[Heart rate variability is significantly reduced in non-diabetic patients with hypertension]. / A szívfrekvencia-variabilitás jelentosen csökken nem diabeteses hypertoniás betegek körében.

INTRODUCTIONS: Heart rate variability is reduced among patients with hypertension and/or with diabetes mellitus. Hypertension and diabetes show frequent co-morbidity, but it is still not entirely clear whether heart rate variability is reduced in non-diabetic patients with hypertension. AIM: The aim of the authors was to evaluate the heart rate variability in hypertensive patients with and without diabetes and in control subjects. METHOD: 130 patients with hypertension, 48 patients with hypertension and type 2 diabetes mellitus, and 87 control subjects were involved in the study. Minimum, mean and maximum heart rate, and parameters of heart rate variability were measured. RESULTS: The mean of minimum heart rate did not differ significantly between the three groups. However, all other parameters were significantly reduced in patients with hypertension with and without diabetes as compared to the control group. No significant differences were observed between hypertensive patients with and without diabetes mellitus. CONCLUSIONS: Heart rate variability is significantly reduced in non-diabetic patients with hypertension. It seems that type 2 diabetes results in no further significant reduction of heart rate variability in patients with hypertension.

Arrhythmogenic Cardiomyopathy: A Review of a Rare Case of Biventricular Phenotype.

Arrhythmogenic cardiomyopathy is a rare hereditary structural heart disease, with various phenotypes, which mostly affects the right ventricle of the heart, resulting in fibrofatty replacement of the heart muscles and a proclivity to create spontaneous malignant cardiac arrhythmias that may lead to sudden death. Most previous reports were noted on young people. We report a case of its biventricular phenotype in a 61-year-old heavy truck driver who has a current medical history of diabetes mellitus and smoking and was incidentally diagnosed based on the Padua criteria after presenting to the hospital with complaints of lightheadedness and syncope. He eventually had an implantable cardioverter defibrillator, hence preventing death. We were able to correctly diagnose the case and prevent sudden cardiac death by instituting the necessary management.

[Significance of arterial stiffness parameters for predicting cardiovascular mortality in hemodialysis patients: a prospective cohort study]. / A különbözô érfali tágulékonysági paraméterek jelentôsége a cardiovascularis mortalitás elôrejelzésében hemodializált betegek között: prospektív kohorszvizsgálat.

UNLABELLED: Previous studies demonstrated that different parameters of arterial stiffness are related to cardiovascular mortality in hemodialysis patients. The relative prognostic value of these parameters has not previously been evaluated in one cohort. PATIENTS AND METHODS: Carotid-femoral pulse wave velocity, carotid augmentation index, carotid pulse pressure and carotid-brachial pulse pressure amplification were measured in 98 patients before and after hemodialysis. Patients were followed for a median of 29 months (1-34) and the association of these parameters with cardiovascular mortality was assessed using log-rank tests and Cox proportional hazards regressions. RESULTS: During follow-up, 40 patients died (mortality rate 20.7/100 patient-year), of which 25 died of cardiovascular causes. Increasing pre- and postdialysis pulse wave velocity tertiles and decreasing predialysis pulse pressure amplification tertiles were significantly related to cardiovascular mortality (p-values are 0.012 and 0.011 for pre- and postdialysis pulse wave velocity, and <0.001 and 0,321 for pre- and postdialysis pulse pressure amplification, respectively). Neither the carotid augmentation index nor carotid pulse pressure was related to cardiovascular mortality. In the Cox-regression, the adjusted hazard ratios for 1 m/s higher pre- and postdialysis pulse wave velocity were 1.24 (1.07-1.44) and 1.17 (1.06-1.28), respectively. The hazard ratio for 10% lower predialysis pulse pressure amplification was 1.41 (1.03-1.92). When included in the same model, both predialysis pulse wave velocity and pulse pressure amplification remained significantly associated with cardiovascular mortality (relative risk: 1.23 [1.07-1.42] and 1.39 [1.02-1.89]). CONCLUSION: Among different stiffness parameters, pulse wave velocity is consistently related to cardiovascular mortality, irrespective of the timing of measurement. Predialysis pulse pressure amplification seems to provide additional prognostic information.

Validation of arteriograph - a new oscillometric device to measure arterial stiffness in patients on maintenance hemodialysis.

