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1. Subclinical Kidney Damage in Hypertensive Patients: A Renal Window Opened on the Cardiovascular System. Focus on Microalbuminuria

Author

Mulè, Giuseppe, Castiglia, Antonella, Cusumano, Claudia, Scaduto, Emilia, Geraci, Giulio, Altieri, Dario, Di Natale, Epifanio, Cacciatore, Onofrio, Cerasola, Giovanni, Cottone, Santina, Cohen, Irun R., Advisory Editor, Lajtha, N. S. Abel, Advisory Editor, Lambris, John D., Advisory Editor, Paoletti, Rodolfo, Advisory Editor, and Islam, Md. Shahidul, Series editor

Published
2017
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21. Management of secondary hyperparathyroidism in uremic patients: the role of the new vitamin D analogs

Author

Brancaccio, Diego, Cozzolino, Mario, Galassi, Andrea, Chiarelli, Giusy, Butti, Alessandra, Bellasi, Antonio, Rocca-Rey, Lisa, Volpi, Angela, Anelli, Adriana, Zoni, Ulisse, Fusaro, Maria, Brambilla, Claudia, Missaglia, Elena, Crovetto, Cesar, Russo, Micol, Longhini, Carlo, Provenzano, Rossana, Incalcaterra, Francesca, Cerasola, Giovanni, Li Vecchi, Maurizio, and Gallieni, Maurizio

