HSOA journal of non invasive vascular investigation, Jan 16, 2022
To analyze, from a historical point of view, the scientific and
technologic progression of the n... more To analyze, from a historical point of view, the scientific and
technologic progression of the non-invasive vascular evaluation,
in particular the huge step ahead in the last 20 years, in parallel
with the evolution from a “treatment-after- event” based Medicine
to Preventive Medicine. No-invasive vascular Evaluation jumped in
the last twenty years from the bench to the bedside, giving rise to
a Precision Medicine, detecting and preventing the atherosclerotic
disease in the earliest stages, in order to control the huge burden of
cardiovascular disease that the human kind has been suffering the
last hundred years. A worldwide and widespread use of non-invasive
vascular evaluation in the current clinical practice for cardiovascular
prevention remains as a challenge, and this review is a call to action
to do so
Cardiovascular disease caused by atherosclerosis is the first cause of mortality and disability a... more Cardiovascular disease caused by atherosclerosis is the first cause of mortality and disability around the world. To understand the pathophysiology of the atherosclerotic plaques and specially their hemodynamics, the changes with their evolution or with the therapeutic interventions are essential to develop effective diagnostic and therapeutic interventions to stop the cardiovascular pandemics. Ultrasound is a cheap, simple and accessible methodology that experienced in the last three decades an astounding development in terms of technology and diagnostic precision. In the field of doppler ultrasound, Power doppler and Color doppler enabled a detailed evaluation of cardiac valves, arteries and veins that conducted to impressive diagnostic precision and to enable advances in therapeutic interventions. Recently a new doppler technology based on processing in blocks the ultrasound information and transduce it into a vector representation of the displacement of blood flow in the space, named VFLOW (acronysm of Vector Flow Imaging), conducted to a new field of investigation of complex flow patterns, by means of the instantaneous measurement of speed, flow gradients, wall shear stress and vessel wall stiffness. We conducted an investigation of different hemodynamic patterns according to plaque structure and vascular regional hemodynamics. Two main groups of plaques have been described, the soft ones ("expanding") and the stiff or hard ones ("non expanding"). The first type has been associated with acute cardiovascular complications and increased cardiovascular risk and just the opposite, chronic lesions in stable disease to the later. We analyze in this paper the characterization of both types of plaques, their hemodynamic patterns and in particular, for the first time, the behavior of the wall shear stress at different sectors of the plaques which may be linked to their development and/or complications. This technology deserves further development face to future applications in the diagnosis and treatment of atherosclerotic vascular disease.
El estrés psicosocial crónico (EPC) fue propuesto como un factor de riesgo cardiovascular (FRC); ... more El estrés psicosocial crónico (EPC) fue propuesto como un factor de riesgo cardiovascular (FRC); sin embargo, la complejidad y la falta de medidas objetivas para evaluarlo, unidas al hecho de que no todas las personas reaccionan ante él de igual manera, determinaron que en la actualidad no se cuente con estudios concluyentes al respecto. Objetivos Determinar si la baja resiliencia (BR) frente al EPC se asocia con hipertensión arterial y daño de órgano blanco en pacientes ambulatorios libres de tratamiento que concurren a realizarse un examen periódico de salud y comprobar si esta asociación tiene relación con el patrón de activación neurohormonal. Material y métodos Se realizó un estudio preliminar, observacional transversal, en el que se enrolaron en forma consecutiva 53 individuos, 32 varones y 21 mujeres. Los pacientes completaron dos cuestionarios: uno para medir EPC y el otro, la Escala de Resiliencia de Connor-Davidson. Quedaron divididos en cuatro grupos: 1, sin EPC y con resiliencia normal (RN); 2, sin EPC y con baja resiliencia (BR); 3, con EPC y RN; 4, con EPC y BR. Resultados El porcentaje de hipertensos fue superior en el grupo 4 (p < 0,001), como también el de individuos con incremento de la circunferencia de la cintura (ICC) (p = 0,05). Si bien los niveles de noradrenalina, cortisol y ácido vanililmandélico fueron ligeramente superiores en el grupo 4, las diferencias no alcanzaron significación estadística. Para determinar si el EPC unido a BR es un factor de riesgo para el desarrollo de hipertensión arterial se empleó un modelo de regresión logística, controlado por confundidores; el odds ratio fue de 10,9 con intervalos de confianza del 95%, inferior de 1,8 y superior de 65,2. Conclusiones Datos preliminares sugieren que individuos con EPC unido a BR tienen un riesgo alto para el desarrollo de hipertensión arterial.
