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Vinereanu D.,Carol Davila University of Medicine and Pharmacy | Vinereanu D.,University of Bucharest | Gherghinescu C.,Carol Davila University of Medicine and Pharmacy | Ciobanu A.O.,Carol Davila University of Medicine and Pharmacy | And 7 more authors.
Journal of Hypertension | Year: 2011

Objectives: To assess the effects of antihypertensive treatment on subclinical left ventricular dysfunction and to compare the effects of nebivolol with metoprolol. Methods: This is a prospective, randomized, parallel, active-controlled, PROBE design study (ClinicalTrials.org: NCT00942487) in 60 patients (53 ± 9 years, 67% men) with arterial hypertension, left ventricular hypertrophy, normal ejection fraction, and no coronary heart disease, randomized to either a nebivolol-based or a metoprolol-based treatment, who had conventional and tissue Doppler echocardiography, at rest and during dobutamine stress, at baseline and after 6 months. Results: SBP and DBP, and resting heart rate decreased by 13, 13, and 12%, respectively, on nebivolol, and by 11, 13, and 7%, respectively, on metoprolol (all, P < 0.01). Mean longitudinal early diastolic velocity increased by 16% (P < 0.05) on nebivolol compared with 9% (P = not significant) on metoprolol (P = not significant for intergroup differences), whereas flow propagation velocity increased by 34% on nebivolol (P < 0.05) and did not change on metoprolol (P < 0.01 for intergroup differences). Mean longitudinal displacement increased by 10% on nebivolol (P < 0.05) and did not change on metoprolol (P < 0.05 for intergroup differences), whereas ejection time increased by 5% on nebivolol (P < 0.05) and did not change on metoprolol. All the other parameters of left ventricular function were not different between the two treatment arms. Conclusion: Patients with mild-to-moderate hypertension have a beneficial effect from 6-month antihypertensive treatment on diastolic longitudinal left ventricular function; effects are significant with nebivolol, but not with metoprolol. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Margulescu A.D.,Wales Heart Research Institute
The American journal of emergency medicine | Year: 2012

A 49-year-old man was admitted with high-risk left ventricular thrombosis and systemic embolization. Prompt and complete resolution of the thrombus was achieved under intravenous lepirudin administration but not under full-dose heparin treatment. Medical physicians, including emergency medicine physicians, cardiologists, cardiac surgeons, and hematologists, should become more aware of these alternative anticoagulant treatments, especially in cases when other therapeutic options (such as thrombolysis or cardiac surgery) may be associated with high morbidity or mortality.

Zagura M.,University of Tartu | Serg M.,University of Tartu | Kampus P.,University of Tartu | Zilmer M.,University of Tartu | And 5 more authors.
European Journal of Vascular and Endovascular Surgery | Year: 2011

Objective: Arterial stiffness is a significant determinant of cardiovascular risk and is related to vascular calcification. Vitamin D may regulate arterial calcification and has been associated with cardiovascular survival benefits. However, data about the relationship between arterial stiffness, aortic calcification and vitamin D levels in patients with peripheral arterial disease (PAD) and in healthy subjects are limited. We examined the potential association between aortic calcification, arterial stiffness and vitamin D levels in patients with symptomatic PAD and in healthy individuals. Methods: We studied 78 men with PAD (aged 63 ± 7 years) and 74 healthy men (aged 61 ± 10 years). Aortic pulse wave velocity (aPWV) was determined by applanation tonometry using the Sphygmocor device. Aortic calcification score (ACS) was quantified by computed tomography. Serum 25-hydroxyvitamin D (25(OH)D) levels were measured using a radioimmune assay. Results: ACS (4.9(2.3-8.9) vs. 0.2(0.03-1.6) (cm 3); p < 0.01), aPWV (9.8 ± 2.4 vs. 8.2 ± 1.6 (m s -1); p < 0.01) and 25(OH)D (15.1 ± 5.4 vs. 19.0 ± 5.9 (ng ml -1); p < 0.01) were different in the patients compared with the controls. In multivariate analysis, ACS was independently determined by 25(OH)D, aPWV, calcium and age in patients with PAD (R 2 = 0.49; p < 0.001) and by 25(OH)D, aPWV, cholesterol/high-density lipoprotein (HDL) and age in the control group (R 2 = 0.55; p < 0.001). Increased aPWV and lower levels of 25(OH)D were associated with decreased ankle-brachial pressure index (p = 0.03). Conclusion: These results indicate that calcification of the aorta is independently associated with aortic stiffness and serum 25(OH)D level in patients with PAD and in healthy subjects. Aortic stiffness and abnormal vitamin D level may contribute to vascular calcification and are related to higher severity grade of atherosclerotic disease. © 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Vinereanu D.,Carol Davila University of Medicine and Pharmacy | Madler C.F.,Wales Heart Research Institute | Gherghinescu C.,Carol Davila University of Medicine and Pharmacy | Ciobanu A.O.,Carol Davila University of Medicine and Pharmacy | Fraser A.G.,Wales Heart Research Institute
Echocardiography | Year: 2011