Published
2007

25. Frequency of Left Ventricular Hypertrophy in Non-Valvular Atrial Fibrillation

Author

Proietti M, Marra AM, Tassone EJ, De Vuono S, Corrao S, Gobbi P, Perticone F, Corazza GR, Basili S, Lip GY, Violi F, Raparelli V, ARAPACIS Study Investigators, GIS Group, Alessandri Cesare, Serviddio Gaetano, Fascetti Stefano, Serra Pietro, Palange Paolo, Greco Eleonora, Bruno Graziella, Averna Maurizio, Giammanco Antonina, Sposito Pietro, De Cristofaro Raimondo, De Gennaro Leonardo, Loria Paola, Pellegrini Elisa, Cominacini Luciano, Mozzini Chiara, Sprovieri Mario, Spagnuolo Vitaliano, Cerqua Giannantonio, Cerasola Giovanni, Mulé Giuseppe, Barbagallo Mario, Lo Sciuto Salvatore, Monteverde Alfredo, Saitta Antonino, Lo Gullo Alberto, Malatino Lorenzo, Cilia Chiara, Licata Giuseppe, Tuttolomondo Antonino, Conigliaro Roberta, Pinto Antonio, Di Raimondo Domenico, Signorelli Santo, Anzaldi Massimiliano, De Palma Daniela, Galderisi Maurizio, Cudemo Giuseppe, Galletti Ferruccio, Fazio Valeria, De Luca Nicola, Meccariello Alfonso, Caputo Dario, De Donato Maria Teresa, Iannuzi Arcangelo, Bresciani Alessandro, Giunta Riccardo, Cimini Claudia, Durante Mangoni Emanuele, Agrusta Federica, Iorio Federica, Adinolfi Luigi E, Sellitto Ausilia, Restivo Luciano, Bellis Paolo, Tirelli Paolo, Sacerdoti David, Pesce Paola, Vanni Dino, Iuliano Luigi, Ciacciarelli Marco, Pacelli Antonio, Palazzuoli Alberto, Cacciafesta Mauro, Gueli Nicola, Capeci William, Tarquinio Nicola, Pellegrini Francesco, Vincentelli Giovanni Maria, Ravallese Ferdinando, Santini Claudio, Letizia Claudio, Petramala Luigi, Zinnamosca Laura, Cilli Mirella, Savoriti Claudio, Falaschi Paolo, Martocchia Antonio, Stefanelli Manuela, Marigliano Vincenzo, Lo Iacono Cristina, Brusco Simona, Bertazzoni Giuliano, Attalla El Halabieh Elias, Paradiso Michele, Lizzi Eugenio Maria, Timmi Stefano, Battisti Paola, Cerci Sabina, Ciavolella Massimo, Di Veroli Claudio, Malci Francesco, De Ciocchis Anita, Abate Damiano, Castellino Pietro, Curto Irene, Vecchio Claudia, Mannarino Elmo, Pasqualini Leonella, Fattori Chiara, Pende Aldo, Denegri Andrea, Artom Nathan, Ricchio Roberto, Fimognari Filippo Luca, Alletto Maurizio, Messina Simona, Sesti Giorgio, Arturi Franco, Grembiale Alessandro, Perticone Francesco, Maio Raffaele, Scarpino Paola Elisa, Carullo Giuseppe, Sciacqua Angela, Frugiuele Pierluigi, Battaglia Giuseppe, Vidili Gianpaolo, Atzori Sebastiana, Delitala Giuseppe, Davì Giovanni, Angelucci Ermanno, Sestili Simona, Traisci Giancarlo, De Feudis Lucrezia, Di Michele Dario, Fava Alessandra, Balsano Clara, De Ciantis Pierpaolo, Desideri Giovambattista, Camerota Antonio, Migliacci Rino, Porciello Giovanni, Mezzetti Matteo, Gresele Paolo, Vedovati Cristina, Fierro Tiziana, Puccetti Luca, Scarpini Francesca, Bertolotti Marco, Mussi Chiara, Boddi Maria, Savino Andrea, Contri Silvia, Saller Alois, Fabris Fabrizio, Pesavento Raffaele, Filippi Lucia, Vedovetto Valentina, Puato Massimo, Treleani Martina, De Luca Elisabetta, De Zaiacomo Francesca, Giantin Valter, Semplicini Andrea, Minuz Pietro, Calabria Stefano, Romano Simone, Fantin Francesco, Manica Angela, Stockner Ingrid, Pattis Peter, Gutmann Bernhard, Catena Cristiana, Colussi GianLuca, Annoni Giorgio, Bruni Adriana Antonella, Castagna Alberto, Spinelli Diana, Corazza Gino Roberto, Miceli Emanuela, Padula, Schinco Giuseppina, Spreafico Sibilla, Secchi Beatrice, Vanoli Massimo, Casella Gianluca, Serra Maria Grazia, Longo Stefania, Antonaci Salvatore, Belfiore Anna, Ricci Lara, Ventrella Francesco, Iamele Luigi, Bianco Cesare, Santovito Donato, Cipollone Francesco, Nicolai Salvatore, Salvati Filippo, Rini Giovan Battista, Scozzari Francesca, Muiesan Maria Lorenza, Salvetti Massimo, Bazza Abramo, Picardi Antonio, De Vincentis Antonio, Cosio Paolo, Terzolo Massimo, Madaffari Bruno, Parasporo Bruno, Fenoglio Luigi, Bracco Christian, Melchio Remo, Gentili Tamira, Salvi Aldo, Nitti Cinzia, Falsetti L, Gabrielli Armando, Paglione Ivano, Capucci Alessandro, Brambatti Michela, Sparagna Armando, Tirotta Daniela, Andreozzi Paola, Ettorre Evaristo, Viscogliosi Giovanni, Rossi Fanelli Fillippo, Delfino Massimo, Glorioso Nicola, Melis Giada, Marras Gianfranca, Matta Michela, Sacco Andrea, Stellitano Elio, Scordo Anna, Russo Franco, Caruso Assunta Antonietta, Porreca Ettore, Santilli Francesca, Tana Marco, Ferri Claudio, Grassi Davide, Cheli Paola, Portincasa Piero, Muscianisi Giuseppe, Giordani Sara, Stanghellini Vincenzo, Sabbà Carlo, Suppressa Patrizia, Mancuso Gerardo, Bartone Mosè, Calipari Daniela, Arcidiacono Giuseppe, Bellanuova Ignazio, Ferraro Maria, Scalzo Antonio, Marigliano Giampietro, Cozzolino Domenico, Lampitella Antonio, Acri Vera, Galasso Domenico, Mazzei Francesca, Galasso Salvatore, Buratti Alberto, Porta Massimo, Brizzi Maria Felice, Fattorini Annalisa, Sampietro Francesca, D’Angelo Armando, Pala Marco, Fabbian Fabio, Manfredini Roberto, Moroni Carlo, Valente Lucia, Lopreiato Francesco, Parente Fernando, Moia Marco, Braham Simon, Rossi Marco, Pesce Margherita, Gentile Adelina, Catozzo Vania, Di Napoli Mariarosaria, Baciarello Giacinto, Rancan Elena, Ageno Walter, Guasti Luigina, Ciccaglioni Antonio, Negri Silvia, Polselli Marco, Abbate Rosanna, Marcucci Rossella, Cangemi Roberto, Pignataro Francesca Serena, Marco Proietti, Pastori Daniele, Ferro Domenico, Loffredo Lorenzo, Perri Ludovica, Catasca Elisa, Raparelli Valeria, Napoleone Laura, Talerico Giovanni, Calvieri Camilla, Vicario Tommasa, Russo Roberta, Saliola Mirella, Del Ben Maria, Angelico Francesco, Bucci Tommaso, Baratta Francesco, DATA AND SAFETY MONITORING BOARD (DSMB): Vestri Anna Rita, Farcomeni Alessio, Di Tanna Gianluca, STUDY COORDINATORS: Basili Stefania, Davi’ Giovanni, STEERING COMMITTEE OF ARAPACIS STUDY: Violi Francesco, Lip Gregory YH, Hiatt William R, Vestri Anna Rita, Mannucci Pier Mannuccio, Proietti Marco, Bazzini Cristina, Bianchi Paola Ilaria, Boari Benedetta, Buonauro Agostino, Buttà Carmelo, Buzzetti Elena, Carleo Pietro, Carrabba Maria Domenica, Castorani Luigi, Cecchetto Lara, Colombo Barbara Maria, De Giorgi Alfredo, De Vuono Stefano, Del Corso Lisette, Di Giosia Paolo, Falsetti Lorenzo, Forgione Alessandra, Hijazi Daniel, Lorusso Giusi, Marra Alberto Maria, Masala Maristella, Montebianco Abenavoli Ludovico, Murgia Giuseppe, Naccarato Paola, Pattoneri Paolo, Perego Francesca, Pinto Daniela, Pinna Miriam Pretti Vincenzo, Pucci Giacomo, Salinaro Francesco, Sirico Domenico, Tassone Eliezer Joseph, Torres Daniele, Vazzana Natale, Vecchio Claudia Rita, Vitale Francesco, Proietti M, Marra AM, Tassone EJ, De Vuono S, Corrao S, Gobbi P, Perticone F, Corazza GR, Basili S, Lip GY, Violi F, Raparelli V, ARAPACIS Study Investigators, GIS Group, Alessandri Cesare, Serviddio Gaetano, Fascetti Stefano, Serra Pietro, Palange Paolo, Greco Eleonora, Bruno Graziella, Averna Maurizio, Giammanco Antonina, Sposito Pietro, De Cristofaro Raimondo, De Gennaro Leonardo, Loria Paola, Pellegrini Elisa, Cominacini Luciano, Mozzini Chiara, Sprovieri Mario, Spagnuolo Vitaliano, Cerqua Giannantonio, Cerasola Giovanni, Mulé Giuseppe, Barbagallo Mario, Lo Sciuto Salvatore, Monteverde Alfredo, Saitta Antonino, Lo Gullo Alberto, Malatino Lorenzo, Cilia Chiara, Licata Giuseppe, Tuttolomondo Antonino, Conigliaro Roberta, Pinto Antonio, Di Raimondo Domenico, Signorelli Santo, Anzaldi Massimiliano, De Palma Daniela, Galderisi Maurizio, Cudemo Giuseppe, Galletti Ferruccio, Fazio Valeria, De Luca Nicola, Meccariello Alfonso, Caputo Dario, De Donato Maria Teresa, Iannuzi Arcangelo, Bresciani Alessandro, Giunta Riccardo, Cimini Claudia, Durante Mangoni Emanuele, Agrusta Federica, Iorio Federica, Adinolfi Luigi E, Sellitto Ausilia, Restivo Luciano, Bellis Paolo, Tirelli Paolo, Sacerdoti David, Pesce Paola, Vanni Dino, Iuliano Luigi, Ciacciarelli Marco, Pacelli Antonio, Palazzuoli Alberto, Cacciafesta Mauro, Gueli Nicola, Capeci William, Tarquinio Nicola, Pellegrini Francesco, Vincentelli Giovanni Maria, Ravallese Ferdinando, Santini Claudio, Letizia Claudio, Petramala Luigi, Zinnamosca Laura, Cilli Mirella, Savoriti Claudio, Falaschi Paolo, Martocchia Antonio, Stefanelli Manuela, Marigliano Vincenzo, Lo Iacono Cristina, Brusco Simona, Bertazzoni Giuliano, Attalla El Halabieh Elias, Paradiso Michele, Lizzi Eugenio Maria, Timmi Stefano, Battisti Paola, Cerci Sabina, Ciavolella Massimo, Di Veroli Claudio, Malci Francesco, De Ciocchis Anita, Abate Damiano, Castellino Pietro, Curto Irene, Vecchio Claudia, Mannarino Elmo, Pasqualini Leonella, Fattori Chiara, Pende Aldo, Denegri Andrea, Artom Nathan, Ricchio Roberto, Fimognari Filippo Luca, Alletto Maurizio, Messina Simona, Sesti Giorgio, Arturi Franco, Grembiale Alessandro, Perticone Francesco, Maio Raffaele, Scarpino Paola Elisa, Carullo Giuseppe, Sciacqua Angela, Frugiuele Pierluigi, Spagnuolo Vitaliano, Battaglia Giuseppe, Vidili Gianpaolo, Atzori Sebastiana, Delitala Giuseppe, Davì Giovanni, Angelucci Ermanno, Sestili Simona, Traisci Giancarlo, De Feudis Lucrezia, Di Michele Dario, Fava Alessandra, Balsano Clara, De Ciantis Pierpaolo, Desideri Giovambattista, Camerota Antonio, Migliacci Rino, Porciello Giovanni, Mezzetti Matteo, Gresele Paolo, Vedovati Cristina, Fierro Tiziana, Puccetti Luca, Scarpini Francesca, Bertolotti Marco, Mussi Chiara, Boddi Maria, Savino Andrea, Contri Silvia, Saller Alois, Fabris Fabrizio, Pesavento Raffaele, Filippi Lucia, Vedovetto Valentina, Puato Massimo, Fabris Fabrizio, Treleani Martina, De Luca Elisabetta, De Zaiacomo Francesca, Giantin Valter, Semplicini Andrea, Minuz Pietro, Calabria Stefano, Romano Simone, Fantin Francesco, Manica Angela, Stockner Ingrid, Pattis Peter, Gutmann Bernhard, Catena Cristiana, Colussi GianLuca, Annoni Giorgio, Bruni Adriana Antonella, Castagna Alberto, Spinelli Diana, Corazza Gino Roberto, Miceli Emanuela, Padula, Schinco Giuseppina, Spreafico Sibilla, Secchi Beatrice, Vanoli Massimo, Casella Gianluca, Serra Maria Grazia, Longo Stefania, Antonaci Salvatore, Belfiore Anna, Ricci Lara, Ventrella Francesco, Iamele Luigi, Bianco Cesare, Santovito Donato, Cipollone Francesco, Nicolai Salvatore, Salvati Filippo, Rini Giovan Battista, Scozzari Francesca, Muiesan Maria Lorenza, Salvetti Massimo, Bazza Abramo, Picardi Antonio, De Vincentis Antonio, Cosio Paolo, Terzolo Massimo, Madaffari Bruno, Parasporo Bruno, Fenoglio Luigi, Bracco Christian, Melchio Remo, Gentili Tamira, Salvi Aldo, Nitti Cinzia, Falsetti L, Gabrielli Armando, Paglione Ivano, Capucci Alessandro, Brambatti Michela, Sparagna Armando, Tirotta Daniela, Andreozzi Paola, Ettorre Evaristo, Viscogliosi Giovanni, Rossi Fanelli Fillippo, Delfino Massimo, Glorioso Nicola, Melis Giada, Marras Gianfranca, Matta Michela, Sacco Andrea, Stellitano Elio, Scordo Anna, Russo Franco, Caruso Assunta Antonietta, Porreca Ettore, Santilli Francesca, Tana Marco, Ferri Claudio, Grassi Davide, Cheli Paola, Portincasa Piero, Muscianisi Giuseppe, Giordani Sara, Stanghellini Vincenzo, Sabbà Carlo, Suppressa Patrizia, Mancuso Gerardo, Bartone Mosè, Calipari Daniela, Arcidiacono Giuseppe, Bellanuova Ignazio, Ferraro Maria, Scalzo Antonio, Marigliano Giampietro, Cozzolino Domenico, Lampitella Antonio, Acri Vera, Galasso Domenico, Mazzei Francesca, Galasso Salvatore, Buratti Alberto, Porta Massimo, Brizzi Maria Felice, Fattorini Annalisa, Sampietro Francesca, D’Angelo Armando, Pala Marco, Fabbian Fabio, Manfredini Roberto, Moroni Carlo, Valente Lucia, Lopreiato Francesco, Parente Fernando, Moia Marco, Braham Simon, Rossi Marco, Pesce Margherita, Gentile Adelina, Catozzo Vania, Di Napoli Mariarosaria, Baciarello Giacinto, Rancan Elena, Ageno Walter, Guasti Luigina, Ciccaglioni Antonio, Negri Silvia, Polselli Marco, Abbate Rosanna, Marcucci Rossella, Cangemi Roberto, Pignataro Francesca Serena, Marco Proietti, Pastori Daniele, Ferro Domenico, Loffredo Lorenzo, Perri Ludovica, Catasca Elisa, Raparelli Valeria, Napoleone Laura, Talerico Giovanni, Calvieri Camilla, Vicario Tommasa, Russo Roberta, Saliola Mirella, Del Ben Maria, Angelico Francesco, Bucci Tommaso, Baratta Francesco, DATA AND SAFETY MONITORING BOARD (DSMB): Vestri Anna Rita, Farcomeni Alessio, Di Tanna Gianluca, STUDY COORDINATORS: Basili Stefania, Davi’ Giovanni, STEERING COMMITTEE OF ARAPACIS STUDY: Violi Francesco, Perticone Francesco, Lip Gregory YH, Hiatt William R, Vestri Anna Rita, Corazza Gino Roberto, Mannucci Pier Mannuccio, Licata Giuseppe, Moroni Carlo, Proietti Marco, Anzaldi Massimiliano, Bazzini Cristina, Bianchi Paola Ilaria, Boari Benedetta, Bracco Christian, Buonauro Agostino, Buttà Carmelo, Buzzetti Elena, Calabria Stefano, Capeci William, Carleo Pietro, Carrabba Maria Domenica, Castorani Luigi, Cecchetto Lara, Cimini Claudia, Colombo Barbara Maria, De Giorgi Alfredo, De Vuono Stefano, Denegri Andrea, Del Corso Lisette, Di Giosia Paolo, Durante Mangoni Emanuele, Falsetti Lorenzo, Forgione Alessandra, Grassi Davide, Grembiale Alessandro, Hijazi Daniel, Iamele Luigi, Lorusso Giusi, Marra Alberto Maria, Masala Maristella, Montebianco Abenavoli Ludovico, Murgia Giuseppe, Naccarato Paola, Pattoneri Paolo, Perego Francesca, Pesce Paola, Petramala Luigi, Pinto Daniela, Pinna Miriam Pretti Vincenzo, Pucci Giacomo, Raparelli Valeria, Salinaro Francesco, Santilli Francesca, Scarpini Francesca, Sirico Domenico, Suppressa Patrizia, Tassone Eliezer Joseph, Torres Daniele, Vazzana Natale, Vecchio Claudia Rita, Vidili Gianpaolo, Vitale Francesco, Proietti, M., Marra, A., Tassone, E., De Vuono, S., Corrao, S., Gobbi, P., Perticone, F., Corazza, G., Basili, S., Lip, G., Violi, F., Raparelli, V., Marra, A. M., Tassone, E. J., Corazza, G. R., and Lip, G. Y. H.

