The Effects of Below-Knee Medical Compression Stockings on Pulse Wave Velocity of Young Healthy Volunteers.

ABSTRACT: Szolnoky, G, Gavallér, H, Gönczy, A, Bihari, I, Kemény, L, Forster, T, and Nemes, A. The effects of below-knee medical compression stockings on pulse wave velocity of young healthy volunteers. J Strength Cond Res 35(1): 275-279, 2021-The effects of graduated medical compression stockings (MCS) on cardiovascular responses are poorly investigated. A simple study was undertaken to investigate whether the application of below-knee leg MCSs with different pressures could influence aortic pulse wave velocity (PWV) as the gold standard for aortic stiffness measurement evaluated by arteriography. Ten volunteers underwent PWV measurement at baseline, then in below-knee compression class (ccl) 1 (18-21 mm Hg), 2 (23-32 mm Hg) and 3 (34-46 mm Hg) MCSs in a consecutive manner. Baseline PWV (mean value: 7.86 ± 1.70 m·s-1) was significantly reduced by ccl 1 MCSs (mean value: 6.55 ± 0.88 m·s-1, p = 0.04). ccl 2 and ccl 3 stockings also notably decreased baseline PWV (mean values: 6.63 ± 0.65 m·s-1, p = 0.058 and 6.62 ± 1.00 m·s-1, p = 0.067; respectively). The application of low compression MCSs (ccl 1) leads to a significant decrease in PWV indicating a beneficial cardiovascular influence.

Right atrial deformation analysis in isolated left ventricular noncompaction - insights from the three-dimensional speckle tracking echocardiographic MAGYAR-Path Study.

OBJECTIVE: Isolated left ventricular noncompaction (ILVNC) is a rare cardiomyopathy characterized by a prominent trabecular meshwork and deep intertrabecular recesses. The present study aimed to examine right atrial (RA) volumes, volume-based functional properties and strains by three-dimensional speckle-tracking echocardiography (3DSTE) in ILVNC patients. METHODS: The study group consisted of 13 patients with ILVNC (mean age: 54.6±14.1 years, six male) and 23 healthy age- and gender-matched volunteers (mean age: 50.4±12.4 years, 10 male), who served as normal controls. Complete two-dimensional Doppler echocardiography and 3DSTE were performed in all cases. RESULTS: Increased systolic maximum (58.2±15.3 ml vs. 40.5±11.8 ml, p=0.0004) and diastolic pre-atrial contraction (39.6±16.1 ml vs. 28.2±9.2 ml, p=0.01) and minimum (46.2±17.5 ml vs. 34.6±11.6 ml, p=0.02) RA volumes were detected in ILVNC patients. Only total (18.6±8.5 ml vs. 12.2±5.9 ml, p=0.01) and passive (12.0±13.3 vs. 5.9±3.7 ml, p=0.05) RA stroke volumes, representing features of RA reservoir and conduit phases, were increased in ILVNC; active RA stroke volume and all emptying fractions did not differ between ILVNC patients and matched controls. Moreover, global, mean segmental and regional peak strains and strains at atrial contraction showed no differences between ILVNC patients and controls. CONCLUSIONS: 3DSTE-derived volumetric analysis confirmed increased cyclic RA volumes in ILVNC. Only mild RA functional alterations were demonstrated in ILVNC.

Short-term beat-to-beat variability of the QT interval is increased and correlates with parameters of left ventricular hypertrophy in patients with hypertrophic cardiomyopathy.

