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Maria Łoboz-Rudnicka,1 Joanna Jaroch,1 Ewa Kruszyńska,1 Zbigniew Bociąga,1 Barbara Rzyczkowska,1 Krzysztof Dudek,2 Andrzej Szuba,3 Krystyna Łoboz-Grudzień1,4 1Department of Cardiology, T. Marciniak Hospital, Wrocław, Poland; 2Faculty of Mechanical Engineering, Wrocław University of Technology, Wrocław, Poland; 3Division of Angiology, Wrocław Medical University, Wrocław, Poland; 4Public Health Department, Wrocław Medical University, Wrocław, Poland Background: In recent years, there has been growing interest in the impact of gender-related factors on the function and structure of the arterial tree. The aim of our study was to identify gender-specific differences in the progression of carotid stiffness parameters with age and in the impact of risk factors on carotid stiffness. Subjects and methods: The study group included 256 subjects (mean age: 54.7 years): 134 women (52%) and 122 men (48%) with cardiovascular risk factors: hypertension, type 2 diabetes mellitus, dyslipidemia, smoking, and obesity. Local parameters of carotid stiffness: β stiffness index (β), Peterson’s elastic modulus (Ep), pulse wave velocity β (PWV-β) and arterial compliance (AC) were determined with ultrasound echo-tracking software application. Results: Women were characterized by lower AC than men (women: 0.57 mm2/kPa vs men: 0.69 mm2/kPa, p < 0.001) and the subanalysis in three age groups revealed that the difference in AC value between genders became significant over the age of 45 years. Although no significant difference in the value of β, Ep and PWV-β were found between genders in the whole study group, women

Joanna Jaroch,1 Olga Vriz,2 Zbigniew Bociąga,1 Caterina Driussi,2 Maria Łoboz-Rudnicka,1 Barbara Rzyczkowska,1 Krystyna Łoboz-Grudzień1,3 1Department of Cardiology, T Marciniak Hospital, Wroclaw, Poland; 2Division of Cardiology, San Antonio Hospital, San Daniele del Friuli, Udine, Italy; 3Health Science Faculty, Wroclaw Medical University, Wroclaw, PolandBackground: Little is known about the sex-specific differences in left ventricular (LV) diastolic dysfunction (DD) predictors. We hypothesized that arterial stiffness (AS) may play a different role in the etiology of LV DD in hypertensive men and postmenopausal women, acting independently from other established predictors of this condition, such as age, obesity, diabetes mellitus, LV remodeling, and systolic function.Objectives: The aim of the study was to analyze the sex-specific differences in AS and other predictors of LV DD in men and postmenopausal women with untreated hypertension (HTN).Patients and methods: The study included 144 patients (63 postmenopausal women and 81 men, mean age 62.7±6.7 years) with previously untreated HTN and no history of cardiovascular diseases. All patients were subjected to detailed echocardiography, vascular ultrasound, and high-resolution echotracking (eTracking) of carotid arteries.Results: In the multivariate analysis, concomitant diabetes mellitus turned out to be an independent predictor of LV DD in women (P=0.02). In turn, two independent predictors of LV DD have been identified in men: S'-tissue Doppler-derived peak LV longitudinal systolic shortening velocity (P=0.001) and β, beta stiffness index (P=0.004).Conclusion: There are sex differences in the predictors of LV DD in untreated HTN. In postmenopausal women, LV DD is mostly determined by diabetes, while in men, it is determined by S', reflecting LV systolic longitudinal function, and β, a parameter of AS. Keywords: sex differences, left ventricular diastolic dysfunction, hypertension