Subjects
Registrie, Male, Cross-sectional study, Myocardial Infarction, Longitudinal Studie, Left ventricular hypertrophy, Cohort Studies, non-valvular atrial fibrillation, Atrial Fibrillation, 80 and over, Prevalence, echocardiography, Myocardial infarction, Longitudinal Studies, Prospective Studies, Registries, Prospective cohort study, Ultrasonography, Aged, 80 and over, education.field_of_study, Medicine (all), Atrial fibrillation, Diabetes Mellitu, Middle Aged, Left Ventricular, left ventricular hypertrophy, Italy, Hypertension, Cardiology, Age Distribution, Aged, Ankle Brachial Index, Cross-Sectional Studies, Diabetes Mellitus, Female, Humans, Hypertrophy, Left Ventricular, Logistic Models, Peripheral Arterial Disease, Cardiology and Cardiovascular Medicine, Human, medicine.medical_specialty, Logistic Model, Population, Concentric hypertrophy, Socio-culturale, non-valvular atrial fibrillation, left ventricular hypertrophy, echocardiography, cardiovascular diseases, Internal medicine, medicine, cardiovascular diseases, education, Cross-Sectional Studie, business.industry, Odds ratio, Hypertrophy, medicine.disease, Prospective Studie, Cohort Studie, business
Abstract

Left ventricular hypertrophy (LVH) is significantly related to adverse clinical outcomes in patients at high risk of cardiovascular events. In patients with atrial fibrillation (AF), data on LVH, that is, prevalence and determinants, are inconsistent mainly because of different definitions and heterogeneity of study populations. We determined echocardiographic-based LVH prevalence and clinical factors independently associated with its development in a prospective cohort of patients with non-valvular (NV) AF. From the "Atrial Fibrillation Registry for Ankle-brachial Index Prevalence Assessment: Collaborative Italian Study" (ARAPACIS) population, 1,184 patients with NVAF (mean age 72 ± 11 years; 56% men) with complete data to define LVH were selected. ARAPACIS is a multicenter, observational, prospective, longitudinal on-going study designed to estimate prevalence of peripheral artery disease in patients with NVAF. We found a high prevalence of LVH (52%) in patients with NVAF. Compared to those without LVH, patients with AF with LVH were older and had a higher prevalence of hypertension, diabetes, and previous myocardial infarction (MI). A higher prevalence of ankle-brachial index ≤0.90 was seen in patients with LVH (22 vs 17%, p = 0.0392). Patients with LVH were at significantly higher thromboembolic risk, with CHA2DS2-VASc ≥2 seen in 93% of LVH and in 73% of patients without LVH (p

Published
2015

27. Influence of Different Methods to Estimate the Glomerular Filtration Rate on the Prevalence of Decreased Renal Function in Arterial Hypertension

Author

CERASOLA, Giovanni, MULE', Giuseppe, NARDI, Emilio, GIAMMARRESI, Gaia, TAMBURELLO, Salvatrice, COTTONE S, CUSIMANO P, LO CICERO A, BUSCEMI B, CERASOLA G, MULE' G, COTTONE S, NARDI E, CUSIMANO P, LO CICERO A, BUSCEMI B, GIAMMARRESI G, and TAMBURELLO S

Subjects
medicine.medical_specialty, Decreased renal function, Pharmacotherapy, business.industry, Internal medicine, Internal Medicine, medicine, Cardiology, Renal function, Cardiology and Cardiovascular Medicine, business
Published
2007

28. Relationship Between Ambulatory Artery Stiffness Index and Glomerular Filtration Rate in Essential Hypertension

Author

MULE', Giuseppe, COTTONE, Santina, CUSIMANO, Paola, INCALCATERRA, Francesca, GIANDALIA, Maria, COSTANZO, Miriam, PALERMO, Alessandro, NARDI, Emilio, GERACI, Calogero, CERASOLA, Giovanni, Costa, R, Mulè, G, Cottone, S, Cusimano, P, Incalcaterra, F, Giandalia, M, Costanzo, M, Palermo, A, Nardi, E, Geraci, C, Costa, R, and Cerasola, G

Subjects
medicine.medical_specialty, Ambulatory blood pressure, Pharmacotherapy, business.industry, Internal medicine, Internal Medicine, medicine, Cardiology, ambulatory artery stiffness index, glomerular filtration rate, essential hypertension, Cardiology and Cardiovascular Medicine, medicine.disease, business, Obesity
Published
2007

30. RELATIONSHIP BETWEEN OBESITY AND LEFT VENTRICULAR MASS IN CAUCASIAN HYPERTENSIVE SUBJECTS. DOES SEX MATTER?

Author

MULE', Giuseppe, NARDI, Emilio, FORACI, Anna Carola, D'IGNOTO, Francesco, CASTIGLIA, Antonella, GUGLIELMO, Chiara, CERASOLA, Giovanni, COTTONE, Santina, Nardi, C., Mulè, G., Nardi, E., Foraci, A., D’Ignoto, F., Castiglia, A., Nardi, C., Guglielmo, C., Cerasola, G., and Cottone, S.

Subjects
LEFT VENTRICULAR MASS, OBESITY, ARTERIAL HYPERTENSION, LEFT VENTRICULAR HYPERTTOPHY
Abstract

Objective The excess of adiposity affects the heart through haemodynamic and non haemodynamic mechanisms leading to left ventricular hypertrophy (LVH) and ultimately to heart failure. It has been been previously observed, in a large study performed in American Indians, that the impact of obesity on left ventricular mass (LVM) is greater in women than men, while the results of other investigations carried out in other ethnic groups have yielded conflicting results .The aim of our study was to evaluate the potential influence of gender on the relationships between obesity and LVM in Caucasian patients with essential hypertension (EHs) . Design and method We enrolled 724 subjects with EH (mean age 45 ± 12 years, 63 % men ) without cardiovascular complications. In all subjects the anthropometric indices (weight, height and waist circumference ) and the routine biochemical parameters were determined . Furthermore, all patients underwent a 24-h blood pressure monitoring and an echocardiogram. LVM was indexed for body surface area (LVMI ) and for height2.7 (LVMH2.7) . Results The univariate correlations of LVM , LVMI , LVMH2.7 with body mass index (BMI) and the comparison of Pearson coefficients between the two sexes, evaluated using the Fisher r-to-z transformation, are shown in the following table. The greatest strength of the association of obesity with LVM , LVMI , LVMH2.7 in women than in men was also confirmed (p always < 0.01) in multivariate models, where the interaction term “sex x obesity' was added along with multiple confounding factors. Similar results were obtained when as an index of adiposity waist circumference was used instead of BMI. Conclusions Our study seems to indicate that in Caucasians hypertensive subjects the impact of obesity and overweight on LVM is greater in women than in men.

Published
2015

31. DIFFERENTE IMPATTO NEI DUE SESSI DELL’OBESITÀ SULLA MASSA VENTRICOLARE SINISTRA IN SOGGETTI CAUCASICI CON IPERTENSIONE ARTERIOSA ESSENZIALE

Author

MULE', Giuseppe, NARDI, Emilio, CASTIGLIA, Antonella, GUGLIELMO, Chiara, Guarino, Laura, FORACI, Anna Carola, CERASOLA, Giovanni, COTTONE, Santina, Oddo, B, Mule, G, Nardi, E, Castiglia, A, Guglielmo, C, Oddo, B, Guarino, L, Foraci, AC, Cerasola, G, and Cottone, S

Subjects
Settore MED/14 - Nefrologia, Settore MED/09 - Medicina Interna, ipertensione arteriosa essenziale, massa ventricolare sinistra, obesità, Settore MED/11 - Malattie Dell'Apparato Cardiovascolare
Abstract

Dati non univoci sono riportati in letteratura sul ruolo della dislipidemia nello sviluppo dell’ipertrofia ventricolare sinistra. Scopo del nostro studio, è stato quello di valutare le potenziali associazioni dei principali parametri lipidici con la massa ventricolare sinistra (LVM) in pazienti con ipertensione essenziale (EHs). Abbiamo arruolato 724 soggetti con EH (età media 45±12 anni; 63% maschi), senza complicanze cardiovascolari e non trattati con farmaci ipolipemizzanti. In tutti i soggetti dono stati dosati la colesterolemia totale (Tchol), la trigliceridemia (TG) e il colesterolo HDL (HDLc). Il colesterolo LDL (LDLc) è stato stimato con la formula di Friedewald ed è stato calcolato il colesterolo nonHDLc. Inoltre, sono stati eseguiti un monitoraggio della pressione arteriosa delle 24 ore ed un ecocardiogramma. La LVM è stata indicizzata per la superficie corporea (LVMI). Nessuna correlazione statisticamente significativa è stata osservata tra Tchol, LDLc e nonHDLc e la LVMI. Abbiamo rilevato correlazioni significative della LVMI con l’HDLc (r=-0.14, p

