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Left atrial (LA) adaptation during the development of left ventricular (LV) dysfunction is not fully understood. We performed echocardiographic assessment of LA volumes simultaneously with recordings of pulmonary wedge pressures in 60 patients. Twenty patients had no structural or functional LV abnormalities, 20 had a recent myocardial infarction with LV dysfunction, and 20 suffered from congestive heart failure (CHF). Pressure-volume loops were obtained at baseline and during increases in LA pressure produced by normal saline infusion. LA afterload was estimated by the effective LV elastance (E(LV)). Atrioventricular coupling was calculated by the E(LV)/E(es) ratio (where E(es) is the end-systolic elastance). E(es) increased in patients with myocardial infarction (0.80 +/- 0.09 mm Hg/ml, p <0.001), whereas it decreased in patients with CHF (0.22 +/- 0.05 mm Hg/ml, p <0.001) compared with controls (0.61 +/- 0.07 mm Hg/ml). Similarly, stroke workload increased in patients with myocardial infarction (60.7 +/- 7.3 mm Hg x ml, p <0.001), whereas it decreased in patients with CHF (25.4 +/- 2.2 mm Hg x ml, p <0.001) compared with controls (44.8 +/- 5.5 mm Hg x ml). In all patients LA stiffness (slope of the relation of the filling portion of the pressure-volume loop) was increased compared with controls (controls: 0.13 +/- 0.04, patients with myocardial infarction: 0.22 +/- 0.05, and patients with CHF: 0.27 +/- 0.05 mm Hg/ml, p <0.001 for both comparisons). Moreover, the E(LV)/E(es) ratio increased gradually as LV function deteriorated (controls: 1.06 +/- 0.10, patients with myocardial infarction: 1.35 +/- 0.16, and patients with CHF: 6.90 +/- 0.84, p <0.001). Thus, early in heart failure, LA pump function is augmented but LA stiffness increases and work mismatch occurs. With further progression of LV dysfunction, LA pump function decreases as a result of increased afterload imposed on the LA myocardium. [ABSTRACT FROM AUTHOR]

There is ongoing scientific interest regarding comorbidities associated with the metabolic syndrome (MeTS). MeTS comprises a combination of parameters that predispose individuals to the development of type 2 diabetes and cardiovascular disease (CVD). Three or more of the following criteria are necessary: fasting glucose > 110 mg/dl (5.6 mmol/l), hypertriglyceridemia > 150 mg/dl (1.7 mmol/l), HDL levels < 40 mg/dl (men)/< 50 mg/dl (women), blood pressure > 130/85 mmHg, waist circumference (values for Mediterranean populations > 94 cm (men)/> 89 cm (women). In this review we attempted to summarize relevant data by searching dermatological literature regarding associations between various skin conditions and MeTS. A multitude of studies was retrieved and a further goal of the present article is to present plausible mechanistic connections. The severity of skin conditions like psoriasis has been linked with MeTS. Parameters of MeTS like insulin resistance are present in patients with early onset androgenic alopecia, hidradenitis suppurativa acne and rosacea. Since MeTS can lead to CVD and type 2 diabetes early detection of patients would be very important. Also therapeutic intervention on MeTS could lead to improvement on the severity of skin conditions. This reciprocal relationship between skin diseases and MeTS in our opinion holds great interest for further investigation. [ABSTRACT FROM AUTHOR]

