Tobacco cigarette smoking accelerates impairment of aortic elastic properties in middle-aged patients with high normal blood pressure

Background The impact of smoking on atherosclerosis progression is greater in patients with arterial hypertension. High blood pressure (BP) is a major determinant of increased aortic stiffness which is an independent predictor of cardiovascular events. Aim of this study was to examine whether there are differences between office BP categorization and aortic stiffness on the basis of smoking status. Methods We measured carotid-femoral pulse wave (PWV) in 185 men (mean age: 55±10 years) who were not receiving antihypertensive medications and they had no history of diabetes and cardiovascular disease. The cohort was divided into three groups according to office systolic BP (SBP) and diastolic BP (DBP): normal (SBP <130 and DBP <85 mmHg, n=79), high normal (130≤SBP<140 or DBP 85≤DBP<90mmHg, n=42), and hypertension (SBP≥140 or DBP≥90mmHg, n=64). Results The three groups had similar age and metabolic parameters (body mass index, fasting blood glucose and LDL-C). PWV progressively increased from normotensive to high normal BP, and to hypertensive patients (7.8±1.4 vs 8.2±1.4 vs 8.6±1.6 m/s, respectively, overall P<0.01). Then we subdivided the three office BP groups into subgroups according to smoking status. Figure shows PWV of the three groups stratified by smoking status. The three subgroups of smokers had similar tobacco exposure (40 pack-years). There were not statistically significant differences between smokers and non smokers in each office BP category with regard to age and metabolic parameters. In separate analysis, among individuals with either normal BP the association of smoking status with PWV level was not significant. However, in hypertensive patients but also in patients with high normal BP, smoking status was significantly correlated with PWV (all P<0.01). Furthermore, the differences in mean PWV between smokers with high normal BP and patients with hypertension were not statistically significant reflecting a detrimental effect of smoking on aortic stiffness among males with high normal BP. Conclusion Smoking has an unfavorable effect on aortic elastic properties in men with high normal BP. The smokers with high normal BP have PWV comparable to that of hypertensive patients. This finding imply that smoking cessation should be a premising non pharmacological intervention in men with high-normal BP and increased aortic stiffness who are considered to be at a higher cardiovascular risk. FUNDunding Acknowledgement Type of funding sources: None. Smoking, BP categories and PWV

Left ventricular rotational abnormalities in adult patients with corrected tetralogy of Fallot following different surgical procedures – a three-dimensional speckle-tracking echocardiographic study