Published
2014

32. LA VARIABILITA’ PRESSORIA A BREVE TERMINE NON E’ ASSOCIATA ALLA DISFUNZIONE RENALE LIEVE NELL'IPERTENSIONE ARTERIOSA PRIMARIA

Author

MULE', Giuseppe, COSTANZO, Miriam, Guarino, Laura, CERASOLA, Giovanni, COTTONE, Santina, CALCATERRA, I, ODDO, B, CACCIATORE, V, MULE', G, CALCATERRA, I, COSTANZO, M, ODDO, B, CACCIATORE, V, GUARINO, L, CERASOLA, G, and COTTONE, S

Subjects
ipertensione arteriosa, disfunzione renale, variabilità pressoria, monitoraggio della pressione arteriosa delle 24 ore
Abstract

RAZIONALE. Il significato prognostico della variabilità pressoria (VP) a breve termine, espressa come deviazione standard (SD), è controverso. Recentemente sono stati proposti altri indici di VP a breve termine, tra i quali l’Average Real Variability (ARV), sembra essere maggiormente associato al rischio cardiovascolare (CV). Non indagata, finora è la relazione tra ARV e disfunzione renale lieve. Scopo del nostro studio è stato quello di analizzare le relazioni dell’ ARV delle 24 h e di altri indici di VP a breve termine con l’ albuminuria (AER) ed il filtrato glomerulare (eGFR) in un gruppo di ipertesi essenziali, non trattati. CASISTICA E METODI. Sono stati arruolati 248 pazienti (età media 48 ± 14 anni, donne 44 %), con ipertensione arteriosa essenziale e con eGFR > 60 ml/min/1.73 m2. Di essi 73 sono stati considerati affetti da disfunzione renale lieve (DRL), in relazione alla appartenenza ai primi due stadi di CKD, secondo le linee guida KDIGO del 2012. RISULTATI. Nessuno degli indici di VP a breve termine studiati [ARV delle pressioni arteriose (PA) delle 24 h, SD ponderata delle PA delle 24 h, SD delle PA del giorno e della notte] sono risultati diversi nei soggetti con DRL, rispetto agli ipertesi con normale funzione renale. Deboli correlazioni sono state osservate tra logaritmo dell’ARV della PA sistolica e logaritmo dell’ AER (r = 0.130; p = 0.04) e tra il primo e l’eGFR (- 0.131; p = 0.04). Tali correlazioni hanno perduto significatività statistica in modelli di regressione lineare multipla, dopo correzione per potenziali fattori confondenti. Analogamente all’analisi di regressione logistica multipla, nessuno degli indici di VP a breve termine esaminati, è risultato associato in maniera indipendente alla DRL. CONCLUSIONI. I nostri risultati, suggeriscono che nell’iperteso essenziale nessuno degli indici di VP a breve termine, ottenibile mediante monitoraggio discontinuo della PA delle 24 ore, sia associato con la DRL.

Published
2014

34. Serum levels of soluble adhesion molecules in pre-dialysis, on chronic hemodialysis and kidney transplanted patients. Which correlation with inflammation and nutrition?

Author

VACCARO, Francesco, GIANNITRAPANI, Lydia, VADALA', Anna, MULE', Giuseppe, COTTONE SANTINA, SORESI, Maurizio, SPARACINO VITO, CALABRESE SERGIO, PICONE F. PAOLO, MONTALTO GIUSEPPE E. CERASOLA GIOVANNI, VACCARO F, MULE' GIUSEPPE, COTTONE SANTINA, SORESI MAURIZIO, GIANNITRAPANI LIDIA, VADALA' ANNA, SPARACINO VITO, CALABRESE SERGIO, PICONE F PAOLO, and MONTALTO GIUSEPPE E CERASOLA GIOVANNI

Published
2004

39. ASSOCIATION OF SERUM URIC ACID WITH AORTIC STIFFNESS IN UNTREATED HYPERTENSIVE SUBJECTS

Author

MULE', Giuseppe, CUSIMANO, Paola, CASTIGLIA, Antonella, VIOLA, Tiziana, FORACI, Anna Carola, RINI, Giovam Battista, CERASOLA, Giovanni, COTTONE, Santina, Mule’, G, Cusimano, P, Castiglia, A, Viola, T, Foraci, AC, Rini, GB, Cerasola, G, and Cottone, S.

Subjects
SERUM URIC ACID, AORTIC STIFFNESS, ARTERIAL HYPERTENSION
Abstract

INTRODUCTION: Recent studies have reported an association between serum uric acid (SUA) and reduced arterial elasticity. However, in these studies arterial elastic properties have been assessed chiefly by measuring brachial-ankle pulse wave velocity (PWV) or peripheral PWV and only sometimes by using aortic PWV, that is considered the gold standard for measuring arterial stiffness. Moreover, the studies exploring the influence of SUA on aortic distensibility in subjects with arterial hypertension yielded conflicting results. AIM: The purpose of our study was to evaluate the relationships between SUA and aortic stiffness in a group of essential hypertensive patients. METHODS: We enrolled 222 untreated hypertensive subjects (mean age: 44 ± 10 years; 60 % males), free from cardiovascular complications and without severe renal insufficiency. In all subjects SUA determination and albumin excretion rate (AER) assay were obtained. Moreover, measurement of carotid-femoral pulse wave velocity (c-f PWV), by an automatic computerised method (Complior) was performed. RESULTS: Patients with c-f PWV [12 m/s (n = 44) showed SUA levels significantly higher than those with lower values of PWV (5.9 ± 1.2 vs 5.3 ± 1.1 m/s; p = 0.002). This difference held after correction by ANCOVA for various confounding factors (p = 0.02), but not after further adjustment for AER. Univariate analysis of correlation disclosed a significant association of SUA with c-f PWV (r = 0.23; p = 0.001). This correlation lost statistical significance when AER was added in a multiple regression model including, as covariates, age, gender, mean arterial pressure, serum creatinine, metabolic syndrome and SUA. CONCLUSIONS: The results of our study showed that, in hypertensive subjects, a positive relationship between SUA and aortic stiffness exists This association may be mediated by endothelial dysfunction, as suggested by the loss of its statistical significance, after adjustment for AER.

Published
2013

40. ASSOCIATION BETWEEN RENAL RESISTIVE INDEX AND CAROTID INTIMA-MEDIA THICKNESS IN HYPERTENSIVE PATIENTS

Author

MULE', Giuseppe, GERACI, Calogero, MOGAVERO, Manuela, GERACI, Giulio, D'IGNOTO, Francesco, CERASOLA, Giovanni, COTTONE, Santina, Mule’, G, Geraci, C, Mogavero, M, D'Ignoto, F, Cerasola, G, and Cottone, S.

Subjects
Carotid atherosclerosi, Renal resistive index, Echo-color doppler, Intima media thickne
Abstract

Introduction: The assessment of renal hemodynamic parameters by duplex Doppler sonography has been used for many years as a diagnostic tool in the daily work-up of kidney diseases. Recent data suggest that these parameters, especially the intrarenal resistive index (RI) may be also associated with changes of the systemic vascular tree and with an enhanced cardiovascular risk. However, conflicting data exist in literature about the independent association of carotid intima-media thickness (IMT) with RI. Aim: To evaluate the relationship between RI and carotid IMT in the hypertensive subjects consecutively attending our hypertension centre. Methods: We enrolled 264 subjects, aged between 30 and 70 years. They were stratified into two groups, either with normal renal function (n = 140) or with chronic kidney disease (CKD), ranging from stage 1 to stage 4 of the KDIGO classification (n = 124). The GFR was estimated by CKD-EPI equation. All the subjects underwent duplex Doppler assessment of the renal and carotid arteries by the GE Logiq P5 PRO instrument. Results: Patients with carotid IMT > 0.9 mm showed higher values of RI, both in the overall population (p < 0.001) and in the subgroups with (p< 0.01) and without CKD (p< 0.01). In addition, a statistically significant correlation was observed between carotid IMT and RI in the whole population (r = 0.43, p

Published
2013

41. RELATIONSHIPS OF SERUM URIC ACID WITH PLASMA RENIN ACTIVITY AND PLASMA ALDOSTERONE IN PRIMARY HYPERTENSION

Author

MULE', Giuseppe, BUSCEMI, Chiara, COSTANZO, Miriam, CASTIGLIA, Antonella, COLLURA, Giuseppina, AJELLO, Elena, VIOLA, Tiziana, ANDRONICO, Giuseppe, CERASOLA, Giovanni, COTTONE, Santina, Mule’, G, Buscemi, C, Costanzo, M, Castiglia, A, Collura, G, Ajello, E, Viola, T, Andronico, G, Cerasola, G, and Cottone S.