Abstract: Background: Surrogates of aortic wave reflection and arterial stiffness, such as augmentation index (AIx), augmentation pressure, pulse wave velocity (PWV) and pulse pressure amplification (PPampl) are independent predictors of cardiovascular risk. A novel ambulatory, brachial cuff-based oscillometric device has been recently developed and validated, yielding 24-h assessment of the aforementioned parameters (Mobilo-O-Graph). Aim of this study was to investigate the feasibility and reproducibility of wave reflection and arterial stiffness estimation by pulse wave analysis using this device. Methods: Thirty treated or untreated hypertensives (mean age: 53.6±11.6years, 17 men) had test–retest 24-h monitoring one week apart using the test device. Results: Mean numbers of valid aortic readings per subject, between test and retest, were comparable. Approximately 12 aortic readings per subject (17%) were not feasible or valid. No differences were observed for any 24-h parameter between the two assessments. Bland–Altman plots showed no systemic difference, while the limits of agreement for each parameter indicated high reproducibility (AIx: −7.2 to 8.2%, AP: −3.7 to 4.1mm Hg, PWV: −0.39 to 0.41m/s, PPampl: −0.08 to 0.06). This was further verified by intraclass correlation coefficients which were >0.8 for each parameter. Conclusions: Non-invasive 24-h estimation of wave reflection and arterial stiffness indices, derived by the test device, appear to be highly reproducible. Future studies should investigate whether these measurements have additive prognostic value for cardiovascular risk stratification, beyond common brachial blood pressure measurements or single estimations of wave reflection and PWV at office settings. [Copyright &y& Elsevier]

J Clin Hypertens (Greenwich). 2012;00:00-00. ©2012 Wiley Periodicals, Inc. Delayed blood pressure (BP) and heart rate (HR) decline at recovery post-exercise are independent predictors of incident coronary artery disease (CAD). Delayed BP recovery and exaggerated BP response to exercise are independent predictors of future arterial hypertension (AH). This study sought to examine whether the combination of two exercise parameters provides additional prognostic value than each variable alone. A total of 830 non-CAD patients (374 normotensive) were followed for new-onset CAD and/or AH for 5 years after diagnostic exercise testing (ET). At the end of follow-up, patients without overt CAD underwent a second ET. Stress imaging modalities and coronary angiography, where appropriate, ruled out CAD. New-onset CAD was detected in 110 participants (13.3%) whereas AH was detected in 41 former normotensives (11.0%). The adjusted (for confounders) relative risk (RR) of CAD in abnormal BP and HR recovery patients was 1.95 (95% confidence interval [CI], 1.28-2.98; P=.011) compared with delayed BP and normal HR recovery patients and 1.71 (95% CI, 1.08-2.75; P=.014) compared with normal BP and delayed HR recovery patients. The adjusted RR of AH in normotensives with abnormal BP recovery and response was 2.18 (95% CI, 1.03-4.72; P=.047) compared with delayed BP recovery and normal BP response patients and 2.48 (95% CI, 1.14-4.97; P=.038) compared with normal BP recovery and exaggerated BP response individuals. In conclusion, the combination of two independent exercise predictors is an even stronger CAD/AH predictor than its components. [ABSTRACT FROM AUTHOR]

Abstract: Background: Controversy still exists regarding the impact of new-onset diabetes (NOD) on CV outcomes among patients with hypertension. Our aim was to determine the incidence of NOD in essential hypertensives and to evaluate its association with major cardiovascular (CV) events. Methods: We followed-up for a mean period of 6years 1572 essential hypertensives (mean age 54.3years, 696 males) for the incidence of NOD, as well as of fatal and non-fatal coronary artery disease and stroke. Based on the development of NOD, the cohort was divided into patients with pre-existing diabetes (10%), patients with NOD (10%) and those who remained free from diabetes. Results: During the follow-up period, new or recurrent cases of coronary artery disease and stroke events occurred at a rate of 5.6% (n=88) and 4.65% (n=73). The independent predictors for NOD were age (OR=1.026, p=0.041), waist circumference (OR=1.044, p<0.001), family history of diabetes (OR=2.173, p=0.003) and systolic BP at follow-up (OR 1.022, p=0.044). The presence of NOD was independently associated with greater incidence of stroke (HR 2.404, p=0.046), along with age (HR 1.078, p<0.001), duration of hypertension (HR 1.039, p=0.017) and office systolic blood pressure at follow-up (HR 1.022, p=0.026), whereas development of NOD had no relationship with the incidence of coronary artery disease. Conclusions: Our findings indicate the high incidence of NOD and its close association with stroke in essential hypertension. Poorer control of hypertension appears to be a common denominator of both NOD and stroke in this setting. [Copyright &y& Elsevier]

