pulmonary arterial hypertension ( IPAH ),and its role of regulation mechanisms in the pathogenesis of the disease.Methods Circulating miR-22 levels of IPAH patients and healthy controls were evaluated by RTPCR.The silico analysis of targets for miR-22 was taken, and followed by eGFP reporter assay for verification of predicted target gene Myc binding protein (MYCBP). Results Compared with healthy controls,the expression of plasma miR-22 in IPAH patients was significantly decreased (P ＜ 0.01 ).The area under curve (AUC) of ROC curve was 0.744.MYCBP was a real target of miR-22 confirmed by silico analysis and eGFP reporter assay. Conclusions The expression of plasma miR-22 was significantly decreased in IPAH patients,and it could serve as a potential biomarker for diagnosis.The miR-22 might be involved in the pathogenesis of the disease through promoting its target gene MYCBP to activate the c-Myc pathway. Key words: Idiopathic pulmonary hypertension (IPAH); MicroRNA-22; Biomarker; Myc binding protein (MYCBP)

Missense Mutations of the &lt;i&gt;BMPR1B&lt;/i&gt; (&lt;i&gt;ALK6&lt;/i&gt;) Gene in Childhood Idiopathic Pulmonary Arterial Hypertension

Missense Mutations of the &lt;i&gt;BMPR1B&lt;/i&gt; (&lt;i&gt;ALK6&lt;/i&gt;) Gene in Childhood Idiopathic Pulmonary Arterial Hypertension

Life-threatening bradycardia after bilateral paramedian thalamic and midbrain infarction

Dear Sirs,Bilateral symmetric thalamic infarcts are uncommon pre-sentations of ischemic stroke that mostly occur in the ter-ritories of the paramedian thalamic arteries [1]. Thesearteries arise either separately from the posterior cerebralarteries (PCAs) or exceptionally from a single commontrunk the artery of Percheron [2]. In this article, a case ofbithalamic paramedian and midbrain stroke presenting withdrowsiness, ophtalmoplegia, and life-threatening brady-cardia is presented. Despite it is known that different stroketopographic patterns can produce slowing of heart rate andasystolia, this is the first report of acute bradycardia inconcomitance to bilateral midbrain infarction [3–5].A 51-year-old man with a 3-year history of idiopathicarterial hypertension (on zofenopril) was admitted to ouremergency room after being found unresponsive in bed. Onadmission he showed fluctuating level of consciousness,dysarthria, anisocoria, and vertical gaze palsy (NIHSS 7,GCS 9). During examination, the patient suddenly devel-oped severe sinus bradycardia (pulse rate \30 beats perminute (bpm), for 3 minutes) that improved only afteratropine administration. Arterial blood pressure (BP),blood exams, toxicological screening, and brain CT scanwere all normal. Within 1 h, another self-limiting episodeof drowsiness and concomitant bradycardia ensued. Dif-fusion-weighted (DW) sequences on brain MRI demon-strated symmetric bilateral thalamic, hypothalamic, andmidbrain acute infarctions, thus, advocating the occlusionof a putative artery of Percheron (Fig. 1a). Top-of-the-basilar syndrome was ruled out documenting patency ofthe basilar artery and both PCAs by MRI angiography.Extensive cardiological workup showed no signs ofhypertensive cardiomyopathy both on ECG and echocar-diography, but revealed a patent foramen ovale (PFO) withsevere right-to-left atrial shunt. Anticoagulant therapy was,therefore, started and PFO closure suggested. In the fol-lowing days, episodes of bradycardia (nadir of 38 bpm,without major alterations of BP) tended to recur duringdrowsiness and night sleep. Particularly, diurnal fluctua-tions of vigilance paralleled recurrent sleep spindle patternson electroencephalography (Fig. 1b). Sinus bradycardiaoccurred less often and heart rate gradually increased in thefollowing weeks. At the 3-month follow-up, despite fullresolution of gaze palsy and arrhythmia, the patient stillpresented recurring episodes of hypersomnolence andimportant disability due to long-lasting apathy.Infarcts at the mesencephalic–diencephalic junctionresult in complex clinical syndromes contingent on thedeep brain structures involved. Supranuclear vertical gazepalsy and associated abnormal ocular reflexes are related tolesions of the rostral interstitial and Edinger–Westphalnuclei [6]. Fluctuating level of consciousness, coma, andhypersomnolence are attributed to the involvement ofintralaminar nuclei and reticular mesencephalic formation[7]. Notably, while presenting symptoms usually reverseover time, cognitive dysfunctions caused by limbic loopinterruption lead to long-term disability [8]. In our patient