Subjects
plasma renin activity, uric acid, Plasma aldosterone, primary hypertension
Abstract

Introduction: In experimental studies conducted in rats, raising serum uric acid (SUA) levels resulted in stimulation of renin expression. Studies in humans exploring the association of SUA with plasma renin activity (PRA) yielded conflicting results. Moreover, little is known about the relationship between plasma aldosterone concentration (PAC) and SUA. Aim: To analyse the relationships between SUA, PRA and PAC in a group of subjects with primary hypertension. Methods: We enrolled 372 patients (mean age 45 ± 12 years; women 33 %), with untreated primary hypertension, with normal renal function and without cardiovascular complications. Results: Spearman’s rank-correlation analyses showed that SUA was significantly associated with PRA and with PAC in the overall study population (rho = 0.127, p = 0.01 and rho = 0.206, p

Published
2013

42. PREVALENCE OF DIASTOLIC DYSFUNCTION IN PATIENTS WITH ARTERIAL HYPERTENSION AND CHRONIC KIDNEY DISEASE

Author

NARDI, Emilio, MULE', Giuseppe, DI SALVO, Caterina, CUSIMANO, Paola, PALERMO, Alessandro, COSTANZO, Miriam, PALADINO, Girolama Gabriella, COSTANZA GAGLIO, Edy, CERASOLA, Giovanni, RINI, Giovam Battista, Nardi, E, Mule’, G, Di Salvo, C, Cusimano, P, Palermo, A, Costanzo, M, Paladino, G, Costanza Gaglio, E, Cerasola, G, and Rini, GB.

Subjects
Diastolic dysfunction, heart failure, chronic kidney disease
Abstract

Introduction: In patients with arterial hypertension and chronic kidney disease (CKD), the prevalence of diastolic heart failure (HF-PEF) is probably very high. However, in these patients the diagnosis is difficult, especially because the signs and symptoms suggestive of HF-PEF are very common in CKD; in these cases the detection of left ventricular structural and functional alterations (as reported in the 2012 ESC guidelines on heart failure), assumes a decisive role for the diagnosis of HF-PEF. Aim: To evaluate the prevalence of patients with diastolic dysfunction according to ESC guidelines 2012 in a population of Hypertensive patients with CKD. Methods: We studied 466 hypertensive patients with mean age of 62.3 ± 12.6 years (M/F = 262/204) suffering from chronic kidney disease (stages 3-4-5 KDIGO), with a mean value of GFR equal to 26.8 ± 15.1 mL/min/1.73 m2. The criteria for exclusion from the study were: EF\50 %, other cardiovascular diseases that could cause heart failure. Were considered with diastolic dysfunction, all patients with a value of Em (evaluated with tissue Doppler imaging at lateral mitral annulus) less than 10 cm/s. Results: We found a value of Em \10 cm/s in 331/466 patients (71 %). In order to determine the role of CKD to explain the very high prevalence of diastolic dysfunction, we selected 160 hypertensive patients with overlapping features to the previous group with regard to age, sex, BMI, etc. In this population the prevalence of diastolic dysfunction was 43.7 %. Conclusions: Our findings demonstrate a very high prevalence of diastolic dysfunction in the studied population; it is possible to assume that a large proportion of these patients had HF-PEF or is at high risk for its development. The finding of a lower prevalence of diastolic dysfunction in a hypertensive population supports the hypothesis of a decisive role of CKD in determining diastolic dysfunction and HF-PEF.

Published
2013

43. RELATIONSHIPS OF SERUM URIC ACID WITH PLASMA RENIN ACTIVITY AND PLASMA ALDOSTERONE IN UNTREATED HYPERTENSIVE SUBJECTS

Author

MULE', Giuseppe, Guarino, Laura, MORREALE, Massimiliano, D'IGNOTO, Francesco, VACCARO, Francesco, VARIO, Maria Giovanna, ANDRONICO, Giuseppe, CERASOLA, Giovanni, COTTONE, Santina, Bellavia, T, Mulé, G, Guarino, L, Bellavia, T, Morreale, M, D'Ignoto, F, Vaccaro, F, Vario, MG, Andronico, G, Cerasola, G, and Cottone S.

Subjects
Plasma renin acitivity, Plasma aldosterone, Serum Uric Acid, Primary Hypertension
Abstract

In experimental studies conducted in rats, raising serum uric acid (SUA) levels resulted in stimulation of intrarenal renin expression. Studies in humans exploring the association of SUA with plasma renin activity (PRA) yielded conflicting results. Moreover, little is known about the relationship between plasma aldosterone concentration (PAC) and SUA. The aim of our study was to analyse the relationships between SUA, PRA and PAC and the influence of age and gender on these relationships in a group of subjects with primary hypertension. We enrolled 281 patients (men 59%), with untreated primary hypertension and normal renal function. The study population wad divided in two subgroups on the basis of the median value of age (47 years). Spearman’s rank-correlation analyses showed that SUA was significantly associated with PRA and with PAC in the overall study population (rho = 0.16, p = 0.007; and rho = 0.23, p < 0.001, respectively), and in the subgroup of subjectsyounger than 47 years (rho = 0.19, p = 0.02; and rho = 0.33, p < 0.001, respectively). The separate analysis by gender disclosed a statistically significant correlation between SUA and PAC in men (rho = 0.20, p = 0.01), whereas in the same gender the correlation between SUA and PRA did not reach statistical significance (rho = 0.14, p = 0.08). No significant correlations were observed between the same variables in subjects older than 47 years and in women. All the associations between SUA, PRA and PAC lost statistical significance in logistic multiple regression analyses aimed at assessing the factors independently associated with an elevation of PRA and of PAC (third tertiles of their distribution). Our results, showing significant relationships of SUA with PRA and PAC only in univariate analyses, seem to suggest that the associations previously reported in some studies between these variables, and particularly that between SUA and PRA, may be mediated by various confounding factors, such as serum creatinine and body mass index.

Published
2013

44. RELATIONSHIP BETWEEN AORTIC PULSE WAVE VELOCITY AND RENAL RESISTIVE INDEX IN HYPERTENSIVE PATIENTS

Author

GERACI, Giulio, MULE', Giuseppe, GERACI, Calogero, MOGAVERO, Manuela, D'IGNOTO, Francesco, CERASOLA, Giovanni, COTTONE, Santina, Geraci, G, Mule’, G, Geraci, C, Mogavero, M, D'Ignoto, F, Cerasola, G, and Cottone S.

Subjects
Pulse wave velocity, Serum uric acid, Aortic stiffness
Abstract

INTRODUCTION: The assessment of renal hemodynamic parameters by duplex Doppler sonography has been used for many years as a diagnostic tool in the daily workup of kidney diseases. Recent data suggest that these parameters, especially the intrarenal resistive index (RI), may be also associated with systemic vascular changes and cardiovascular risk. However, conflicting data exist about the independent association of aortic stiffness with RI. AIM: The aim was to evaluate the relationship between RI and arterial stiffness, assessed by aortic pulse wave velocity (PWV), in the hypertensive subjects consecutively attending our hypertension centre. METHODS: We enrolled 264 subjects, aged between 30 and 70 years. They were divided into two groups, either with normal renal function (n = 140) or with chronic kidney disease (CKD), ranging from stage 1 to stage 4 of the KDIGO classification (n = 124). RESULTS: The aortic PWV was measured by a computerized oscillometric method (Arteriograph). The GFR was estimated byCKD-EPI equation.Asingle operator performed duplex Doppler assessment of the renal arteries. Doppler signals were obtained by placing the sample volume along the course of the interlobar arteries. The RI was calculated as the average of six measurements (three from each kidney). Patients with PWV> 12 m/s showed higher values of RI, both in the overall population (p< 0.001) and in the subgroups with (p

Published
2013

45. Prevalence of peripheral artery disease by abnormal ankle-brachial index in atrial fibrillation: implications for risk and therapy