Abstract: The purpose of the present study was to evaluate the effect of arterial hypertension familial history on arterial stiffness and wave reflection in young offsprings. The effect of arterial hypertension familial history on arterial stiffness in young offsprings has not been well documented yet. The study comprised 143 subjects, aged 14 to 30 years who were initially divided in three groups: Group A, 55 offsprings with normotensive parents, Group B, 63 offsprings with 1 hypertensive parent, and group C, 25 offsprings with both hypertensive parents. Arterial stiffness was evaluated using carotid-brachial (PWVc-r) and carotid-femoral (PWVc-f) pulse wave velocity. Concurrently, aortic pressures and augmentation index (AIx) corrected for heart rate were assessed by radial applanation tonometry. Arterial stiffness was evaluated by measuring central augmentation index (AIx) with the Sphygmocor device and pulse wave velocity carotid-brachial (PWVc-r) and carotid-femoral (PWVc-f) with the Complior device. The three groups had no differences in age, peripheral arterial blood pressure (BP), lipid profile and smoking habits. Arterial stiffness indices and wave reflection were higher (p <0.001) in group C, followed by group B and group A (PWVc-f: 7.0±1.3 vs 6.4±1.0 vs 5.8±0.9 m/s, PWVc-r: 8.9±1.0 vs 8.2±1.2 vs 7.8±1.1 m/s, and AIx: 13±19 vs 4.5±14 vs −2.6±13%). This was also seen after adjustment for body mass index and gender distribution among the three groups (p <0.001). The purpose of the present study was to evaluate the effect of arterial hypertension familial history on arterial stiffness and wave reflection in young offsprings. Large artery properties are aggravated in offsprings with parental history of arterial hypertension compared to offsprings of normotensive parents, independently of age and blood pressure levels. Moreover, the greater the familial burden, the more arterial function is compromised. [Copyright &y& Elsevier]

Abstract: Exercise testing (ET) stands as one of the most easy, affordable, cost effective, non invasive methods for diagnosing coronary heart disease. Its sensitivity, specificity and prognostic value, especially in the prime era of its implementation in the cardiac diagnostic procedure, is relatively limited. Novel exercise criteria and indices based either on ST segment changes or ST segment independent parameters, such as “Athens QRS score”, have greatly improved the diagnostic ability and accuracy of ET. Complex ECG-derived indices linked to ST changes along with the use of right-sided precordial leads have also enhanced the diagnostic accuracy of ET with respect to the extent of ischemic heart disease and the detection of specific culprit vessels. ET contains also a prognostic value, since several ET-derived parameters have been associated with adverse outcome, including ST changes, blood pressure and heart rate response to exercise and duration of exercise. [ABSTRACT FROM AUTHOR]

Abstract: Background: Arterial stiffness and wave reflections are independent predictors of cardiovascular disease. Metabolic syndrome (MS) is related to increased aortic stiffness in several populations. However, it is unclear whether the association of MS with aortic stiffness differs according to the considered definition. Moreover, data regarding the association of wave reflections with MS are limited. For this purpose, we examined the relationship of arterial stiffness and wave reflections with MS by using four current definitions and a score. Methods: We studied 732 never treated, non-diabetic hypertensive patients. Metabolic syndrome was defined by Adult Treatment Panel III, American Heart Association, World Health Organization (WHO), International Diabetes Federation criteria and MS (GISSI) score. Arterial stiffness was assessed by measuring carotid-femoral pulse wave velocity (PWVc-f). Heart rate-corrected augmentation index (AIx75) was estimated as a measure of wave reflections. Results: By all definitions, hypertensive patients with MS had higher PWVc-f compared to hypertensives without MS. On the contrary, no significant difference was observed in AIx75 between patients with and those without MS except when MS was defined by WHO criteria. An independent association emerged between PWVc-f and GISSI score and MS components (p =0.038 and 0.033 respectively) in patients with MS, after adjustment for age, gender, LDL cholesterol and smoking. Nevertheless, after further adjustment for systolic blood pressure or body mass index, the strength of this association was reduced to a non-significant level. Conclusion: Arterial stiffness is increased in patients with metabolic syndrome irrespective of the definition criteria. On the contrary, metabolic syndrome has no effect on wave reflections, except when this is defined by WHO criteria. Regarding the high prognostic significance of both arterial stiffness and wave reflections, these findings might have important clinical implications. [Copyright &y& Elsevier]