To determine whether angiotensin converting enzyme inhibition by perindopril can reduce cardiac t... more To determine whether angiotensin converting enzyme inhibition by perindopril can reduce cardiac transforming growth factor b1 (TGFb1) and plasminogen activator inhibitor 1 (PAI-1) and therefore control collagen accumulation in an animal model with the metabolic syndrome such as the obese Zucker rat (OZR). Animals: Male OZR (group 1, n = 10); OZR treated with perindopril (group 2, n = 10); and lean Zucker rats (group 3, n = 10). Methods: During six months, group 2 received 3 mg/kg/day of perindopril orally and group 1 and group 3 were given a vehicle. Hearts were processed for pathology studies including immunohistochemical analysis with antibodies to PAI-1, TGFb1, collagen type I, and collagen type III. Results: Group 2 had lower blood pressure (126.7 (2) v 148.6 (2.7) mm Hg, p , 0.01) than untreated OZR and had decreased cardiac PAI-1 (3.6 (0.4) v 13.5 (1.7)% of positive area/field, p , 0.01), TGFb1 in myocytes (0.13 (0.1) v 9.14 (4.7)%/area, p , 0.01) and in interstitium (19.8 (6.8) v 178.9 (27.4) positive cells/area, p , 0.01), collagen I (3 (0.8) v 13.3 (1)%/area, p , 0.01), collagen III (5 (0.6) v 9.5 (0.9)%/area, p , 0.01), and collagen I to collagen III ratio (0.59 (0.13) v 1.40 (0.15) p , 0.01) compared with untreated OZR. Conclusion: These results suggest that perindopril reduces cardiac PAI-1 and TGFb1 and ameliorates cardiac fibrosis in a rat model with multiple cardiovascular risk factors.
Conclusion: Cardiovascular syphilis is still present. A serologic test for syphilis is recommende... more Conclusion: Cardiovascular syphilis is still present. A serologic test for syphilis is recommended in patients with dilated ascending aortas irrespective of whether or not they have aortic regurgitation. Summary: In the 19 th century, 15% of the adult population in the United States was afflicted by syphilis. Syphilology was a separate medical specialty devoted to the treatment of the manifestations of this disease. It is infrequent for patients with primary syphilis to develop tertiary syphilis. Syphilis is a difficult disease to study in that the spirochete Treponema pallidum cannot be convincingly demonstrated in histologic sections of the aorta in patients with dilated aortas presumably secondary to tertiary syphilis. In addition T pallidum cannot be cultured. There have been no large studies of cardiovascular syphilis since 1964. In this well-illustrated study, the authors present results of autopsies in 90 patients with characteristic morphologic findings of syphilitic aortitis. All but two patients were examined by a single author from 1966 to 1990. All 90 patients had extensive involvement of the ascending aorta by the syphilitic process. The sinus of Valsalva was spared in all but four patients. In 26% of the 90 patients, syphilis was the cause of death in patients in whom the aortic arch and descending thoracic aorta were examined. There was evidence of syphilitic involvement of the aortic arch in 49 of 54 patients (91%) and syphilitic involvement of the descending thoracic aorta in 47 of 52 patients (90%). In the 23 patients who died, death was secondary to rupture of the ascending or descending thoracic aorta in 12 and form severe aortic regurgitation in 10. One patient had severe narrowing of the osteum of the right coronary artery as the cause of death. Serologic testing for syphilis was performed in 40 patients and 28 (70%) had a positive finding. Patients with negative or nonreactive tests who did not undergo serologic tests for syphilis had histologic and morphologic findings in the aorta at autopsy similar to the finding in the patients who had positive serologic tests. Comment: The paper is a fascinating review of the aortic manifestations of tertiary syphilis. Key points are that syphilis still occurs in the general population. Seventy-seven of the 90 cases in this series were from Washington, DC-area hospitals or institutions. Men outnumbered women 2:1. The series also serves to remind us that a negative serologic test does not exclude the presence of syphilis. As vascular surgeons become more involved in the treatment of patients with thoracic aortic disease, including the development of hybrid procedures to treat aortic arch disease, it will be necessary to keep in mind that the underlying etiology of the disease may in some cases still be tertiary syphilis.