Stratification models for the prediction of sudden cardiac death (SCD) are inappropriate in patients with hypertrophic cardiomyopathy (HCM). We investigated conventional electrocardiogram (ECG) repolarization parameters and the beat-to-beat short-term QT interval variability (QT-STV), a new parameter of proarrhythmic risk, in 37 patients with HCM (21 males, average age 48 ± 15 years). Resting ECGs were recorded for 5 min and the frequency corrected QT interval (QTc), QT dispersion (QTd), beat-to-beat short-term variability of QT interval (QT-STV), and the duration of terminal part of T waves (Tpeak-Tend) were calculated. While all repolarization parameters were significantly increased in patients with HCM compared with the controls (QTc, 488 ± 61 vs. 434 ± 23 ms, p < 0.0001; QT-STV, 4.5 ± 2 vs. 3.2 ± 1 ms, p = 0.0002; Tpeak-Tend duration, 107 ± 27 vs. 91 ± 10 ms, p = 0.0015; QTd, 47 ± 17 vs. 34 ± 9 ms, p = 0.0002), QT-STV had the highest relative increase (+41%). QT-STV also showed the best correlation with indices of left ventricular (LV) hypertrophy, i.e., maximal LV wall thickness normalized for body surface area (BSA; r = 0.461, p = 0.004) or LV mass (determined by cardiac magnetic resonance imaging) normalized for BSA (r = 0.455, p = 0.015). In summary, beat-to-beat QT-STV showed the most marked increase in patients with HCM and may represent a novel marker that merits further testing for increased SCD risk in HCM.

Increased Short-Term Beat-To-Beat Variability of QT Interval in Patients with Acromegaly.

Cardiovascular diseases, including ventricular arrhythmias are responsible for increased mortality in patients with acromegaly. Acromegaly may cause repolarization abnormalities such as QT prolongation and impairment of repolarization reserve enhancing liability to arrhythmia. The aim of this study was to determine the short-term beat-to-beat QT variability in patients with acromegaly. Thirty acromegalic patients (23 women and 7 men, mean age±SD: 55.7±10.4 years) were compared with age- and sex-matched volunteers (mean age 51.3±7.6 years). Cardiac repolarization parameters including frequency corrected QT interval, PQ and QRS intervals, duration of terminal part of T waves (Tpeak-Tend) and short-term variability of QT interval were evaluated. All acromegalic patients and controls underwent transthoracic echocardiographic examination. Autonomic function was assessed by means of five standard cardiovascular reflex tests. Comparison of the two groups revealed no significant differences in the conventional ECG parameters of repolarization (QT: 401.1±30.6 ms vs 389.3±16.5 ms, corrected QT interval: 430.1±18.6 ms vs 425.6±17.3 ms, QT dispersion: 38.2±13.2 ms vs 36.6±10.2 ms; acromegaly vs control, respectively). However, short-term beat-to-beat QT variability was significantly increased in acromegalic patients (4.23±1.03 ms vs 3.02±0.80, P<0.0001). There were significant differences between the two groups in the echocardiographic dimensions (left ventricular end diastolic diameter: 52.6±5.4 mm vs 48.0±3.9 mm, left ventricular end systolic diameter: 32.3±5.2 mm vs 29.1±4.4 mm, interventricular septum: 11.1±2.2 mm vs 8.8±0.7 mm, posterior wall of left ventricle: 10.8±1.4 mm vs 8.9±0.7 mm, P<0.05, respectively). Short-term beat-to-beat QT variability was elevated in patients with acromegaly in spite of unchanged conventional parameters of ventricular repolarization. This enhanced temporal QT variability may be an early indicator of increased liability to arrhythmia.

[Relationship between early myocardial reperfusion assessed by videodensitometry and late left ventricular function. Results following invasive treatment of acute myocardial infarction]. / A videodenzitometriával vizsgált korai myocardialis reperfúzió és a kései balkamra-funkció összefüggései. Eredmények acut myocardialis infarctus invazív ellátását követoen.

INTRODUCTION: It is known that there is a relationship between myocardial perfusion and left ventricular function. AIM: The aim of the current study was to examine the relationship between myocardial reperfusion as assessed by videodensitometry on coronary angiograms following invasive treatment of ST elevation myocardial infarction and magnetic resonance imaging-derived late left ventricular function. METHOD: The study included 25 patients with ST elevation myocardial infarction. A quantitative parameter of myocardial (re)perfusion was calculated by the ratio of maximal density (Gmax) and the time to reach maximum density (Tmax) following invasive treatment. Magnetic resonance imaging was performed 387±262 days after ST elevation myocardial infarction for the evaluation of left ventricular function in all cases. RESULTS: Significant correlations were demonstrated between left ventricular ejection fraction and Gmax (r = 0.40, p = 0.05) and Gmax/Tmax (r = 0.41, p = 0.04) following vessel masking. CONCLUSIONS: The results demonstrate significant relationship between densitometric Gmax/Tmax and late left ventricular function following ST elevation myocardial infarction. Orv. Hetil., 2014. 155(5), 187-193.