Objectives. Mitral valve prolapse (MVP) is a known cause for false positive exercise test (ET). The purpose of this study was to establish additional electrocardiographic criteria to distinguish the false positive exercise results in patients with MVP. Methods. We studied 218 consecutive patients (53 ± 6 years, 103 males) with MVP (according to echocardiographic study), and positive treadmill ET was performed due to multiple cardiovascular risk factors or angina-like symptoms. A coronary angiography was performed to detect coronary artery disease (CAD). Results. From 218 patients, 90 (group A) presented with normal coronary arteries according to the angiography (false positive ET) while the rest 128 (group B) presented with CAD. ST-segment depression in hyperventilation phase was present in 54 patients of group A (60%) while only in 14 patients of group B (11%), P < .05. Conclusions. Presence of ST-segment depression in hyperventilation phase favors a false positive ET in patients with MVP. [ABSTRACT FROM AUTHOR]

Objective: Smoking is a modifiable cardiovascular risk factor. It has been reported to affect inflammatory, coagulation indices and homocysteine. The purpose of the present study was to evaluate the effect of smoking on inflammatory, coagulation indices and homocysteine as well as on traditional risk factors, in a large cohort of patients with essential hypertension. Methods: The study comprised 4000 consecutive patients, with uncomplicated essential hypertension (2572 non-smokers and 1428 smokers). Inflammatory indices such as high-sensitivity C-reactive protein (hsCRP), white blood cell count (WBC) and serum amyloid A (SAA) as well as coagulation markers such as serum fibrinogen, plasminogen activator inhibitor (PAI-1) and homocysteine were measured in all patients. Finally, all patients were asked about their smoking habits and, thus, information about smoking intensity and smoking duration was obtained. Results: All studied markers were significantly higher in smokers compared with non-smokers after adjusting for age and gender (p < 0.001). Furthermore, hsCRP, serum fibrinogen and WBC were positively associated with both increasing smoking intensity and time since smoking initiation, while SAA was positively associated with smoking intensity (p = 0.003) and PAI-1 with smoking duration (p = 0.003). No such association was noticed with homocysteine (p = not significant). Conclusions: Smoking affects inflammatory, coagulation indices, homocysteine and traditional risk factors in patients with essential hypertension independently of age and gender. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: The myocardial performance index, Tei index, is a relatively new echocardiography indice which is related to parameters which express both the systolic and diastolic myocardial function. The purpose of the present study was to investigate the possible correlation of Tei index to microalbuminuria, which is an indice of kidney target-organ damage in hypertensive patients. Materials and methods: We evaluated 9680 consecutive patients (mean age 55.2 years, 5144 male and 4536 female) with chronic uncomplicated essential hypertension and the correlation between Tei index, defined as the sum of the isovolumetric relaxation and contraction time divided by the ejection time, and kidney target damage (microalbuminuria) was evaluated. Results: In univariate analysis we noticed a positive correlation of Tei index with microalbuminuria (r =0.353 p <0.001). Furthermore, a significant difference was found in each Tei quartile for microalbumin levels (p <0.001). In multivariate analysis with Tei index as a dependent variable (high versus low quartile) and independent variables gender, age, body mass index, plasma glucose, heart rate, blood pressure, kidney function indices and lipids, the independent prognostic correlation to microalbuminuria was noticed (ΟR: 1.002 p <0.001). Conclusions: In the present study we found that Tei index correlates with microalbuminuria in essential hypertensive patients. Thus we can assume that this index could be used not only for the evaluation of the global myocardial performance of hypertensive patients but also for the assessment of the cardiovascular risk in arterial hypertension since it correlates with kidney damage. [Copyright &y& Elsevier]