Author

Violi, Francesco, Daví, Giovanni, Hiatt, William, Lip, Gregory Y. H., Corazza, Gino R., Perticone, Francesco, Proietti, Marco, Pignatelli, Pasquale, Vestri, Anna R., Basili, Stefania, Desideri, ARAPACIS Study Investigators Alessandri Cesare (Dipartimento di Scienze e Biotecnologie Medico-Chirurgiche, G., Sapienza-Università di Roma), Serviddio Gaetano (Department of Medical and Surgical Sciences, University of Foggia), Fascetti Stefano (UOC Medicina Generale, USL 12 Viareggio, Toscana), Serra, Pietro, Palange Paolo(UOC Medicina Interna, I, Dipartimento di Sanità Pubblica, e Malattie Infettive, Greco, Eleonora, Bruno Graziella (Medicina, 3, Department of Medical Sciences, Città della Salute e della Scienza, A. O., University of Turin), Averna, Maurizio, Giammanco Antonina (Dipartimento Biomedico di Medicina Interna, e Specialistica (DIBIMIS), Università di Palermo), Sposito Pietro (Azienda Ospedaliera Ospedali Riuniti Papardo Piemonte, Messina), De Cristofaro Raimondo, De Gennaro Leonardo(Istituto di Medicina Interna, e Geriatria, Centro Emostasi, e Trombosi, Gemelli, Policlinico A., Roma), Loria, Paola, Pellegrini Elisa(Medicina Interna ad Indirizzo Metabolico, – NOCSAE Baggiovara, Department of Internal Medicine, Endocrinology, Metabolism and Geriatrics, Università degli Studi di Modena, e Reggio Emilia), Cominacini, Luciano, Mozzini Chiara (Dipartimento di Medicina, Sezione di Medicina Interna, D, Università di Verona), Sprovieri, Mario, Spagnuolo Vitaliano (UOC Medicina d'Urgenza, e PS, Stabilimento Ospedaliero dell'Annunziata, Cosenza), Cerqua Giannantonio (UOC Medicina Interna per l'Urgenza, S Giovanni Addolorata, Ao, Cerasola Giovanni, Mulé Giuseppe (Università degli Studi di Palermo), Barbagallo, Mario, Lo Sciuto Salvatore, Monteverde Alfredo(UOC di Geriatria, e Lungodegenza, Azienda Ospedaliera Universitaria Policlinico, Aoup, Palermo), Saitta, Antonino, Lo Gullo Alberto (UOC Medicina Interna, Università di Messina), Malatino, Lorenzo, Cilia Chiara (Clinica Medica, Ospedale, Cannizzaro, Università degli Studi di Catania), Licata, Giuseppe, Tuttolomondo, Antonino, Conigliaro Roberta (UOC Medicina Interna, e Cardioangiologia, Dipartimento Biomedico di Medicina Interna, e Specialistica, Università degli Studi di Palermo), Pinto, Antonio, Di Raimondo Domenico (UOC Medicina Vascolare, Dipartimento Biomedico di Medicina Interna e Specialistica, (Di. Bi. M. I. S. )., Signorelli, Santo, Anzaldi Massimiliano (Dipartimento di Medicina Interna, e Patologia, Università degli studi di Catania), De Palma Daniela, Galderisi, Maurizio, Cudemo Giuseppe (Dipartimento di Medicina Clinica, e Sperimentale, AUP Federico II di Napoli), Galletti, Ferruccio, Fazio Valeria(Dipartimento di Medicina Clinica, e Chirurgia, Università di Napoli Federico II), De Luca Nicola, Meccariello Alfonso (Centro Ipertensione, AUO Federico II, Napoli), Caputo, Dario, De Donato Maria Teresa (UO Medicina Interna, Azienda Ospedaliera Universitaria San Giovanni di Dio, e Ruggi D'Aragona, Salerno), Iannuzi, Arcangelo, Bresciani Alessandro (Divisione di Medicina Interna, Cardarelli, Osp. A., Giunta, Riccardo, Cimini Claudia (V Divisione Medicina Interna ed Immunoallergologia, Policlinico, Sun, Utili, Riccardo, Durante Mangoni Emanuele, Agrusta Federica (Medicina Infettivologica, e dei Trapianti, Monaldi, Ao, Sun, Napoli), Adinolfi Luigi, E., Sellitto, Cristiana, Restivo Luciano (Medicina Interna, Seconda Università di Napoli, Ospedale di Marcianise), Bellis, Paolo, Tirelli Paolo (UOC Medicina Interna e di Urgenza, e Pronto Soccorso, del Loreto Nuovo, P. O. S. M., Loreto, Mare), Sacerdoti, David, Pesce Paola (Clinica Medica, 5, Dipartimento di Medicina DIMED, Università degli Studi di Padova), Vanni Dino (UO Medicina Interna Arezzo, Ospedale San Donato, Azienda USL, 8 Arezzo), Iuliano, Luigi, Ciacciarelli, Marco, Pacelli Antonio (Department of Medico-Surgical Sciences and Biotechnology, Vascular Biology, Mass Spectrometry Lab, Sapienza-University of Rome), Palazzuoli Alberto (Sezione Cardiologia, Dipartimento di Medicina Interna, e Malattie Metaboliche, Università di Siena, Ospedale Le Scotte), Cacciafesta, Mauro, Gueli Nicola (UOC di Medicina Geriatrica, e Riabilitazione, Sapienza- Università di Roma, Capeci, William, Tarquinio, Nicola, Pellegrini Francesco (UO Medicina 'SS Benvenuto, e Rocco', Dipartimento di Medicina Interna, Asur, Marche, Area Vasta, n. 2., ex ZT 7), Vincentelli Giovanni Maria (UOS Breve Osservazione, Calibita 'Fatebenefratelli' Isola Tiberina, Ospedale S. G., Ravallese, Ferdinando, Santini Claudio (UOC Medicina Interna, Ospedale, Vannini, Letizia, Claudio, Petramala, Luigi, Zinnamosca Laura (UOD Ipertensione Secondaria, Dipartimento di Medicina Interna, e Specialità Mediche, Cilli, Mirella, Savoriti Claudio (UOC Medicina Interna F, e Malattie Metaboliche Dell'osso-Direttore Minisola Salvatore, Falaschi, Paolo, Martocchia, Antonio, Stefanelli Manuela (UO Geriatria, Andrea, Azienda Ospedaliera S., Facoltà di Medicina, e Psicologia, Marigliano, Vincenzo, Lo Iacono Cristina, Brusco Simona (Centro di Ricerca Interdipartimentale Scienze dell’Invecchiamento, Bertazzoni, Giuliano, Attalla El Halabieh Elias (UOC Medicina d’Urgenza, Dipartimento di Emergenza ed Accettazione, Paradiso, Michele, Lizzi Eugenio Maria, Timmi Stefano (Ospedale San Giovanni Battista, Ordine di Malta, Battisti Paola (Medicina Interna II, Ospedale San Giovanni-Addolorata, Cerci Sabina (UOC Medicina Interna, Ospedali Riuniti Frascati, Marino), Ciavolella Massimo (UOC Cardiologia-UTIC, Ospedale di Frascati, Di Veroli Claudio (Centro dell’Ipertensione Arteriosa e delle Malattie Metaboliche, e Renali, Casa di Cura 'San Domenico', Malci, Francesco, De Ciocchis Anita (UOC di Medicina Interna, Ospedale, ASL Roma, G, Subiaco), Abate, Damiano(Az., Castellino, Pietro, Curto, Irene, Vecchio Claudia (UOC Medicina Interna, Dipartimento di Scienze Mediche, e Pediatriche, Mannarino, Elmo, Pasqualini, Leonella, Fattori Chiara (Medicina Interna, Angiologia, e Malattie da Arteriosclerosi, Università degli Studi di Perugia), Pende, Aldo, Denegri, Andre, Artom Nathan (Clinica di Medicina Interna, 1, Università di Genova, San Martino - IST, IRCCS Az. Osp. Univ., Genova), Ricchio, Roberto, Fimognari Filippo Luca (UOC Geriatria, Azienda Ospedaliera di Cosenza, Alletto, Maurizio, Messina Simona (Unità Operativa di Medicina, Elia, Ospedale S., Caltanissetta), Sesti, Giorgio, Arturi, Franco, Grembiale Alessandro (Università degli Studi, UOC Medicina Interna, Policlinico Universitario 'Mater Domini'), Scarpino Paola Elisa, Carullo Giuseppe (Cattedra di Medicina Interna, UO Malattie Cardiovascolari, Campus Universitario di Germaneto, Università Magna Graecia di Catanzaro), Frugiuele, Pierluigi, Spagnuolo Vitaliano (UOC Medicina Interna, e Reumatologia, Stabilimento Ospedaliero Annunziata, Azienda Ospedaliera Cosenza), Battaglia Giuseppe (UO Lungodegenza, Serra San Bruno, S. O., ASP Vibo Valentia), Vidili, Gianpaolo, Atzori, Sebastiana, Delitala Giuseppe (Clinica Medica, Dipartimento di Medicina Clinica, e Sperimentale, Aou, Sassari), Davì, Giovanni, Angelucci, Ermanno, Sestili Simona (UOC di Clinica Medica, PO Clinicizzato di Chieti), Traisci, Giancarlo, De Feudis Lucrezia (UOC Medicina Interna, 2, PO di Pescara), Di Michele Dario, Fava Alessandra (UOC Medicina Interna, Asl, Teramo), Balsano, Clara, De Ciantis Pierpaolo (Dipartimento di Medicina Interna, e Sanità Pubblica, Università, dell'Aquila), Desideri, Giovambattista, Camerota Antonio (UOC Geriatria, e Lungodegenza Geriatrica, Dipartimento Medico ORM, Avezzano), Po, Migliacci, Rino, Medicina Interna, Porciello Giovanni (S. C., Ospedale della Valdichiana, Cortona, Usl, 8 Arezzo), Mezzetti Matteo (UOC Medicina Interna Ospedale del Casentino-Direttore Dr. Emilio Santoro, AUSL8 Arezzo), Gresele, Paolo, Vedovati, Cristina, Fierro Tiziana (Dipartimento di Medicina Interna, Sezione di Medicina Interna, e Cardiovascolare, Università di Perugia), Puccetti, Luca, Scarpini Francesca (Centro Aterosclerosi, Trombosi, e Coagulopatie, Università degli Studi di Siena, Azienda Ospedaliero-Universitaria Senese), Bertolotti, Marco, Mussi Chiara (UO Geriatria, Università degli Studi di Modena e Reggio Emilia), Dipartimento Integrato di Medicina Endocrinologia Metabolismo e Geriatria., Boddi, Maria, Savino, Andrea, Contri Silvia (Dipartimento di Area Critica Medico- Chirurgica, Università degli Studi di Firenze), Saller, Alois, Fabris Fabrizio (Clinica Medica1, Medicina Interna CLOPD, Departement of Medicine DIMED, University of Padova, Italy), Pesavento, Raffaele, Filippi, Lucia, Vedovetto Valentina (Dipartimento di Scienze Cardiologiche, Toraciche, e Vascolari, Clinica Medica, 2, Azienda Ospedaliera-Università di Padova), Puato Massimo (Clinica Medica IV, Dipartimento di Medicina, Azienda Ospedaliera Universitaria Padova, Padova), Fabris, Fabrizio, Treleani Martina (UOA Medicina, Policlinico, Universitario, Maselli, Monica, Corradin Maria Luisa, Giantin Valter (Clinica Geriatrica, Università di Padova), Semplicini Andrea (Medicina Interna, 1, Giovanni e Paolo, Ospedale SS., Venezia), Minuz, Pietro, Calabria, Stefano, Romano Simone (Sezione di Medicina Interna, C, Università di Verona, Aoui, Verona), Fantin, Francesco, Manica Angela (Dipartimento di Medicina, Sezione di Geriatria, Stockner, Ingrid, Pattis, Peter, Wiedermann), Gutmann Bernhard (Divisione di Medicina Interna-Direttore Prof. J., Ospedale centrale di Bolzano), Catena, Cristiana, Colussi GianLuca (Hypertension Unit and Division of Internal Medicine, Department of Experimental and Clinical Medical Science, University of Udine, Udine, Italy), Annoni, Giorgio, Bruni Adriana Antonella, Castagna Alberto (Clinica Geriatrica, Università degli Studi di Milano- Bicocca, Dipartimento di Scienze della Salute, AO San Gerardo, Monza), Spinelli Diana (Medicina Interna 1a, Dipartimento di Scienze Cliniche, e