Introduction Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Abnormal aortic dimensions and elasticity parameters have been long described for corrected TOF (cTOF) together with left ventricular (LV) rotational abnormalities. The present study focuses on investigating LV rotational mechanics in cTOF, and possible correlation of these parameters with aortic elastic properties. It was also aimed to be examined whether different surgical strategies has any effect on the results. Methods The study involved 26 adult cTOF patients, from which 14 had palliative surgery first [Blaloc-Taussig (n=10), Waterstone-Cooley (n=2) shunts, or Brock procedure (n=2)] (mean age at the repair: 7.3±10.2 years) and a late total correction (mean age at the repair: 10.0±13.3 years) (pcTOF), while the early total correction was the treatment of choice in 12 patients (mean age at the repair: 4.2±3.2 years) (etrTOF). Their results were compared to that of 37 age- and gender-matched healthy adults. Routine transthoracic two-dimensional Doppler echocardiography extended with assessment of aortic elastic properties and three-dimensional speckle-tracking echocardiography (3DSTE) was performed in all cTOF patients and controls. Results Sixteen out of 26 cTOF patients showed normally directed LV rotational mechanics, while apical and basal LV rotations were in the same clockwise and counterclockwise directions in 7 and 3 cTOF cases, respectively (38%). This sort of LV movement is called as LV rigid body rotation (RBR). The ratio of LV-RBR between etrTOF and pcTOF patients did not differ significantly (33% vs. 43%, p=0.70). Significantly reduced LV apical rotation (5.2±3.7 degree vs. 10.2±4.5 degree, p<0.05) and twist (9.0±3.3 degree vs. 14.6±4.9 degree, p<0.05) could be demonstrated in cTOF patients with normally directed LV rotational mechanics with preserved LV basal rotation regardless of previous procedure. pcTOF patients showed significantly reduced LV apical rotation as compared to that of etrTOF cases (3.2±3.7 degree vs. 7.1±2.5 degree, p<0.05). From the 7 cTOF patients with clockwise LV-RBR, apical and basal LV rotation proved to be −6.8±5.4 degree and −4.9±2.4 degree, respectively with LV apico-basal gradient of 4.3±3.6 degree. The mean LV apical and basal LV rotation of 3 cTOF patients with counterclockwise LV-RBR prove to be −2.1±3.4 degree and 0.2±0.9 degree, respectively with LV apico-basal gradient of 2.5±2.4 degree. Significant correlations could be demonstrated between LV apical rotation and aortic stiffness index (r=−0.55, p=0.03) and aortic distensibility (r=0.52, p=0.04). Conclusions Significant LV rotational abnormalities could be demonstrated in cTOF with the high prevalence of LV-RBR. cTOF patients with early total reconstruction proved to have beneficial results. Abnormal physiologic response of LV rotational mechanics to increased aortic stiffness can be detected in cTOF patients without LV-RBR. Funding Acknowledgement Type of funding source: None

Evaluation of the Effect of Essential Hypertension on Elasticity of Ascending Aorta in Type 2 Diabetic Mellitus Patients by Echocardiography

Both essential hypertension (EH) and type 2 diabetes mellitus (T2DM) can impair the elasticity of the ascending aorta. We prospectively enrolled 42 patients with T2DM, 44 patients with EH, 45 patients with T2DM and EH (T2DM + EH), and 41 healthy subjects (HS). They all underwent transthoracic echocardiography to measure ascending aorta inner diameters and a brachial blood pressure measurement to calculate aortic elastic parameters (ie, compliance, distensibility, strain, stiffness index, and Peterson elastic modulus). We found that there were no significant differences as regard with age, sex, body mass index, blood lipids and glucose, carotid atherosclerosis, and ascending aorta inner diameters among the 4 groups. The aortic elastic properties were significantly impaired in T2DM, EH, and T2DM + EH patients compared with the HS, and more impaired in EH and T2DM + EH patients than T2DM patients; there were no significant differences between EH and T2DM + EH patients. Our findings suggest that both T2DM and EH can impair aortic elastic properties. Essential hypertension may play a more important role in the process of ascending aorta sclerosis in patients with T2DM + EH.

The relationship between coronary slow flow phenomenon and carotid femoral pulse wave velocity and aortic elastic properties

Introduction In this study, we aimed to investigate the relationship between coronary slow flow (CSF) and carotid-femoral pulse wave velocity (CFPWV). Methods 78 (27 women, mean age 43.95 ± 7.28) patients with CSF, and 70 (22 women, mean age 44.34 ± 7.08) healthy individuals were included in the study. Arterial stiffness measurement was performed to both groups via CFPWV, which is considered the gold standard. Aortic elastic properties (ASI-β and aortic distensibility) were evaluated in both groups. Results The CSF group had significantly higher CFPWV and aortic distensibility values and significantly lower ASI-β values compared to the control group. There was a positive correlation between TIMI frame count (TFC) obtained in all coronary arteries and CFPWV and aortic distensibility, and a negative correlation between TFC and ASI-β. It was determined that CFPWV predicted CSF with 97% specificity and 98% sensitivity at a 7.68 cut-off value (ROC area = 994, p < 0.001). ASI-β was determined to predict CSF with 64% specificity and 47% sensitivity at a 2.98 cut-off value (ROC area = 047, p < 0.001). Aortic distensibility was determined to predict CSF with 76% specificity and 79% sensitivity at a 3.94 cut-off value (ROC area = 706, p < 0.001). Conclusion Arterial stiffness increases in CSF patients, suggesting that CSF is a systemic pathology rather than a local disease and that a systemic cause such as atherosclerosis plays a role in etiology.