almost statistically significant differences (p values ranging from 0.07 and 0.13) could only be ... more almost statistically significant differences (p values ranging from 0.07 and 0.13) could only be recorded consistently in the 40-49 age class concerning PWV/ cSBP/ cPP / AI. Authors discuss the relevance of these findings concerning risk stratification in a Portuguese population with high incidence of stroke.
Introduction: Increased carotid intima-media thickness (IMT), as early sign of atherosclerosis, c... more Introduction: Increased carotid intima-media thickness (IMT), as early sign of atherosclerosis, closely correlates with traditional risk factors: increased cholesterol level, high blood pressure (BP), age, metabolic syndrome. The aim of our study was to evaluate the relationship between IMT and other arterial wall parameters. Methods: Consecutive high cardiovascular risk patients aged from 50 to 55 were investigated at the Vilnius University Hospital, including detailed assessment of cardiovascular risk factors, serum lipid profile, C-reactive protein (CRP). Carotid IMT and carotid stiffness were measured by echotracking with ART.LAB system. Aortic and brachial pulse wave velocity (aPWV and bPWV), heart rate adjusted aortic augmentation index (AIx/HR) were evaluated by applanation tonometry with SphygmoCor. Endothelial function in brachial artery was assessed by calculating the flow mediated dilatation (FMD). Correlations between IMT and other arterial wall parameters were estimated. Results: 860 patients (mean ageAESD 52.63AE1.58; 536 (62.3%) females) were analyzed. There was only a very weak correlation between IMT and femoral PWV (rZ0.094; pZ0.049) in the whole group. IMT did not correlate with arterial wall parameters in female group, however, IMT correlated with AIx/HR in male group (rZ0.190; pZ0.004). Significant but relatively weak IMT correlations with age (rZ0.079; pZ0.024), BMI (rZ0.134 ; p<0.001), systolic BP (rZ0.122; pZ0.001), diastolic BP (rZ0,106; pZ0,003), HDL-Ch (rZ-0.143 ; p<0.001), CRP (rZ0.089 ; pZ0.013) were observed without impact of gender. Regression models showed that IMT may not be predicted by PWV, AIx/HR, FMD. Conclusions: Carotid IMT has a weak correlation with the new arterial measures in high cardiovascular risk patients.
almost statistically significant differences (p values ranging from 0.07 and 0.13) could only be ... more almost statistically significant differences (p values ranging from 0.07 and 0.13) could only be recorded consistently in the 40-49 age class concerning PWV/ cSBP/ cPP / AI. Authors discuss the relevance of these findings concerning risk stratification in a Portuguese population with high incidence of stroke.