di Comunità, Fondazione, Irccs, Università di Milano), Corazza Gino Roberto, Miceli, Emanuela, Padula Donatella (Clinica Medica, I, Reparto, 11, IRCCS Policlinico San Matteo di Pavia, Pavia), Schinco, Giuseppina, Spreafico Sibilla (UOC Geriatria, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico), Secchi Beatrice (UOC Medicina Interna, Ospedale, Bassini, Milano), Vanoli, Massimo, Casella Gianluca (SC Medicina Interna, Azienda Ospedaliera della Provincia di Lecco, Ospedale di Merate, Lecco), Serra Maria Grazia (UOC Medicina, Panico', Azienda Ospedaliera 'Cardinale G., Lecce), Longo, Stefania, Antonaci Salvatore (UOC Medicina Interna, Azienda Ospedaliera Policlinico, Bari), Belfiore, Anna, Giuseppe Palasciano, Frualdo Mariella (Clinica Medica 'A. Murri'-Direttore Prof., Ventrella, Francesco, Iamele Luigi (Struttura Complessa di Medicina Interna, Cerignola, Asl, Foggia), Bianco Cesare (UOC Medicina Interna, Tropea), Santovito, Donato, Mezzetti, Andrea, Cipollone Francesco (Centro di Eccellenza Europeo, e di Riferimento Regionale per l'Aterosclerosi, l'Ipertensione Arteriosa, e le Dislipidemie, Università, Chieti), Nicolai, Salvatore, Salvati Filippo (UO Medicina Interna, Ospedale di Ortona, ASL 02 Abruzzo), Rini Giovan Battista, Scozzari Francesca (UOC Medicina Interna ed Ipertensione, Dipartimento Biomedico di Medicina Interna e Specialistica (Di. Bi. M. I., S), Giaccone' di Palermo), Policlinico 'P., Muiesan Maria Lorenza, Salvetti, Massimo, Bazza Abramo (Dipartimento di Scienze Cliniche, e Sperimentali, Università di Brescia, 2° Medicina Generale Spedali Civili, Brescia), Picardi, Antonio, De Vincentis Antonio (UOC Medicina Clinica, Policlinico Universitario Campus Bio-Medico, Cosio, Paolo, Terzolo Massimo (Medicina Interna, 1, Dipartimento di Scienze Cliniche, e Biologiche, AOU San Luigi Gonzaga, Università di Torino), Madaffari, Bruno, Parasporo Bruno (UO Medicina Interna, Azienda Ospedaliera Bianchi Melacrino Morelli, Reggio, Calabria), Fenoglio, Luigi, Bracco, Christian, Melchio Remo (SC Medicina Interna, Croce e Carle, AO S., Cuneo), Gentili, Tamira, Salvi Aldo (Medicina Generale, - Settore Subintensivo, Azienda, Ospedaliero-Universitaria, Ancona), Nitti, Cinzia, Falsetti Lorenzo (Medicina Generale, - Settore Ordinario, Gabrielli, Armando, Paglione Ivano (Clinica Medica, Capucci, Alessandro, Brambatti, Michela, Sparagna Armando (Clinica di Cardiologia, Ospedale, Torrette, Tirotta Daniela (UO Medicina Generale IV, Ospedale, Cervesi, Cattolica), Andreozzi, Paola, Ettorre, Evaristo, Cipriani Elisa (Area Geriatria, DAI Medicina Interna, Sapienza-Università di Roma, Rossi Fanelli Fillippo, Delfino Massimo (UOC Medicina Interna, H, Immunologia, Clinica, Nutrizione, Clinica, Endocrinologia, Glorioso, Nicola, Melis, Giada, Marras, Gianfranca, Matta Michela (Ambulatorio Ipertensione Arteriosa, e Patologie Correlate, Aou, Sassari, Sassari), Sacco Andrea (UOC Medicina Interna, PO Madonna delle Grazie, Matera), Stellitano, Elio, Scordo Anna (UO Medicina, PO 'Tiberio Evoli', Melito Porto Salvo), Russo, Franco, Caruso Assunta Antonietta (UOC Medicina Generale di Rogliano, AO di Cosenza), Porreca, Ettore, Santilli, Francesca, Tana Marco (UO Medicina Interna, e Geriatria, Ospedale Clinicizzato Colle Dell'Ara, D'Annunzio, Università G., Chieti-Pescara), Ferri, Claudio, Grassi, Davide, Di Giosia Paolo (Divisione di Medicina Interna Universitaria, - Ospedale San Salvatore, Dipartimento, Mesva, Università, Dell'Aquila, L'Aquila), Portincasa Piero (Clinica Medica 'Murri', Dipartimento di Scienze Mediche, e Oncologia Umana, Università degli Studi di Bari), Muscianisi Giuseppe (ASP Reggio Calabria, Saline Joniche), Giordani, Sara, Stanghellini Vincenzo (Dipartimento di Scienze Mediche, e Chirurgiche, Università degli Studi di Bologna), Sabbà, Carlo, Suppressa Patrizia (UOC Geriatria e Centro di assistenza, e ricerca sovraziendale per le malattie rare, Mancuso, Giuseppe, Bartone, Mosè, Calipari Daniela (UOC Medicina Interna, Presidio, Ospedaliero, ASP di Catanzaro), Arcidiacono, Giuseppe, Bellanuova Ignazio (UOC Cardiologia, e UTIC, Catania), Ferraro, Maria, Scalzo, Antonio, Marigliano Giampietro (ASP Cosenza), Cozzolino, Domenico, Lampitella, Antonio, Acri Vera (Dipartimento di Internistica Clinica, e Sperimentale, Galasso, Domenico, Mazzei, Francesca, Galasso Salvatore (RSA Madonna di Porto Gimigliano, Catanzaro), Buratti Alberto (Azienda Ospedaliera della Provincia di Pavia, UO Medicina Interna, Ospedale, Civile, Casorate, Primo, Porta, Massimo, Brizzi Maria Felice (SC Medicina Interna 1U, Azienda, Ospedaliera, Torino), Fattorini, Annalisa, Sampietro, Francesca, D’Angelo Armando (Coagulation Service and Thrombosis Research Unit, IRCCS Ospedale San Raffaele, Pala, Marco, Fabbian, Fabio, Manfredini Roberto (UOC Clinica Medica, Anna, Azienda Ospedaliera-Universitaria S., Ferrara), Moroni, Carlo, Valente, Lucia, Lopreiato Francesco (Laboratorio di Ecocardiografia-Cardiologia Preventiva, DAI Cuore, e Grossi Vasi, Parente Fernando (UOC Medicina Interna, Granata Massimo (Immunologia Clinica, A, Moia, Marco, Braham Simon (Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, Rossi, Marco, Pesce Margherita (Dipartimento di Medicina Clinica, e Sperimentale, Università di Pisa), Gentile, Adelina, Catozzo Vania (UO Medicina, Ldp, Loreto, Ferranti, Edoardo, Soldini, Maurizio, Di Napoli Mariarosaria, Baciarello Giacinto (UOC Cardiologia Preventiva, e Riabilitativa, Rancan, Elena, Ageno, Walter, Guasti Luigina (Dipartimento di Medicina Clinica, e Sperimentale, Università, Dell'Insubria, Varese), Ciccaglioni, Antonio, Negri, Silvia, Polselli Marco (Centro Elettro-Stimolazione Cardiaca, Prisco Domenico (SOD Patologia Medica, Aou, Careggi, Firenze), Pignataro Francesca Serena, Pastori, Daniele, Ferro, Domenico, Loffredo, Lorenzo, Cangemi, Roberto, Perri, Ludovica, Polimeni, Licia, Catasca, Elisa, Raparelli, Valeria, Napoleone, Laura, Schillizzi, Marianna, Vicario, Tommasa, Russo, Roberta, Gentile Maria Cristina, Saliola, Mirella, Del Ben Maria, Angelico Francesco (I Clinica Medica, Sapienza-Università di, Roma)., Violi F, Daví G, Hiatt W, Lip GY, Corazza GR, Perticone F, Proietti M, Pignatelli P, Vestri AR, Basili S, ARAPACIS Study Investigators: […, Alessandri C, Serviddio G, Fascetti S, Serra P, Palange P, Greco E, Bruno G, Averna M, Giammanco A, Sposito P, De Cristofaro R, De Gennaro L, Loria P, Pellegrini E, Cominacini L, Mozzini C, Spovieri M, Spagnuolo V, Cerqua G, Cerasola G, Mulé G, Barbagallo M, Lo Sciuto S, Monteverde A, Saitta A, Lo Gullo A, Malatino L, Cilia C, Licata G, Tuttolomondo A, Conigliaro R, Pinto A, Di Raimondo D, Signorelli S, Anzaldi M, De Palma D, Galderisi M, Cudemo G, Galletti F, Fazio V, De Luca N, Meccariello A, Caputo D, De Donato MT, Iannuzi A, Bresciani A, Giunta R, Cimini C, Utili R, Durante M, Emanuele AF, Adinolfi LE, Cristiana S, Restivo L, Bellis P, Tirelli P, Sacerdoti D, Pesce P, Vanni D, Iuliano L, Palazzuoli A, Cacciafesta M, Gueli N, Capeci W, Tarquino N, Pellegrini F, Vincentelli GM, Ravallese F, Santini C, Letizia C, Petramala L, Zinnamosca L, Cilli M, Savoriti C, Falaschi P, Martocchia A, Stefanelli M, Marigliano V, Lo Iacono C, Brusco S, Bertazzoni G, El Halabieh Elias A, Paradiso M, Lizzi EM, Stefano T, Paola B, Cerci S, Ciavolella M, Di Veroli C, Malci F, De Ciocchis A, Abate D, Castellino P, Curto I, Vecchio C, Mannarino E, Pasqualini L, Fattori C, Pende A, Denegri A, Nathan A, Ricchio R, Fimognari FL, Alletto M, Messina S, Sesti G, Arturi F, Gembiale A, Scarpino PE, Carullo G, Pierluigi F, Battaglia G, Vadili G, Atzori S, Delitala G, Davì G, Angelucci E, Simona S, Giancarlo T, De Feudis L, Di Michele D, Fava A, Balsano C, De Ciantis P, Giovambattista D, Camerota A, Migliacci R, Porciello G, Mezzetti M, Gresele P, Vedovati C, Fierro T, Puccetti L, Scarpini F, Bertolotti M, Mussi C, Boddi M, Savino A, Contri S, Saller A, Fabris F, Pesavento R, Filippi L, Vedovetto V, Puato M, Treleani M, Maselli M, Corradin ML, Giantin V, Semplicini A, Minuz P, Calabria S, Romano S, Fantin F, Manica A, Stockner I, Pattis P, Guttman B, Catena C, Colussi GL, Annoni G, Bruni AA, Castagna A, Miceli E, Padula D, Schinco G, Spreafico S, Secchi B, Vanoli M, Casella G, Serra MG, Longo S, Antonaci S, Belfiore A, Frualdo M, Francesco V, Iamele L, Bianco C, Santovito D, Mezzetti A, Cipollone F, Nicolai S, Salvati F, Battista RG, Scozzari F, Muiesan ML, Salvetti M, Bazza A, Picardi A, De Vincentis A, Cosio P, Terzolo M, Fenoglio L, Bracco C, Melchio R, Gentili T, Salvi A, Nitti C, Falsetti L, Gabrielli A, Paglione I, Capucci A, Brambatti M, Sparagna A, Tirotta D, Andreozzi P, Ettorrre E, Cipriani E, Fanelli Fillippo R, Delfino M, Glorioso N, Melis G, Marras G, Matta M, Sacco A, Stellitano E, Scordo A, Russo F, Caruso Assunta A, Porreca E, Santilli F, Tana M, Ferri C, Grassi D, Di Giosia P, Portincasa P, Muscianisi G, Giordani S, Stanghellini V, Sabbà C, Supressa P, Mancuso G, Bartone M, Calipari D, Arcidiacono G, Bellanuova I, Ferraro M, Scalzo A, Marigliano G, Cozzolina D, Lampitella A, Acri V, Galasso D, Mazzei F, Galasso S, Buratti A, Porto M, Brizzi MF, Fattorini A, Sampietro F, D'Angelo A, Pala M, Fabbian F, Manfredini R, Moroni C, Valente L, Lopreiato F, Parente F, Granata M, Moia M, Braham S, Rossi M, Pesce M, Gentile A, Catozzzo V, Ferranti E, Soldini M, Di Napoli M, Baciarello G, Rancan E, Ageno W, Guasti L, Ciccaglioni A, Negri S, Polselli M, Prisco D, Pignataro FS, Pastori D, Ferro D, Loffredo L, Cangemi R, Perri L, Polimeni L, Catasca E, Raparelli V, Napoleone L, Schillizzi M, Vicario T, Russo R, Gentile MC, Saliola M, Del Ben M, Angelico F, Farcomeni A, Di Tanna G, Davi' G, Traisci G, Montebianco Abenavoli L, Grembiale A, Di Minno G, Durante ME, Pattoneri P, Boari B, Fabio G, Perego F, Bianchi Paola I, Angeli A, Colombo BM, Giannelli G, Vidili G, Torres D, Hijazl D, Gatta A, Mannucci Mannuccio P, Licata G., and …]

