Pulse Wave Velocity: Retrospective Analysis in a Balkan Normotensive and Hypertensive Population: A Study of 9923 Patients.

We compared pulse wave velocity (PWV) between hypertensive patients and control patients to identify demographics and patient characteristics related to PWV. We retrospectively analyzed 9923 participants (3105 controls and 6818 hypertensive patients) from 5 outpatient hypertensive clinics (in Serbia and Greece). Pulse wave velocity had different distribution between controls and hypertensive patients ( P < .001). The magnitude of PWV increase was related to blood pressure (BP) category (from optimal to stage III hypertension; P < .001). Even in hypertensive patients with systolic BP (SBP) <140 and/or diastolic BP (DBP) <90 mm Hg, PWV was greater than in control patients ( P < .001). Pulse wave velocity was associated with almost all baseline characteristics of hypertensive patients (body mass index [BMI], gender, age, SBP, DBP, smoking status, and heart rate; P < .001). This association remained after adjustment of PWV confounders. There were 2231 (32.7%) hypertensive patients who had reached SBP <140 mm Hg and DBP <90 mm Hg. Pulse wave velocity was increased in hypertensive patients, and the degree of PWV increase was associated with baseline BP as well as with anthropometric parameters (eg, BMI, gender, age, heart rate, and smoking status).

The value of left ventricular global longitudinal strain assessed by three-dimensional strain imaging in the early detection of anthracyclinemediated cardiotoxicity.

INTRODUCTION: Anthracyclines are important anticancer drugs, but their use is limited by acute and chronic cardiotoxicity. Current approaches to surveillance are often inadequate to detect myocardial disease. Strain imaging might detect earlier myocardial dysfunction. Speckle analysis of three-dimensional (3D) echocardiography improves information about left ventricular (LV) segmental and global deformation by avoiding the loss of speckles seen in monoplane bidimensional-strain analysis. We assessed whether early 3D-strain analysis could predict later anthracycline-induced cardiotoxicity. METHODS: Echocardiography, troponin T (TnT) and N-terminal pro-brain natriuretic peptide were used to evaluate 59 patients (age 51 ± 10 years) before, and at 12 and 36 weeks after anthracycline treatment. LV global longitudinal strain (3DGLS), global radial strain (3DGRS) and global circumferential strain (3DGCS) were determined using 3D-strain imaging before and after 12 weeks of chemotherapy. Percentage changes from baseline to 12 weeks after initiation of chemotherapy () were calculated for all parameters analysed. RESULTS: During the follow-up period, eight patients (13.5%) developed cardiotoxicity. At 12 weeks after the initiation of chemotherapy, isovolumic relaxation time, 3DGLS, 3DGCS and 3DGRS had deteriorated and troponin was elevated (all p<0.05), before any decrease in LV ejection fraction. Cumulative anthracycline dose at 12 weeks, LVEF, 3DGLS and TnT were predictors of the later development of cardiotoxicity on univariate logistic regression. By multiple logistic regression, 3DGLS emerged as the only independent predictor of later cardiotoxicity (Odds ratio 1.09, p=0.04). CONCLUSIONS: Anthracycline therapy induced early deterioration of 3DGLS, 3DGCS and 3DGRS. 3DGLS seems to be a good predictor of the future development of anthracycline-induced cardiotoxicity.

The relationship between the time interval difference of isovolumic relaxation (T[IVRT-IVRTa]) and serum levels of N-terminal pro-brain natriuretic peptide in patients with intermediate E/Ea ratio.

INTRODUCTION: The ratio of early diastolic transmitral velocity to early mitral annular diastolic velocity (E/Ea) can be used to group patients according to filling pressures. However this relationship has not been validated in the intermediate group (E/Ea = 8-15). The time difference between the onset of E and Ea also correlates with left ventricular (LV) filling pressures. The purpose of our study was to evaluate the correlation between the time interval difference of isovolumic relaxation (T[IVRT-IVRTa]) and N-terminal pro-brain natriuretic peptide (NTpro-BNP) in patients with an intermediate E/Ea ratio. METHODS: Echocardiography was performed simultaneously with NTpro-BNP measurement in 60 consecutive patients who had an intermediate E/Ea and were in sinus rhythm. Ea and the isovolumic relaxation time (IVRTa) at the septal and lateral sites of the mitral annulus were measured using pulsed tissue Doppler and the average was utilised. Pulsed Doppler was used to measure E and IVRT. E/Ea and IVRT-IVRTa (T[IVRT-IVRTa]) were calculated. RESULTS: We demonstrated significant correlations between T[IVRT-IVRTa] and NTpro-BNP (r = -0.72, p<0.001), maximal systolic velocity of the mitral annulus (Sa: r = -0.50, p < 0.001), pulmonary artery systolic pressure (r = 0.42, p = 0.002), IVRTa (r = -0.27, p = 0.03), LV ejection fraction (LVEF: r = -0.26, p = 0.04), IVRT (r = -0.24, p = 0.04). We were unable to demonstrate significant relationships between NTpro-BNP and E deceleration time, left atrial diameter/area/volume, Ea or E. By a multiple linear regression analysis, including T[IVRT-IVRTa], IVRT, IVRTa, E/Ea, LVEF, pulmonary artery systolic pressure and Sa as potential determinants, TIVRT-IVRTa (= -0.57, p < 0.001) was shown to be the best independent predictor of NTpro-BNP (r 2 = 0.68, p < 0.001). CONCLUSIONS: T[IVRT-IVRTa] correlates strongly with NTpro-BNP levels in patients with intermediate E/Ea, and could be used as a simple echocardiographic index, with reasonable accuracy.