Introduction: The Mycoplasma pneumoniae and the Clhamydia pneumoniae are habitual pathogens in re... more Introduction: The Mycoplasma pneumoniae and the Clhamydia pneumoniae are habitual pathogens in respiratory infections, specially in winter period. Both germs, according to evidence, could cause, inflammation and this activation may lead to alter the endothelial function. The identification of this condition using vascular function studies, may contribute to an early detection of a vulnerable population. Aims: Based on this hypothesis, we assessed the vascular function (IMT, atherosclerotic plaques assessment, PWV and FMD) in individuals with a history of chronic or acute infection of Mycoplasma pneumoniae; and the relation between this chronic or acute infection with the vascular dysfunction. Material and Methods: 26 patients were evaluated according to the following inclusion criteria: age between 20 and 45 years, low risk according Framingham scale, and a low risk European score. The control group were 14 individuals (50 % masc.) with negative serology for all the studied germs The study group were 12 individuals with positive serology for Mycoplasma Pneumoniae (IGG and IGM). Both groups were studied by vascular ultrasound doppler scan, evaluating vascular function. The qualitative variables were analyzed using Chi square and Fisher's exact Test and the quantitative variables using Proved Rank Sum Test (Wilcoxon): Results: The different variables of vascular function IMT, PWV and FMD abnormality showed a trend to be higher in subjects with positive serology but without statistical significance (P:0,22; p:0,15:p:0,15). The proportion of subjects with atherosclerotic plaques was significantly higer in the seropositive subjects, which is the single objective evidence (P:0,04) consistent with the trend observed in the other determinations of structure and vascular function. Conclusions: There are numerous known factors influencing vascular dysfunction. The infectious could be one of them, and Mycoplasma Pneumoniae one of the germs related at least with alterations of the vascular structure.
Central hemodynamics by means of pulse wave velocity (PWV) in several territories, central aortic... more Central hemodynamics by means of pulse wave velocity (PWV) in several territories, central aortic pressure, and the augmentation and amplification indexes offer several non-invasive, easy and accurate ways to evaluate arterial stiffening, closely
linked to the beginning of hypertension and its evolution.
In the near future, simplified and cheaper measurements of both parameters will be used in clinical practice. Their response
to different cardiovascular and non-cardiovascular drugs and the 24-hour monitoring of arterial stiffness markers are now the
new challenges for better and more effective cardiovascular prevention, as they determine the root of the problem, thereby
providing a more effective treatment option based on the physiopathology of the arterial disease..
In hypertension, arterial stiffness evaluation can be particularly useful beyond its prognostic value and for CV risk restratification in three different situations :
1. In young hypertensives to differentiate spurious isolated systolic hypertension from true hypertension.
2. In middle-aged adults, it detects early vascular ageing and allows early intervention and CV risk reduction. An interplay between PWV and augmentation /amplification indexes leads to a better understanding and treatment of vascular
disease as the cause of hypertension.
3. In the elderly, PWV explains the higher pulsatility in isolated systolic hypertension and the main cause of target organ
damage; it is a prognostic marker and a therapeutic target. Eventually, the SUPERNOVA patients could be a group of interest in the future in understanding vascular protection mechanisms
HSOA journal of non invasive vascular investigation, Jan 16, 2022
To analyze, from a historical point of view, the scientific and
technologic progression of the n... more To analyze, from a historical point of view, the scientific and
technologic progression of the non-invasive vascular evaluation,
in particular the huge step ahead in the last 20 years, in parallel
with the evolution from a “treatment-after- event” based Medicine
to Preventive Medicine. No-invasive vascular Evaluation jumped in
the last twenty years from the bench to the bedside, giving rise to
a Precision Medicine, detecting and preventing the atherosclerotic
disease in the earliest stages, in order to control the huge burden of
cardiovascular disease that the human kind has been suffering the
last hundred years. A worldwide and widespread use of non-invasive
vascular evaluation in the current clinical practice for cardiovascular
prevention remains as a challenge, and this review is a call to action
to do so
Cardiovascular disease caused by atherosclerosis is the first cause of mortality and disability a... more Cardiovascular disease caused by atherosclerosis is the first cause of mortality and disability around the world. To understand the pathophysiology of the atherosclerotic plaques and specially their hemodynamics, the changes with their evolution or with the therapeutic interventions are essential to develop effective diagnostic and therapeutic interventions to stop the cardiovascular pandemics. Ultrasound is a cheap, simple and accessible methodology that experienced in the last three decades an astounding development in terms of technology and diagnostic precision. In the field of doppler ultrasound, Power doppler and Color doppler enabled a detailed evaluation of cardiac valves, arteries and veins that conducted to impressive diagnostic precision and to enable advances in therapeutic interventions. Recently a new doppler technology based on processing in blocks the ultrasound information and transduce it into a vector representation of the displacement of blood flow in the space, named VFLOW (acronysm of Vector Flow Imaging), conducted to a new field of investigation of complex flow patterns, by means of the instantaneous measurement of speed, flow gradients, wall shear stress and vessel wall stiffness. We conducted an investigation of different hemodynamic patterns according to plaque structure and vascular regional hemodynamics. Two main groups of plaques have been described, the soft ones ("expanding") and the stiff or hard ones ("non expanding"). The first type has been associated with acute cardiovascular complications and increased cardiovascular risk and just the opposite, chronic lesions in stable disease to the later. We analyze in this paper the characterization of both types of plaques, their hemodynamic patterns and in particular, for the first time, the behavior of the wall shear stress at different sectors of the plaques which may be linked to their development and/or complications. This technology deserves further development face to future applications in the diagnosis and treatment of atherosclerotic vascular disease.