Letter by Asosingh et al Regarding Article, “Circulating Endothelial Progenitor Cells in Patients With Eisenmenger Syndrome and Idiopathic Pulmonary Arterial Hypertension”

To the Editor: Diller and colleagues1 report a decrease in circulating progenitor cells and a trend of increased colony-forming units endothelial-like cells in idiopathic arterial hypertension compared with healthy controls. This is an interesting article in light of other reports, including 1 by our group, which report that circulating CD34+/CD133+ and colony-forming units endothilial-like cells are increased in idiopathic pulmonary arterial hypertension.2,3 Given this disparity, clarification of technical aspects related to the way in which …

Atrial and Brain Natriuretic Peptide and Endothelin-1 Concentration in Patients with Idiopathic Arterial Hypertension: The Dependence on the Selected Morphological Parameters

Introduction. The aim of the work was to study the maintenance of atrial and brain natriuretic peptide (ANP, BNP) and endothelin-1 (ET-1) in patients with idiopathic arterial hypertension and the relationships between cardiac morphological parameters and concentrations of examined peptides in group of patients with left ventricular hypertrophy (LVH). Methods. Seventy-six patients were enrolled in the study: 21 patients with confirmed idiopathic arterial hypertension (group 1), 18 with idiopathic hypertension and eccentric hypertrophy (group 1a), 14 with idiopathic hypertension and concentric hypertrophy (group 1b), and 23 patients without arterial hypertension, organic heart disease, or chronic respiratory tract diseases (group 2—control group). All subjects were submitted for echocardiographic evaluation. Posterior wall thickness (PWT), interventricular septum thickness (IVST), left ventricular end-diastolic diameter (LVEDd), left atrium diameter (LAD), left ventricular mass index (LVMI), ejection fraction (EF), fractional shortening (FS), midwall shortening fraction (MWS), and relative wall thickness index (RWT) were studied. Concentrations of ANP(1-28), BNP, and ET-1 were determined with the use of radioimmunological kits (RIA). The obtained results were subjected to statistical analysis. Results. A considerable increase of ANP and BNP was observed in all patients with hypertension (group 1) in comparison to patients without hypertension (group 2). Significant increases of ANP were found in groups 1a and 1b in comparison to group 1 and 2, as well as considerably increase of BNP in group 1b compared to groups 1, 1a, and 2. In the group of patients with hypertension (group 1), a significant increase in the concentration of ET-1 compared to group 2 was found. However, the concentrations of ET-1 in groups 1 and 2 were not statistically different. Significant differences in concentrations of ET-1 between groups 1a, 1b, and 1 and 2 were seen. Significant correlations were found between concentrations of ANP, BNP, ET-1 and morphological parameters: PWT, IVST, LVMI and RWT. In group 1b, a correlation between concentrations of ANP, BNP, MWS, and LAD was found. The multiple regression analysis showed that RWT independently correlates with concentrations of ANP and BNP, and the concentration of BNP is in closer relation to RWT than ANP. In the case of ET-1, the multiple regression analysis did not show that LVMI or RWT had any independent influence on secretion of ET-1 in patients with idiopathic hypertension and LVH. Conclusions. Increased concentration of ANP in patients with idiopathic hypertension may point to the coexistence of complications with type of LVH. High concentration of BNP may specifically suggest concentric LVH. This is important—especially if there are difficulties in interpretations of results of other clinical examinations. However, increased concentrations of ET-1 in the plasma of patients with hypertension and LVH should not be treated as an indicator of LVH degree.