The purpose of the present study was to assess angiotensin receptor blocker (ARB) treatment on arterial stiffness in select hypertensive patients and define possible differences between smokers and nonsmokers. The authors evaluated 81 consecutive, nondiabetic patients (mean age, 52 years; 47 men) with uncomplicated essential hypertension with high plasma renin activity who were administered monotherapy with irbesartan, an ARB, at maximal dose. Patients were divided into smokers (n=24) and nonsmokers (n=57). Carotid-radial pulse wave velocity (PWVc-r), carotid-femoral pulse wave velocity (PWVc-f), and augmentation index (AIx) were measured before and 6 months after ARB antihypertensive treatment. All mean values of elastic effect indices were decreased after irbesartan monotherapy (AIx, from 26.3%to 21.2% [P <.01]; PWVc-f, from 7.7 m/s to 7.3 m/s [P <.05], and PWVc-r, from 8.9 m/s to 8.3 m/s [P <.001]). When comparing smokers vs nonsmokers, no difference was noted in AIx and PWVc-f change (P =not significant), while PWVc-r change was greater in smokers compared with nonsmokers (P <.05). Chronic ARB treatment may favorably affect arterial stiffness and wave reflections in hypertensive chronic smokers with elevated plasma renin levels. [ABSTRACT FROM AUTHOR]

Background: This study was designed to investigate the association of the 894G>T polymorphism in the eNOS gene with risk of acute myocardial infarction (AMI), extent of coronary artery disease (CAD) on coronary angiography, and in-hospital mortality after AMI. Methods: We studied 1602 consecutive patients who were enrolled in the GEMIG study. The control group was comprised by 727 individuals, who were randomly selected from the general adult population. Results: The prevalence of the Asp298 variant of eNOS was not found to be significantly and independently associated with risk of AMI (RR = 1.08, 95%CI = 0.77-1.51, P = 0.663), extent of CAD on angiography (OR = 1.18, 95%CI = 0.63-2.23, P = 0.605) and in-hospital mortality (RR = 1.08, 95%CI = 0.29-4.04, P = 0.908). Conclusion: In contrast to previous reports, homozygosity for the Asp298 variant of the 894G>T polymorphism in the eNOS gene was not found to be associated with risk of AMI, extent of CAD and in-hospital mortality after AMI [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate whether a novel noncylindric “stent,” implanted upstream of one or more mild arterial stenoses could be beneficial, by increasing in-stent wall shear stresses (WSS) and by limiting the flow recirculation zones in the vicinity of the stenoses. An in vitro model employing flow visualization, and computational fluid dynamics were used for the study of steady and unsteady flow fields in a model of a coronary artery with two sequential 50% stenoses. Two different tube-entrance geometries (a cylindric and a convergent nozzle), modeling an ostial stented arterial segment, were studied regarding their effect on flow patterns and WSS at various Reynolds numbers ( Re = 200–800). In this preliminary study, the internal walls of these tube entrance geometries were smooth, not taking into account the roughness of the actual stent's strut. “In-stent” WSS was significantly increased at the noncylindric configuration compared to that in the regular cylindric geometry. The difference of the spatially averaged “in-stent” WSS between the two designs gradually increased with the increase in Re, reaching a peak value up to 50% in the case of the noncylindric endovascular device, for the examined Re range. For the same configuration, both the experimental and numerical analyses indicated a decrease in flow recirculation region at the vicinity distally to a sequential stenosis up to 6%, and the mean flow velocity was increased for both steady and pulsatile flow. These effects of the new “stent” configuration could be important for the delay of restenosis processes and should be further investigated in vivo. [ABSTRACT FROM AUTHOR]