El estrés psicosocial crónico (EPC) fue propuesto como un factor de riesgo cardiovascular (FRC); ... more El estrés psicosocial crónico (EPC) fue propuesto como un factor de riesgo cardiovascular (FRC); sin embargo, la complejidad y la falta de medidas objetivas para evaluarlo, unidas al hecho de que no todas las personas reaccionan ante él de igual manera, determinaron que en la actualidad no se cuente con estudios concluyentes al respecto. Objetivos Determinar si la baja resiliencia (BR) frente al EPC se asocia con hipertensión arterial y daño de órgano blanco en pacientes ambulatorios libres de tratamiento que concurren a realizarse un examen periódico de salud y comprobar si esta asociación tiene relación con el patrón de activación neurohormonal. Material y métodos Se realizó un estudio preliminar, observacional transversal, en el que se enrolaron en forma consecutiva 53 individuos, 32 varones y 21 mujeres. Los pacientes completaron dos cuestionarios: uno para medir EPC y el otro, la Escala de Resiliencia de Connor-Davidson. Quedaron divididos en cuatro grupos: 1, sin EPC y con resiliencia normal (RN); 2, sin EPC y con baja resiliencia (BR); 3, con EPC y RN; 4, con EPC y BR. Resultados El porcentaje de hipertensos fue superior en el grupo 4 (p < 0,001), como también el de individuos con incremento de la circunferencia de la cintura (ICC) (p = 0,05). Si bien los niveles de noradrenalina, cortisol y ácido vanililmandélico fueron ligeramente superiores en el grupo 4, las diferencias no alcanzaron significación estadística. Para determinar si el EPC unido a BR es un factor de riesgo para el desarrollo de hipertensión arterial se empleó un modelo de regresión logística, controlado por confundidores; el odds ratio fue de 10,9 con intervalos de confianza del 95%, inferior de 1,8 y superior de 65,2. Conclusiones Datos preliminares sugieren que individuos con EPC unido a BR tienen un riesgo alto para el desarrollo de hipertensión arterial.
To determine whether angiotensin converting enzyme inhibition by perindopril can reduce cardiac t... more To determine whether angiotensin converting enzyme inhibition by perindopril can reduce cardiac transforming growth factor b1 (TGFb1) and plasminogen activator inhibitor 1 (PAI-1) and therefore control collagen accumulation in an animal model with the metabolic syndrome such as the obese Zucker rat (OZR). Animals: Male OZR (group 1, n = 10); OZR treated with perindopril (group 2, n = 10); and lean Zucker rats (group 3, n = 10). Methods: During six months, group 2 received 3 mg/kg/day of perindopril orally and group 1 and group 3 were given a vehicle. Hearts were processed for pathology studies including immunohistochemical analysis with antibodies to PAI-1, TGFb1, collagen type I, and collagen type III. Results: Group 2 had lower blood pressure (126.7 (2) v 148.6 (2.7) mm Hg, p , 0.01) than untreated OZR and had decreased cardiac PAI-1 (3.6 (0.4) v 13.5 (1.7)% of positive area/field, p , 0.01), TGFb1 in myocytes (0.13 (0.1) v 9.14 (4.7)%/area, p , 0.01) and in interstitium (19.8 (6.8) v 178.9 (27.4) positive cells/area, p , 0.01), collagen I (3 (0.8) v 13.3 (1)%/area, p , 0.01), collagen III (5 (0.6) v 9.5 (0.9)%/area, p , 0.01), and collagen I to collagen III ratio (0.59 (0.13) v 1.40 (0.15) p , 0.01) compared with untreated OZR. Conclusion: These results suggest that perindopril reduces cardiac PAI-1 and TGFb1 and ameliorates cardiac fibrosis in a rat model with multiple cardiovascular risk factors.