Maria Łoboz-Rudnicka,1 Joanna Jaroch,1 Zbigniew Bociąga,1 Barbara Rzyczkowska,1 Izabella Uchmanowicz,2 Jacek Polański,3 Krzysztof Dudek,4 Andrzej Szuba,5 Krystyna Łoboz-Grudzień2 1Department of Cardiology, T. Marciniak Hospital, 2Public Health Department, Wroclaw Medical University, 3Private Practice, Na Biskupinie, Wroclaw, 4Faculty of Mechanical Engineering, Wroclaw University of Technology, 5Division of Angiology, Wroclaw Medical University, Wroclaw, Poland Background and purpose: There has been growing interest in the sex-related differences in the impact of cardiovascular (CV) risk factors on carotid intima–media thickness (CIMT). Therefore, we aimed at examining the influence of CV risk factors on CIMT in men and women and identifying differences between males and females in the risk profiles affecting CIMT. Patients and methods: The study group consisted of 256 patients (mean age 54.7 years), including 134 females (52%), with the following CV risk factors: arterial hypertension, type 2 diabetes mellitus, dyslipidemia, nicotine addiction, overweight, and obesity. Subjects with the history of any overt CV disease were excluded. CIMT was measured through B-mode ultrasound examination of the right common carotid artery. In the analysis of CIMT values at different ages, the patients were divided into three age groups: 1) 60 years. Regression analysis was used to examine the influence of CV risk factors on CIMT in men and women. Results: CIMT increased with age in both men and women. Women had lower values of CIMT than men (0.54 mm vs 0.60 mm, P=0.011). The analysis in three age subgroups revealed that CIMT values were comparable in men and women in group 1 (0.48 mm vs 0.48 mm, P=0.861), but over the age of 45 years, CIMT values became significantly lower in women compared to men (group 2: 0.51 mm vs 0.63 mm, P=0.005; group 3: 0.63 mm vs 0.72 mm, P=0.020). Significant differences were observed between the sexes in terms of risk factor impact on CIMT. In men, only three factors significantly affected CIMT: age (b=+0.009, P

Abstract: The contribution of arterial functional and structural changes to left ventricular (LV) diastolic dysfunction has been the area of recent research. There are some studies on the relationship between arterial stiffness (a.s.) and left atrial (LA) remodelling as a marker of diastolic burden. Little is known about the association of arterial structural changes and LA remodelling in hypertension (H)., Aim: The aim of this study was to examine the relationship between carotid a.s. and intima-media thickness (IMT) and LA volume in subjects with H. The study included 245 previously untreated hypertensives (166 women and 79 men, mean age 53.7 ± 11.8 years). Each patient was subjected to echocardiography with measurement of LA volume, evaluation of left ventricular hypertrophy (LVH) and LV systolic/diastolic function indices, integrated assessment of carotid IMT and echo-tracking of a.s. and wave reflection parameters., Results: Univariate regression analysis revealed significant correlations between indexed LA volume and selected clinical characteristics, echocardiographic indices of LVH and LV diastolic/systolic function and a.s./wave reflection parameters. The following parameters were identified as independent determinants of indexed LA volume on multivariate regression analysis: diastolic blood pressure (beta = -0.229, P < 0.001), left ventricular mass index (LVMI; beta = 0.258, P < 0.001), E/e’ index (ratio of early mitral flow wave velocity – E to early diastolic mitral annular velocity – e’; beta = 0.266, P = 0.001), augmentation index (AI; beta = 0.143, P = 0.008) and body mass index (BMI; beta = 0.132, P = 0.017). No correlations between indexed LA volume and IMT were found., Conclusion: There is a significant relationship between carotid arterial stiffness but not intima-media thickness and LA volume in patients with untreated hypertension.

Background: Left ventricular hypertrophy (LVH) and geometry patterns vary in different hemodynamic profiles The concentric hypertrophy (CH) pattern has been proved to have the worst prognosis., Objectives: The aim of the study was to test the hypothesis that carotid artery stiffness, as a marker of vascular damage, is associated with CH, independently of other potential determinants such as demographic factors (age, sex, BMI), clinical parameters (smoking, diabetes, creatinine level) and hemodynamic variables (blood pressure, pulse pressure [PP])., Material and Methods: The study involved 262 subjects (89 men): 202 patients with hypertension (153 untreated, 49 on medication), aged 55.7 ± 10 years, and 60 age-matched normal controls. The subjects were examined by echocardiography and carotid ultrasound with a high-resolution echo-tracking system. Based on the left ventricular mass index (LVMI) and relative wall thickness (RWT), the patients with hypertension were divided into four patterns of LVH and geometry: normal geometry (N, n = 57), concentric remodeling (CR, n = 48), concentric hypertrophy CH (n = 62) and eccentric hypertrophy (EH, n = 35). Intima-media thickness (IMT) and the parameters of arterial stiffness were also assessed using the β stiffness index (β), Young elastic modulus (Ep), arterial compliance (AC), one-point pulse wave velocity (PWVβ) and the wave reflection augmentation index (AI)., Results: Univariate analysis showed that the following variables are significant in determining CH: β > 8.4, Ep > 136 kPa, PWVβ > 7.1 m/s, AI > 21.9%, systolic BP > 151 mm Hg, PP > 54, IMT > 0.56 and the presence of diabetes. However, by multivariate analysis only AI (OR 3.65, p = 0.003), PWVβ > 7.1 m/s (OR 2.86, p = 0.014), systolic BP (OR 3.12, p = 0037) and the presence of diabetes (OR 3.75, p = 0.007) were associated independently with the occurrence of CH., Conclusions: Concentric hypertrophy in hypertension is strongly associated with carotid arterial stiffness and wave reflection parameters, independently of the influence of systolic blood pressure and diabetes.