Abstract: Background: It has been previously postulated that Thallium-201 (Tl201) scintigraphy is characterized by relatively low specificity in hypertensive patients. This study was undertaken to assess any possible influence of false-positive scintigraphic results on the prognosis of hypertensive patients. Methods: The study group comprised 179 consecutive hypertensive patients (128 men and 51 women), aged 50±7 years, who underwent exercise Tl201 scintigraphy and coronary angiography (patients with normal scintigraphic results underwent coronary angiography due to persistent angina-like symptoms). All patients with normal coronary arteries underwent a second Tl201 scintigraphy within 36±6 months. Patients with reversible ischemia in the second scintigraphy underwent also a second coronary angiography. Results: Coronary artery disease (CAD) was detected in 78 (44%) patients, while the rest 101 (56%) patients had normal coronary arteries. Abnormal scintigraphic results were revealed in 66 (85%) patients with CAD and in 38 (38%) patients without CAD. Twenty-two (58%) of the 38 hypertensive patients with false-positive scintigraphic results presented reversible ischemia of the infero-posterior wall of the left ventricle. Coronary artery disease was detected in 7 (32%) of these patients during the follow-up period. Conclusions: Hypertensive patients with normal coronary arteries and false-positive scintigraphic results usually present with reversible ischemia of the infero-posterior wall of the left ventricle. This group of patients seems to be at increased risk of developing CAD in a long-term follow-up period. [Copyright &y& Elsevier]

Abstract: Background: Ischemic preconditioning (IP) is a cardioprotective phenomenon, induced by brief episodes of myocardial ischemia, which is supposed to affect not only the myocardium, but also the entire cardiovascular system. Considering that patients with coronary artery disease (CAD) have also been described to present impaired aortic mechanical properties, we tried to investigate the possible influence of the late phase of IP on aortic distensibility in patients with CAD. Methods: Fifty patients, aged 48 to 72 (mean, 57±6 years), with angiographically confirmed CAD and exercise-induced myocardial ischemia, underwent two treadmill exercise testings (ETs). The second ETs was performed the next day. Thallium-201 scintigraphy was performed during the first and the second ET. Aortic distensibility was evaluated before each exercise testing by a non-invasive technique, using two-dimensional guided M-mode transthoracic echocardiography and arterial pressure was measured simultaneously at the brachial artery by sphygmomanometry. Results: The patients were divided in 2 groups according to the extent of myocardial ischemia at peak exercise of the second test, compared to the first test. In 35 (70%) of the studied patients ischemia signs were reduced during the second ET (Group A), while in the rest 15 (30%) of the patients (Group B) no improvement or even worsening of the observed ischemia signs was demonstrated by the studied exercise parameters and the extent of myocardial ischemia in thallium-scintigraphy. Increased aortic distensibility during the second measurement was found in 33 (94%) of the 35 patients of Group A but only in 1 (7%) of the 15 patients of Group B. Aortic distensibility was found to be significantly improved in patients of Group A, while it was found to be worsened in Group B patients. Conclusions: The aortic distensibility alteration could be used as an index of influence of ischemic preconditioning to exercise-induced myocardial ischemia, which could be considered indicative of the systemic effects of IP in humans. [Copyright &y& Elsevier]

Abstract: Background: Female patients with acute myocardial infarction (MI) exhibit higher unadjusted in-hospital mortality rates compared to male patients. However, contradictory evidence exists on whether this survival disadvantage disappears after adjustment for age and other prognostic factors. This study, based on a countrywide survey of consecutive unselected patients with acute MI, examined whether female gender is an independent predictor of poor short-term outcome and less intensive in-hospital treatment. Methods: Data on a total of 7433 patients were analyzed. Results: The mean age was 64±13 years and the proportion of females in this population was 23%. Univariate and multivariate predictors of in-hospital mortality in female patients were estimated. Unadjusted in-hospital mortality rates of women were significantly higher compared to men (17.7 vs. 8.6, p <0.001). In multivariate analysis, female gender was an independent predictor of in-hospital mortality in the total population [relative risk (RR)=1.29, 95% confidence interval (CI)=1.02–1.64, p =0.036]. The RR of women for in-hospital death was exaggerated among younger patients, aged <55 years (RR=3.84, 95% CI=1.07–13.74, p =0.039). Female gender was also independently and inversely associated with administration of thrombolytic treatment (RR=0.724, 95% CI=0.630–0.831, p =<0.001). Conclusion: Although female gender is an independent predictor of higher post-MI in-hospital mortality with a pronounced effect among younger patients, women are less likely to receive thrombolysis than men. Based on the results from this countrywide study, we should consider women, especially of younger age, as patients at particular high risk, who contrary to common practice, deserve more intensive and aggressive in-hospital treatment. [Copyright &y& Elsevier]