Conclusion: Cardiovascular syphilis is still present. A serologic test for syphilis is recommende... more Conclusion: Cardiovascular syphilis is still present. A serologic test for syphilis is recommended in patients with dilated ascending aortas irrespective of whether or not they have aortic regurgitation. Summary: In the 19 th century, 15% of the adult population in the United States was afflicted by syphilis. Syphilology was a separate medical specialty devoted to the treatment of the manifestations of this disease. It is infrequent for patients with primary syphilis to develop tertiary syphilis. Syphilis is a difficult disease to study in that the spirochete Treponema pallidum cannot be convincingly demonstrated in histologic sections of the aorta in patients with dilated aortas presumably secondary to tertiary syphilis. In addition T pallidum cannot be cultured. There have been no large studies of cardiovascular syphilis since 1964. In this well-illustrated study, the authors present results of autopsies in 90 patients with characteristic morphologic findings of syphilitic aortitis. All but two patients were examined by a single author from 1966 to 1990. All 90 patients had extensive involvement of the ascending aorta by the syphilitic process. The sinus of Valsalva was spared in all but four patients. In 26% of the 90 patients, syphilis was the cause of death in patients in whom the aortic arch and descending thoracic aorta were examined. There was evidence of syphilitic involvement of the aortic arch in 49 of 54 patients (91%) and syphilitic involvement of the descending thoracic aorta in 47 of 52 patients (90%). In the 23 patients who died, death was secondary to rupture of the ascending or descending thoracic aorta in 12 and form severe aortic regurgitation in 10. One patient had severe narrowing of the osteum of the right coronary artery as the cause of death. Serologic testing for syphilis was performed in 40 patients and 28 (70%) had a positive finding. Patients with negative or nonreactive tests who did not undergo serologic tests for syphilis had histologic and morphologic findings in the aorta at autopsy similar to the finding in the patients who had positive serologic tests. Comment: The paper is a fascinating review of the aortic manifestations of tertiary syphilis. Key points are that syphilis still occurs in the general population. Seventy-seven of the 90 cases in this series were from Washington, DC-area hospitals or institutions. Men outnumbered women 2:1. The series also serves to remind us that a negative serologic test does not exclude the presence of syphilis. As vascular surgeons become more involved in the treatment of patients with thoracic aortic disease, including the development of hybrid procedures to treat aortic arch disease, it will be necessary to keep in mind that the underlying etiology of the disease may in some cases still be tertiary syphilis.
almost statistically significant differences (p values ranging from 0.07 and 0.13) could only be ... more almost statistically significant differences (p values ranging from 0.07 and 0.13) could only be recorded consistently in the 40-49 age class concerning PWV/ cSBP/ cPP / AI. Authors discuss the relevance of these findings concerning risk stratification in a Portuguese population with high incidence of stroke.