Introduction: Evidence of left atrial appendage thrombogenic milieu (LAA TM) on transesophageal echocardiography (TEE) is recognized as a surrogate marker for an increased stroke risk. Although the CHA2DS2-VASc scale is commonly used as a measure of thromboembolic risk in patients with atrial fibrillation (AF), it was shown to have only low-to-moderate ability to predict the presence of LAA TM. The potential role of transthoracic echocardiography (TTE) in the refinement of clinical scales for the detection of LAA TM in patients with AF has been readdressed recently., Objectives: The aim of the study was to identify the predictors of LAA TM among the components of the CHA2DS2-VASc scale and TTE parameters in patients scheduled for electrical cardioversion due to persistent AF., Patients and Methods: We conducted a retrospective analysis of demographic, clinical, laboratory, echocardiographic, and medication data of 202 patients (123 men and 79 women; mean age, 65.6 years) with persistent AF, who underwent TEE before electrical cardioversion., Results: Duration of AF exceeding 1 year (odds ratio [OR] = 13.9; P = 0.02), left atrial diameter exceeding 51 mm (OR = 3.98; P = 0.009), left ventricular end-diastolic dimension (LVEDd) exceeding 52 mm (OR = 2.42; P = 0.01), and radiographic evidence of aortic plaques (OR = 2.97; P = 0.007) were shown to be independent predictors of LAA TM in a multivariate regression analysis., Conclusions: The CHA2DS2-VASc scale did not predict the presence of LAA TM on TEE in patients scheduled for electrical cardioversion due to persistent AF. Of the CHA2DS2-VASc components, only radiographic evidence of aortic plaques, and of TTE parameters, only left atrial enlargement and LVEDd were independent predictors of LAA TM. A comprehensive clinical and echocardiographic assessment of individual risk is indicated in patients before electrical cardioversion due to persistent AF.

Recently, there has been growing interest in an interplay of vascular mechanics and heart function (arterial-ventricular-atrial coupling). The contribution of arterial stiffness (AS) to left atrial (LA) enlargement is unclear. The aim of this study was to verify whether the association between carotid AS and LA volume in untreated arterial hypertension is independent of such confounders as age, sex, body mass index (BMI), blood pressure, left ventricular hypertrophy (LVH), left ventricular (LV) diastolic and systolic function. The study included 133 patients, among them 107 individuals with hypertension (51 men and 56 women, mean age 56.8 ± 10.3 years) and 26 matched controls. Each patient was subjected to echocardiography, ultrasonographic measurement of mean carotid intima-media thickness (IMT) and echo-tracking assessment of AS and wave reflection. LA volume was calculated by ellipsoid method. The indexed LA volume showed significant linear correlations with age (r = 0.32; p < 0.05), BMI (r = 0.21; p < 0.05), pulse pressure (r = 0.26; p < 0.05), B-type natriuretic peptide (r = 0.64; p < 0.05), LV end-diastolic volume (r = 0.42; p < 0.05), LV mass index (LVMI; r = 0.58; p < 0.05), septum thickness (r = 0.40; p < 0.05), posterior wall thickness (r = 0.34; p < 0.05), early filling wave of mitral inflow (E; r = 0.30; p < 0.05), early diastolic myocardial velocity of mitral annulus (e'; r = - 0.22; p < 0.05), E/e' ratio (r = 0.45; p < 0.05), IMT (r = 0.26; p < 0.05) and augmentation index (AI; r = 0.27; p < 0.05). Progressive multivariate analysis identified LVMI, age, AI and BMI as independent determinants of indexed LA volume in patients with arterial hypertension. The study showed the significant relationship between wave reflection expressed by AI and LA structural remodeling, which supports the hypothesis of arterial-atrial coupling in hypertension.