Quantification of changes in septal strain after alcohol septal ablation in hypertrophic obstructive cardiomyopathy-cases from the three-dimensional speckle tracking echocardiographic MAGYAR-path study.

Patients with hypertrophic obstructive cardiomyopathy undergoing alcohol septal ablation are presented. Three-dimensional speckle tracking echocardiography (3DSTE) is a new, noninvasive tool for quantification of myocardial deformation. In both cases, 3DSTE was performed 1 day before and 3 days after alcohol septal ablation to quantify changes in septal strain of ablated area. Results could suggest the possible role of 3DSTE in the quantitative evaluation of the success of alcohol septal ablation.

Hypertrophic cardiomyopathy is associated with abnormal echocardiographic aortic elastic properties and arteriograph-derived pulse-wave velocity.

OBJECTIVE: Hypertrophic cardiomyopathy (HCM) is a genetic cardiac disease and defined by the presence of unexplained left ventricular hypertrophy (LVH). Vascular alterations are frequently associated with HCM including microvascular and/or peripherial endothelial dysfunction. This study was designed to evaluate echocardiographic ascending aortic elastic properties and arteriograph-derived pulse-wave velocity (PWV) and augmentation index (Aix) in HCM. METHODS: This study comprised 38 patients with typical features of HCM. Their results were compared to 20 hypertensive patients with LVH and 23 controls. Systolic and diastolic ascending aortic diameters were recorded in M-mode at a level of 3 cm above the aortic valve from a parasternal long-axis view. The following echocardiographic aortic elastic properties were measured from aortic data and forearm blood pressure values: aortic strain, distensibility, and stiffness index. Arteriograph-derived PWV and AIx were also measured. RESULTS: Aortic stiffness index (18.4 ± 17.6 vs. 6.88 ± 3.63, P < 0.05), PWV (9.44 ± 4.08 vs. 7.97 ± 1.20 m/sec, P < 0.05) and Aix (-24.9 ± 32.6 vs. -41.4 ± 24.3, P < 0.05) were increased, while aortic strain (0.061 ± 0.053 vs. 0.100 ± 0.059, P < 0.05) and aortic distensibility (1.94 ± 1.68 cm(2) /dynes 10(-6) vs. 3.08 ± 1.77 cm(2) /dynes 10(-6) , P < 0.05) were decreased in HCM patients compared to controls. Aortic elastic properties of hypertensive patients with LVH showed similar alterations to HCM patients. CONCLUSIONS: Abnormal echocardiographic aortic elastic properties and arteriograph-derived PWV and Aix could be demonstrated in HCM patients compared to matched controls.

Correlations between Arteriograph-derived pulse wave velocity and aortic elastic properties by echocardiography.

INTRODUCTION: There is an increased scientific interest on the evaluation of parameters characterizing aortic elasticity. The current study was designed to compare two characteristics of aortic distensibility: Arteriograph-derived pulse wave velocity (PWV) and augmentation index standardized to 80 per minutes heart rate (AIx80) and aortic elastic properties by echocardiography. METHODS: The study comprised 21 adult healthy volunteers. In all cases, systolic and diastolic ascending aortic diameters were recorded during transthoracic echocardiography in M-mode at a level 3 cm above the aortic valve from a parasternal long-axis view. Using forearm blood pressure values, the following aortic elastic properties were calculated: aortic strain, distensibility and stiffness index. All patients were examined by Arteriograph at the same time, as well. RESULTS: The Arteriograph-derived AIx80 and PWV correlated with aortic strain (R = -0·495, P = 0·023 and R = -0·527, P = 0·014, respectively) and aortic stiffness index (R = 0·454, P = 0·039 and R = 0·608, P = 0·003, respectively). Aortic distensibility did not correlated with AIx80 (R = -0·344, P = 0·127), only with PWV (R = -0·593, P = 0·005, respectively). DISCUSSION: Low to moderate correlations could be demonstrated between Arteriograph-derived PWV and aortic elastic properties by echocardiography.