Introduction: Increased carotid intima-media thickness (IMT), as early sign of atherosclerosis, c... more Introduction: Increased carotid intima-media thickness (IMT), as early sign of atherosclerosis, closely correlates with traditional risk factors: increased cholesterol level, high blood pressure (BP), age, metabolic syndrome. The aim of our study was to evaluate the relationship between IMT and other arterial wall parameters. Methods: Consecutive high cardiovascular risk patients aged from 50 to 55 were investigated at the Vilnius University Hospital, including detailed assessment of cardiovascular risk factors, serum lipid profile, C-reactive protein (CRP). Carotid IMT and carotid stiffness were measured by echotracking with ART.LAB system. Aortic and brachial pulse wave velocity (aPWV and bPWV), heart rate adjusted aortic augmentation index (AIx/HR) were evaluated by applanation tonometry with SphygmoCor. Endothelial function in brachial artery was assessed by calculating the flow mediated dilatation (FMD). Correlations between IMT and other arterial wall parameters were estimated. Results: 860 patients (mean ageAESD 52.63AE1.58; 536 (62.3%) females) were analyzed. There was only a very weak correlation between IMT and femoral PWV (rZ0.094; pZ0.049) in the whole group. IMT did not correlate with arterial wall parameters in female group, however, IMT correlated with AIx/HR in male group (rZ0.190; pZ0.004). Significant but relatively weak IMT correlations with age (rZ0.079; pZ0.024), BMI (rZ0.134 ; p<0.001), systolic BP (rZ0.122; pZ0.001), diastolic BP (rZ0,106; pZ0,003), HDL-Ch (rZ-0.143 ; p<0.001), CRP (rZ0.089 ; pZ0.013) were observed without impact of gender. Regression models showed that IMT may not be predicted by PWV, AIx/HR, FMD. Conclusions: Carotid IMT has a weak correlation with the new arterial measures in high cardiovascular risk patients.
almost statistically significant differences (p values ranging from 0.07 and 0.13) could only be ... more almost statistically significant differences (p values ranging from 0.07 and 0.13) could only be recorded consistently in the 40-49 age class concerning PWV/ cSBP/ cPP / AI. Authors discuss the relevance of these findings concerning risk stratification in a Portuguese population with high incidence of stroke.
Introduction: The Mycoplasma pneumoniae and the Clhamydia pneumoniae are habitual pathogens in re... more Introduction: The Mycoplasma pneumoniae and the Clhamydia pneumoniae are habitual pathogens in respiratory infections, specially in winter period. Both germs, according to evidence, could cause, inflammation and this activation may lead to alter the endothelial function. The identification of this condition using vascular function studies, may contribute to an early detection of a vulnerable population. Aims: Based on this hypothesis, we assessed the vascular function (IMT, atherosclerotic plaques assessment, PWV and FMD) in individuals with a history of chronic or acute infection of Mycoplasma pneumoniae; and the relation between this chronic or acute infection with the vascular dysfunction. Material and Methods: 26 patients were evaluated according to the following inclusion criteria: age between 20 and 45 years, low risk according Framingham scale, and a low risk European score. The control group were 14 individuals (50 % masc.) with negative serology for all the studied germs The study group were 12 individuals with positive serology for Mycoplasma Pneumoniae (IGG and IGM). Both groups were studied by vascular ultrasound doppler scan, evaluating vascular function. The qualitative variables were analyzed using Chi square and Fisher's exact Test and the quantitative variables using Proved Rank Sum Test (Wilcoxon): Results: The different variables of vascular function IMT, PWV and FMD abnormality showed a trend to be higher in subjects with positive serology but without statistical significance (P:0,22; p:0,15:p:0,15). The proportion of subjects with atherosclerotic plaques was significantly higer in the seropositive subjects, which is the single objective evidence (P:0,04) consistent with the trend observed in the other determinations of structure and vascular function. Conclusions: There are numerous known factors influencing vascular dysfunction. The infectious could be one of them, and Mycoplasma Pneumoniae one of the germs related at least with alterations of the vascular structure.
Central hemodynamics by means of pulse wave velocity (PWV) in several territories, central aortic... more Central hemodynamics by means of pulse wave velocity (PWV) in several territories, central aortic pressure, and the augmentation and amplification indexes offer several non-invasive, easy and accurate ways to evaluate arterial stiffening, closely
linked to the beginning of hypertension and its evolution.
In the near future, simplified and cheaper measurements of both parameters will be used in clinical practice. Their response
to different cardiovascular and non-cardiovascular drugs and the 24-hour monitoring of arterial stiffness markers are now the
new challenges for better and more effective cardiovascular prevention, as they determine the root of the problem, thereby
providing a more effective treatment option based on the physiopathology of the arterial disease..