The insertion/deletion (I/D) polymorphism in the ACE gene and the A1166C polymorphism in the AT1R gene have been associated with left ventricular remodelling and prognosis after acute myocardial infarction (AMI). We investigated whether these genetic variants associate with impaired left ventricular ejection fraction (LVEF) and increased risk for in-hospital mortality after AMI. Consecutive AMI patients were recruited on admission and were genotyped for the above-mentioned polymorphisms. The frequency of the studied genotypes did not differ significantly between deceased patients and those who survived. The LVEF did not differ among patients with or without the DD genotype (45 ± 10 vs. 45 ± 10%, p = 0.892) or the CC genotype (45 ± 10 vs. 46 ± 10%, p = 0.859). These data question the role of the studied genotypes in the pathogenesis of AMI and do not support the previously supported hypothesis that these genotypes influence prognosis after AMI. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Several clinical and observational studies have established that exercise capacity and activity status are strong predictors of cardiovascular and overall mortality. We aimed to evaluate the relationship between exercise tolerance test (ETT) indices and occurrence of coronary heart disease (CHD), in patients with heterozygous Familial Hypercholesterolemia (eFH). Methods: During 1987–1997, we enrolled 639 cardiovascular disease-free patients with heterozygous eFH; 58 (9%) patients were excluded since they had a positive ETT. A fatal or non-fatal CHD event was the end point. Cox proportional hazards models were applied to evaluate the association between the investigated outcome and ETT indices. Results: During the follow-up (1987–2002), 53 (18%) men and 34 (10%) women developed a CHD event (11 were fatal). The age-adjusted event rate was 87 events per 2915 person-years (3%). Statistical analysis revealed that exercise capacity (hazard ratio=0.82, P<0.001), heart rate recovery at 1 min (hazard ratio=0.91, P<0.05), and peak pulse pressure levels (hazard ratio=1.03, P<0.001), were predictors of CHD, after controlling for several potential confounders. Conclusion: Decreased exercise capacity, a delayed decrease in heart rate during the first minute of graded exercise, and increased peak pulse pressure are strong predictors of coronary events in patients with eFH. Physical activity should be strongly recommended in these patients. [Copyright &y& Elsevier]

Pulmonary balloon valvuloplasty results in improvement in the right coronary artery blood flow velocity pattern and the volumetric flow in patients with pulmonary valve stenosis. These changes are closely related to concomitant changes in right ventricular systolic pressure. [ABSTRACT FROM AUTHOR]

Abstract: Offsprings of hypertensive parents are reported to have higher blood pressure, decreased aortic elasticity and higher arterial stiffness indices. The present study comprised 55 offsprings aged 14 to 30 years who were divided in two groups according to their familial hypertension history. Arterial stiffness was evaluated by measuring central augmentation index with the Sphygmocor device and pulse wave velocity carotid-brachial and carotid–femoral with the Complior SP device. The purpose of the present study was to evaluate the role of positive familial history of hypertension in arterial function in young subjects. [Copyright &y& Elsevier]

The effect of habitual cocoa consumption on arterial stiffness and wave reflection indexes, as well as on peripheral and central blood pressure, was assessed in 198 healthy subjects. In conclusion, higher cocoa intake was an independent determinant of low arterial stiffness and wave reflection indexes and was also independently associated with significantly lower central (aortic) pulse pressure. [Copyright &y& Elsevier]

Presents a letter to the editor about mild cyanosis.