Correlations between aortic stiffness and parasympathetic autonomic function in healthy volunteers.

Cardiovascular autonomic dysfunction and alterations in vascular elasticity are known complications of several disorders, including diabetes mellitus, hypertension, hypercholesterolemia, aging, and chronic kidney disease. The current study was designed to test whether a relationship existed between pulse wave velocity (PWV), augmentation index (AIx), aortic elastic properties, and cardiovascular autonomic function in healthy volunteers. The study comprised 25 healthy volunteers, whose aortic strain, distensibility, and stiffness index were measured by echocardiography, whereas PWV and AIx were evaluated by Arteriograph (TensioMed, Budapest, Hungary) in all cases. Autonomic function was assessed by means of 5 standard cardiovascular reflex tests. We found that heart rate response to deep breathing, as the most reproducible cardiovascular reflex test to characterize parasympathetic function, showed low to moderate correlations with PWV (r = -0.431, p = 0.032), aortic strain (r = 0.594, p = 0.002), distensibility (r = 0.407, p = 0.043), and stiffness index (r = -0.453, p = 0.023). Valsalva ratio and autonomic neuropathy score (ANS) correlated with PWV (r = -0.557, p = 0.004 and r = -0.421, p = 0.036, respectively) and AIx (r = -0.461, p = 0.020 and r = -0.385, p = 0.057, respectively), while ANS correlated with even aortic stiffness index (r = -0.457, p = 0.022). Cardiovascular reflex tests mainly characterizing sympathetic function had no correlation with aortic stiffness parameters (p = NS for all correlations). Correlations exist between parameters characterizing aortic elasticity and parasympathetic autonomic function, as shown by standard cardiovascular reflex tests in healthy volunteers.

[Coronary artery dissection in the postpartum period--a case study]. / Postpartum coronaria dissectio esete.

Spontaneous coronary dissection is a rare condition occurring more often in women, with a higher frequency during the peripartum period. No specific aetiology has been defined to this uncommon, but often fatal disease. We describe the case of a young woman admitted to our intensive care unit with ECG-findings of acute anterior myocardial infarction presented one week after delivery. The acute coronary angiography didn't show significant stenoses or occlusion, therefore angioplasty was not done. Cardiogenic shock developed, which could be reverted by mechanical circulatory support and the condition of our patient stabilized. Later, new-onset cardiac ischemic signs presented warranting a repeated coronary angiography, which detected dissection on the distal part of the left main coronary artery with signs of flow-limiting even in the circumflex artery. Therefore, urgent coronary bypass surgery was performed with good results. Spontaneous coronary dissection must be considered when evaluating a patient in the peripartum period with signs of acute coronary syndrome, given its high overall mortality. The treatment holds specific points of consideration.

Obesity is associated with aortic enlargement and increased stiffness: an echocardiographic study.

BACKGROUND: Obesity may be associated with early vascular changes. The current study was designed to assess the relationship between obesity and aortic stiffness in two populations, one aged 18-40 years and one aged 41-64 years. METHODS: The study complied 121 subjects, all of them underwent a physical examination, transthoracic echocardiography and blood pressure measurement. Aortic stiffness index (beta) was evaluated from aortic diameter and blood pressure data. RESULTS: beta was higher in obese subjects both in the young (4.26 +/- 1.57 vs. 6.88 +/- 5.96, P < 0.05) and old patient populations (7.13 +/- 4.99 vs. 14.89 +/- 14.64, P < 0.05). Systolic (SD) aortic diameters (in mm) were enlarged in obese young patients (25.7 +/- 2.8 vs. 27.1 +/- 2.5, P < 0.05) and obese old subjects (28.0 +/- 3.0 vs. 30.3 +/- 3.3, P < 0.05). Diastolic (DD) aortic diameter (in mm) showed similar tendency in youngs (22.8 +/- 2.9 vs. 24.9 +/- 2.5, P < 0.05) and old subjects (25.9 +/- 2.7 vs. 28.0 +/- 3.1, P < 0.05). CONCLUSIONS: Aortic stiffness is higher in young obese patients and similar to older subjects without obesity. Both SD and DD are increasing with age, but subjects within similar age group have larger SD and DD suggesting early vascular remodelling in obesity.