In hypertension, arterial stiffness evaluation can be particularly useful beyond its prognostic value and for CV risk restratification in three different situations :
1. In young hypertensives to differentiate spurious isolated systolic hypertension from true hypertension.
2. In middle-aged adults, it detects early vascular ageing and allows early intervention and CV risk reduction. An interplay between PWV and augmentation /amplification indexes leads to a better understanding and treatment of vascular
disease as the cause of hypertension.
3. In the elderly, PWV explains the higher pulsatility in isolated systolic hypertension and the main cause of target organ
damage; it is a prognostic marker and a therapeutic target. Eventually, the SUPERNOVA patients could be a group of interest in the future in understanding vascular protection mechanisms
Uploads
Papers by Pedro Forcada
technologic progression of the non-invasive vascular evaluation,
in particular the huge step ahead in the last 20 years, in parallel
with the evolution from a “treatment-after- event” based Medicine
to Preventive Medicine. No-invasive vascular Evaluation jumped in
the last twenty years from the bench to the bedside, giving rise to
a Precision Medicine, detecting and preventing the atherosclerotic
disease in the earliest stages, in order to control the huge burden of
cardiovascular disease that the human kind has been suffering the
last hundred years. A worldwide and widespread use of non-invasive
vascular evaluation in the current clinical practice for cardiovascular
prevention remains as a challenge, and this review is a call to action
to do so
linked to the beginning of hypertension and its evolution.
In the near future, simplified and cheaper measurements of both parameters will be used in clinical practice. Their response
to different cardiovascular and non-cardiovascular drugs and the 24-hour monitoring of arterial stiffness markers are now the
new challenges for better and more effective cardiovascular prevention, as they determine the root of the problem, thereby
providing a more effective treatment option based on the physiopathology of the arterial disease..
In hypertension, arterial stiffness evaluation can be particularly useful beyond its prognostic value and for CV risk restratification in three different situations :
1. In young hypertensives to differentiate spurious isolated systolic hypertension from true hypertension.
2. In middle-aged adults, it detects early vascular ageing and allows early intervention and CV risk reduction. An interplay between PWV and augmentation /amplification indexes leads to a better understanding and treatment of vascular
disease as the cause of hypertension.
3. In the elderly, PWV explains the higher pulsatility in isolated systolic hypertension and the main cause of target organ
damage; it is a prognostic marker and a therapeutic target. Eventually, the SUPERNOVA patients could be a group of interest in the future in understanding vascular protection mechanisms
technologic progression of the non-invasive vascular evaluation,
in particular the huge step ahead in the last 20 years, in parallel
with the evolution from a “treatment-after- event” based Medicine
to Preventive Medicine. No-invasive vascular Evaluation jumped in
the last twenty years from the bench to the bedside, giving rise to
a Precision Medicine, detecting and preventing the atherosclerotic
disease in the earliest stages, in order to control the huge burden of
cardiovascular disease that the human kind has been suffering the
last hundred years. A worldwide and widespread use of non-invasive
vascular evaluation in the current clinical practice for cardiovascular
prevention remains as a challenge, and this review is a call to action
to do so
linked to the beginning of hypertension and its evolution.
In the near future, simplified and cheaper measurements of both parameters will be used in clinical practice. Their response
to different cardiovascular and non-cardiovascular drugs and the 24-hour monitoring of arterial stiffness markers are now the
new challenges for better and more effective cardiovascular prevention, as they determine the root of the problem, thereby
providing a more effective treatment option based on the physiopathology of the arterial disease..
In hypertension, arterial stiffness evaluation can be particularly useful beyond its prognostic value and for CV risk restratification in three different situations :
1. In young hypertensives to differentiate spurious isolated systolic hypertension from true hypertension.
2. In middle-aged adults, it detects early vascular ageing and allows early intervention and CV risk reduction. An interplay between PWV and augmentation /amplification indexes leads to a better understanding and treatment of vascular
disease as the cause of hypertension.
3. In the elderly, PWV explains the higher pulsatility in isolated systolic hypertension and the main cause of target organ
damage; it is a prognostic marker and a therapeutic target. Eventually, the SUPERNOVA patients could be a group of interest in the future in understanding vascular protection mechanisms