Background: The risk factors that contribute to atherosclerosis also predict clinical heart failure, but it is unclear how they affect myocardial function. Aims were to assess if major cardiovascular risk factors cause subclinical myocardial dysfunction in asymptomatic subjects. Methods: We measured regional left ventricular (LV) function at rest and during dobutamine stress echocardiography in 246 subjects (54 ± 12 years, 54% men) analyzed in five groups according to the presence of six risk factors (diabetes, hypertension, obesity, dyslipidemia, smoking, and family history; age was similar in the five groups). LV longitudinal function was assessed from the mean velocities of four basal segments, and radial function from the velocities of the basal posterior wall. Results: Risk factors did not affect LV ejection fraction, but longitudinal systolic velocity decreased progressively with the number of risk factors, at rest (6.8 ± 1.3 vs. 6.2 ± 1.6 vs. 5.8 ± 1.5 vs. 5.4 ± 1.3 vs. 5.3 ± 1.3 cm/sec, for the five groups, respectively) and at peak stress (14.3 ± 3.3 vs. 12.9 ± 3.2 vs. 11.8 ± 3.4 vs. 11.3 ± 2.6 vs. 11.1 ± 2.3 cm/sec) (both P < 0.0001). Radial systolic velocity increased according to the number of risk factors (P < 0.01). By multivariate regression, determinants of reduced longitudinal systolic velocity at rest were body mass index, diastolic blood pressure, age, and fasting plasma glucose (r = 0.57, r 2= 0.32, P < 0.0001). Conclusion: Asymptomatic subjects have impaired LV long-axis function at rest and during stress, according to their number of major cardiovascular risk factors. Global LV systolic function is maintained by compensatory increases in radial function. These changes provide new targets for preclinical diagnosis and for monitoring responses to preventive strategies. © 2011, Wiley Periodicals, Inc.

Lobo M.D.,Queen Mary, University of London | Sobotka P.A.,ROX Medical | Sobotka P.A.,Ohio State University | Stanton A.,Royal College of Surgeons in Ireland | And 16 more authors.
The Lancet | Year: 2015

Background: Hypertension contributes to cardiovascular morbidity and mortality. We assessed the safety and efficacy of a central iliac arteriovenous anastomosis to alter the mechanical arterial properties and reduce blood pressure in patients with uncontrolled hypertension. Methods: We enrolled patients in this open-label, multicentre, prospective, randomised, controlled trial between October, 2012, and April, 2014. Eligible patients had baseline office systolic blood pressure of 140 mm Hg or higher and average daytime ambulatory blood pressure of 135 mm Hg or higher systolic and 85 mm Hg or higher diastolic despite antihypertensive treatment. Patients were randomly allocated in a 1:1 ratio to undergo implantation of an arteriovenous coupler device plus current pharmaceutical treatment or to maintain current treatment alone (control). The primary endpoint was mean change from baseline in office and 24 h ambulatory systolic blood pressure at 6 months. Analysis was by modified intention to treat (all patients remaining in follow-up at 6 months). This trial is registered with ClinicalTrials.gov, number NCT01642498. Findings: 83 (43%) of 195 patients screened were assigned arteriovenous coupler therapy (n=44) or normal care (n=39). Mean office systolic blood pressure reduced by 26.9 (SD 23.9) mm Hg in the arteriovenous coupler group (p<0.0001) and by 3.7 (21.2) mm Hg in the control group (p=0.31). Mean systolic 24 h ambulatory blood pressure reduced by 13.5 (18.8) mm Hg (p<0.0001) in arteriovenous coupler recipients and by 0.5 (15.8) mm Hg (p=0.86) in controls. Implantation of the arteriovenous coupler was associated with late ipsilateral venous stenosis in 12 (29%) of 42 patients and was treatable with venoplasty or stenting. Interpretation: Arteriovenous anastomosis was associated with significantly reduced blood pressure and hypertensive complications. This approach might be a useful adjunctive therapy for patients with uncontrolled hypertension.

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