P4568Effect of intravitreal anti-vascular endothelial growth factor therapy on aortic stiffness and serum interleukin-6 levels in hypertensive patients with age-related macular degeneration

Purpose Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in adults over 65 years old and it is associated with moderate to severe arterial hypertension and increased aortic stiffness. Anti-vascular endothelial growth factor (anti-VEGF) agents, injected intravitreally, can reverse the symptoms of neovascular (wet) AMD. We sought to investigate whether intravitreal anti-VEGF therapy may influence aortic elastic properties of hypertensive patients with AMD. Methods 54 hypertensive patients with exudative (“wet”) AMD received intravitreal ranibizumab (0.5mg) and blood pressure (BP) and carotid-femoral pulse wave velocity (PWV) were measured at baseline (approximately 2 days before the first injection), 24 h after the first and second injection (time interval between the injections: 1 month) and 1 month after the second injection. Serum levels of high sensitivity interleukin-6 (hsIL-6) were measured at three time points (baseline, first injection, 1 month after the second injection). Results Systolic BP decreased by 3.2 mmHg and by 3.0 mmHg after the first and second injection respectively and remained decreased (by 2.6 mmHg) 1 month after the second injection (overall p=0.07, by ANOVA). The changes in diastolic BP were minimal (overall p=0.74). Ranibizumab injection caused a significant decrease of PWV after the first (by 0.34 m/s) and the second injection (by 0.31 m/s). Furthermore, as upper figure shows, PWV remained decreased 1 month after the second injection. Among the treated naïve eyes, 45 (83%) had a good response to ranibizumab while 9 (17%) were poor responders. Interestingly, PWV decreased significantly in good responders to AMD therapy (overall p=0.004) whereas, it increased in poor responders (overall p=0.21) over the study period. In responders to therapy serum hsIL-6 decreased after the first injection and remained decreased 1 month after the second injection (by 0.63 pg/ml, overall p=0.02, lower figure). The levels of hsIL-6 increased in poor responders (overall p=0.54). Ranibizumab, PWV and serum hsIL-6 levels Conclusions This is the first study showing that intravitreal administration of ranibizumab, a anti-VEGF used for improvement of wet AMD was associated with a beneficial acute and mid-term systematic effect on aortic elastic properties. Changes in systemic inflammatory activation may be involved. The findings have important implications for assessing the effect of anti-VEGF interventions on cardiovascular performance in hypertensive patients with exudative AMD.

The Relationship Between Serum Endocan Level and Aortic Elastic Properties in Patients With Newly Diagnosed Essential Hypertension

Endothelial dysfunction plays role in the generation of both essential hypertension (EH) and aortic stiffness. We evaluated the relationship between serum endocan level and aortic elastic properties (AEPs) assessed with the aortic strain, aortic distensibility, and aortic stiffness index by echocardiography. Newly diagnosed EH patients (n = 67) and controls (n = 70) were included in the study. The EH group was subdivided into stage 1 and 2 EH groups. A higher endocan level was found in the EH group, compared to the controls (34.2 ± 13.0 vs 24.1 ± 7.3 ng/mL, respectively, P < .001). All the AEP parameters were worse in the EH group, compared to the controls. Further, endocan levels correlated with aortic distensibility ( r = −0.305, P < .001) and aortic strain ( r = −0.181, P = .038), but not with aortic stiffness index ( r = 0.162, P = .064) in the whole study population. Aortic elastic properties deteriorate and serum endocan level increases in patients with EH. Moreover, serum endocan level shows a correlation with deteriorated AEPs, and hence may a surrogate marker of escalating aortic stiffness in patients with newly diagnosed EH.