Background: We aimed at establishing if the substitution of vascular age (VA) for chronological age (CA) causes a change in the Framingham Risk Score (FRS) categories. Sex differences in predictors of increased VA among cardiovascular (CV) risk factors and arterial stiffness (AS) parameters were identifi ed., Methods: In 187 asymptomatic subjects with CV risk factors, classifi ed into 3 FRS categories the VA was derived from the nomograms of the carotid intima-media thickness. Two groups: 1 - subjects whose VA has exceeded CA for at least 5 years and 2 - others were established. Carotid AS parameters were obtained from echo-tracking., Results: Substitution of VA for CA changed the FRS category into the higher one in 11.8% of subjects. Diabetes mellitus (DM) was the predictor of increased VA in both sexes, while metabolic syndrome (MS) only in women. The cut-off values of AS parameters that allow for prediction of increased VA were determined from the ROC-curve analysis - in men: b > 7.3, Ep > 103 kPa, AC < 0.61 mm2/kPa after adjustment for DM, BMI > 29.1 kg/m2, WHR > 0.85 and CA > 51 years; in women: b > 9.6, Ep > 126 kPa, AC < 0.75 mm2/kPa, PWV-b > 7.4 m/s after adjustment for DM, BMI > 25.8 kg/m2, WHR > 0.80 and CA > 60 years., Conclusions: The substitution of VA for CA may increase the FRS category. Sex differences in predictors of increased VA were identifi ed. AS parameters proved to be predictors of increased VA besides the classic risk factors.

Background: Interest in the role of arterial stiffness in the pathomechanism of left ventricular (LV) diastolic dysfunction has grown in recent years., Aim: To examine the relationship between local carotid arterial stiffness parameters assessed by the ultrasonic high-resolution echo-tracking (eT) method and LV diastolic function indices in patients with untreated hypertension (H)., Methods: The study group consisted of 173 subjects, 78 male and 95 female, 113 of them with untreated H, mean age 55.7 ± 10.4 years, and 60 age-matched controls. Using 2D echo, conventional and tissue Doppler echocardiography, LV systolic and diastolic function and left ventricular hypertrophy (LVH) indices were assessed. Hypertensives were divided into two groups: those with diastolic dysfunction (HDD+: with relaxation abnormalities, n = 55 and with pseudonormalisation pattern, n = 12); and those without diastolic dysfunction (HDD-, n = 46). Using carotid arteries ultrasound, intima media thickness (IMT) and eT arterial stiffness parameters were evaluated, as also were β - beta, Ep - epsilon, AC - arterial compliance, PWVβ - one-point pulse wave velocity and AI - augmentation index., Results: Linear regression analysis revealed significant correlations between arterial stiffness indices and diastolic function parameters in the study groups: the ratio of early to late transmitral pulse Doppler velocities - E/A - correlated to Ep,β, AC and PWVβ (r = -0.30, r = -0.25, r = 0.26, r = -0.30, respectively, p < 0.05); early diastolic mitral annular velocity - e' - correlated to Ep, β and PWVβ (r = -0.22, r = -0.26, r = -0.25, respectively, p < 0.05); the ratio of early to late diastolic mitral annular velocities - e'/a' - was correlated with β and PWVβ (r = -0.28, r = -0.28, respectively, p < 0.05). HDD+ did not present echocardiographic LVH. Using ROC curve analysis, we identified optimal cut-off values of different parameters in the determination of diastolic dysfunction occurrence. Univariable analysis revealed the following significant variables in determining LV diastolic dysfunction: β > 9.2 (OR 2.65, p = 0.026), Ep > 118 kPa (OR 3.53, p = 0.040), PWVβ > 6.2 m/s (OR 3.92, p = 0.002), AI > 7.8 (OR 2.62, p = 0.049), age > 54 (OR 4.76, p < 0.001), diabetes presence (OR 2.78, p = 0.013), IMT > 0.51 mm (OR 4.49, p < 0.001), diastolic blood pressure < 70 mm Hg (OR 3.38, p = 0.047), pulse pressure > 64 (OR 2,90, p = 0.031) and ejection fraction < 76 (OR 3.38, p = 0.019). However, at multivariate analysis, only age (OR = 2.43, p = 0.073), IMT (OR = 4.56, p = 0.002) and PWVβ (OR = 2.18; p = 0.091) were independently associated with diastolic dysfunction occurrence., Conclusions: Carotid IMT as a marker of subclinical atherosclerosis and PWVβ as an index of carotid arterial stiffness are, besides age, independently associated with LV early diastolic dysfunction occurrence in untreated middle-aged hypertensives.