BACKGROUND: Measuring arterial stiffness (augmentation index (AI), aortic pulse wave velocity (PWV)) in hemodialysis (HD) patients has prognostic significance. To assess its validity, the new oscillometric Arteriograph device (AI(A), PWV(A)) was compared to the validated PulsePen tonometer (AI(P), PWV(P)). METHODS: AI and PWV were measured in 98 patients with both devices before HD. Validity was evaluated by Pearson's correlation, Bland-Altman analysis, and by assessing the prognostic value of AI and PWV to predict cardiovascular (CV) mortality over 29 months. RESULTS: Correlation between AI(P) and AI(A) was significant (R = 0.527, p < 0.001). The mean difference of AI values obtained by the two devices was -20.6%, and 30% of the paired AI differences fall outside the +/-1 SD boundary of the mean between-device difference. There was no significant correlation between the PWV(P) and PWV(A) readings (R = 0.173, p = 0.097). The average difference of PWV values by the two devices was -1.2 m/s, and 20.6% of the paired PWV differences fall outside the +/-1 SD boundary. In survival analyses, only PWV(P) but not PWV(A) was significantly related to CV mortality. CONCLUSION: Lack of correlation between PWV(P) and PWV(A) and lack of prognostic significance of PWV(A) suggest limited validity of Arteriograph to determine PWV in patients on HD.

Serum osteoprotegerin level, carotid-femoral pulse wave velocity and cardiovascular survival in haemodialysis patients.

BACKGROUND: Osteoprotegerin (OPG) is a marker and regulator of arterial calcification, and it is related to cardiovascular survival in haemodialysis patients. The link between OPG and aortic stiffening--a consequence of arterial calcification--has not been previously evaluated in this population, and it is not known whether OPG-related mortality risk is mediated by arterial stiffening. METHODS: At baseline, OPG and aortic pulse wave velocity (PWV) were measured in 98 chronic haemodialysis patients who were followed for a median of 24 months. The relationship between OPG and PWV was assessed by multivariate linear regression. The role of PWV in mediating OPG related cardiovascular mortality was evaluated by including both OPG and PWV in the same survival model. RESULTS: At baseline mean (standard deviation) PWV was 11.2 (3.3) m/s and median OPG (interquartile range) was 11.1 (7.5-15.9) pmol/L. There was a strong, positive, linear relationship between PWV and lnOPG (P = 0.009, model R(2) = 0.540) independent of covariates. During follow-up 23 patients died of cardiovascular causes. In separate univariate survival models both PWV and lnOPG were related to cardiovascular mortality [hazard ratios 1.31 (1.14-1.50) and 8.96 (3.07-26.16), respectively]. When both PWV and lnOPG were entered into the same model, only lnOPG remained significantly associated with cardiovascular mortality [hazard ratio 1.11 (0.93-1.33) and 7.18 (1.89-27.25), respectively). CONCLUSION: In haemodialysis patients OPG is strongly related to PWV and OPG related cardiovascular mortality risk is, in part, mediated by increased PWV.

[Osteoprotegerin: regulator, protector and marker]. / Osteoprotegerin: a regulátor, a protektor és a marker. Osszefoglalás irodalmi adatok és saját eredményeink alapján.

Experimental and clinical trials in the field of bone biology helped to clarify the role of receptors, which belong to the tumor necrosis factor family, such as osteoprotegerin and receptor activator of nuclear factor kappaB (RANK), in the regulation of bone remodeling. The ligand of the receptor activator of nuclear factor kappaB (RANKL) is a stimulator of bone resorption, while osteoprotegerin is the soluble "decoy" receptor to RANKL, protecting thereby bone from resorption. Pathological states of bone remodeling (like osteoporosis) are associated with imbalance in the activity of osteoprotegerin and the receptor activator of nuclear factor kappaB. Recent studies, however, also indicate that the osteoprotegerin/RANKL/RANK system has important roles in the regulation of the immune and vascular system as well. In this review we summarize the function and regulation of osteoprotegerin, its role in pathological states--primarily in cardiovascular diseases--and its relevance as a marker of cardiovascular risk. Finally, we present our prospective trial performed among the chronic dialyzed patients, where we examined the association between the cardiovascular mortality, osteoprotegerin levels and the arterial stiffness.