Aortic stiffness is increased in acromegaly--a transthoracic echocardiographic study.

BACKGROUND: Acromegaly is associated with increased cardiovascular risk. Recent studies suggested a direct effect of growth hormone and insuline-like growth factor 1 excess on the vasculature over the conventional risk factors. The aim of the present study was to evaluate the stiffness of ascending aorta by means of transthoracic echocardiography (TTE) in patients with acromegaly. PATIENTS AND METHODS: The following patient populations were compared: 20 subjects with negative coronary angiograms, 16 acromegalics and 21 patients with significant coronary artery disease (CAD). Aortic stiffness index (beta) was evaluated by means of TTE by use of the formula: beta=ln (SBP/DBP)/(DeltaD/DD), where SBP and DBP are the systolic and diastolic blood pressures, DD is the diastolic aortic diameter, DeltaD is the pulsatile change in aortic diameter (systolic diameter minus diastolic diameter) and 'ln' is the natural logarithm. RESULTS: The average time from diagnosis was 162+/-127 days in acromegalic patients. Transsphenoidal hypophysectomy was performed in 12 patients, while the mean growth hormone level was 10.8+/-11.7 mIU/ml. beta was similarly increased in acromegalics and in CAD patients as compared to controls (6.23+/-3.29 vs 16.47+/-14.53 and 16.66+/-15.49, p<0.05, respectively). CONCLUSIONS: Stiffness of ascending aorta evaluated by a routine TTE examination is increased in acromegalics without overt cardiovascular disease as compared to controls and similar to CAD patients.

Increased aortic stiffness in glycogenosis type 2 (Pompe's disease).

BACKGROUND: Pompe's disease, also known as acid maltase deficiency or glycogen storage disease type II, is an autosomal recessive disorder in which deficient activity of the enzyme acid alpha-glucosidase causes intra-lysosomal accumulation of glycogen in muscle and other tissues. The current study was designed to assess aortic stiffness index (beta), as a characteristic of aortic elasticity during transthoracic echocardiography in patients with Pompe's disease. METHODS: A total of 17 patients (age 44+/-8 years, 5 males) with Pompe's disease were studied. Their results were compared to 17 age- and gender-matched controls. In all patients, the ascending aorta was recorded with M-mode echocardiography. Beta was calculated as ln(SBP/DBP)/[(SD-DD)/DD], where SBP and DBP are the systolic and diastolic blood pressures, SD and DD are the systolic and diastolic aortic diameters, and 'ln' is the natural logarithm. RESULTS: Diastolic aortic diameter was 27.4+/-2.4 mm in Pompe patients and 25.6+/-2.7 mm in controls (P<0.05). Systolic aortic diameters did not differ between the groups (29.4+/-2.5 mm vs 28.3+/-2.4 mm, P=ns). Aortic stiffness index (beta) was increased in Pompe patients compared to controls (14.6+/-10.1 vs 5.1+/-2.6, P<0.001). CONCLUSIONS: The results of this study indicate that aortic stiffness is increased in patients with Pompe's disease. This may be due to glycogen storage in the vessel wall causing reduced vascular elasticity.

Transthoracic echocardiographic evaluation of aortic distensibility in a Takayasu's arteritis patient.

Takayasu's arteritis (TA) is a chronic, nonspecific, rare, and segmental inflammatory disease that primarily affects the aorta and its main branches. In the present case, the aortic elastic properties were decreased (aortic distensibility was practically normal) suggesting that ascending aorta was not affected by TA. For preoperative assessment, a routine transthoracic echocardiography can be a valuable method for the noninvasive functional evaluation of ascending aorta in a patient with TA.