Subjects
Adult, Male, Risk, therapy, atrial fibrillation, cardiovascular disease, peripheral vascular disease, Aged, Atrial Fibrillation, Female, Humans, Internal Medicine, Italy, Middle Aged, Peripheral Arterial Disease, Prevalence, Registries, Societies, Medical, Ankle Brachial Index, ATRIAL FIBRILLATION, Cardiology and Cardiovascular Medicine, Medical, RISK FACTORS, cardiovascular diseases, Societies
Abstract

To the Editor: Nonvalvular atrial fibrillation (NVAF) is the most common sustained arrhythmia encountered in clinical practice and is associated with a 5-fold increased risk for stroke (1). Moreover, patients with NVAF often suffer from atherosclerotic complications such as acute myocardial infarction (AMI) (2). Peripheral artery disease (PAD) is an established marker of systemic atherosclerosis but its prevalence in NVAF is still unclear. We reasoned that inclusion of ankle-brachial index (ABI), which is an established tool for diagnosis of PAD (3), in the CHA2DS2-VASc (4) score would better define the prevalence of vascular disease. To address this issue, the Italian Society of Internal Medicine (SIMI) established an Italian registry documenting ABI in NVAF patients. The Atrial Fibrillation Registry for the ARAPACIS (Ankle-brachial Index Prevalence Assessment: Collaborative Italian Study) study is an independent research project involving all Regional Councils of SIMI. The first objective of the study was to estimate the prevalence of ABI ≤0.90 in NVAF patients. Consecutive patients with NVAF referred to internal medicine wards were eligible for the enrollment. Enrollment started in October 2010 and continued until October 30, 2012. Patients were enrolled if they were 18 years or older and had a diagnosis of NVAF, recording during the qualifying admission/consultation or in the preceding 12 months, and if it was possible to obtain the ABI measurement. Exclusion criteria included the following: acquired or congenital valvular AF, active cancer, disease with life expectancy 0.90 (93% vs. 82%; p < 0.0001). Logistic regression analysis demonstrated that ABI ≤0.90 was significantly associated with a smoking habit (odds ratio [OR]: 1.99; 95% confidence interval [CI]: 1.48 to 2.66; p < 0.0001), diabetes (OR: 1.93; 95% CI: 1.51 to 2.46; p < 0.0001), age class 65 to 74 years (OR: 2.05; 95% CI: 1.40 to 3.07; p < 0.0001), age class ≥75 years (OR: 3.12; 95% CI: 2.16 to 4.61; p < 0.0001), and history of previous transient ischemic attack/stroke (OR: 1.64; 95% CI: 1.20 to 2.24; p = 0.002). Vascular disease, as assessed by the history elements of CHA2DS2VASc score, was recorded in 17.3% of patients; inclusion of ABI ≤0.90 in the definition of vascular disease yielded a total prevalence of 33%. A higher prevalence of vascular disease was detected if ABI ≤0.90 was included in the CHA2DS2VASc score (Fig. 1). CHA2DS2VASc including ABI ≤0.90 was more associated with previous stroke (43%; OR: 1.85; 95% CI: 1.41 to 2.44; p < 0.0001) compared to CHA2DS2VASc with ABI 0.91 to 1.39 (23%; OR: 1.52; 95% CI: 1.10 to 2.11; p = 0.0117). To the best of our knowledge, there is no large-scale study that specifically examined the prevalence of ABI ≤0.90 in NVAF. In our population, 21% had ABI ≤0.90 indicating that NVAF is often associated with systemic atherosclerosis. The CHADS2 has been recently refined with the CHA2DS2-VASc score, which includes vascular disease as documented by a history of AMI, symptomatic PAD, or detection of atherosclerotic plaque in the aortic arch (4). Comparison of vascular prevalence as assessed by CHA2DS2-VASc score and/or ABI ≤0.90 is of interest to define the potentially positive impact of measuring ABI in the management of NVAF patients. Inclusion of ABI ≤0.90 in the definition of vascular disease greatly increased the prevalence of vascular disease, which increased from 17.3% (based on history alone) to 33% (based on ABI) in the entire population. If ABI ≤0.90 was encompassed in the definition of vascular disease of CHA2DS2-VASc score the prevalence of vascular disease increased in every risk class. Inclusion of ABI ≤0.90 in the CHA2DS2-VASc score allowed us to better define the risk profile of NVAF patients with an up-grading of the risk score in each CHA2DS2-VASc score category. This may have important therapeutic implications if the new score could be tested prospectively, as a higher number of NVAF patients would potentially be candidates for an anticoagulant treatment by measuring ABI. A prospective study is, therefore, necessary to validate the risk score of this new definition of vascular disease. In conclusion, this study provides the first evidence that one-fifth of NVAF patients had an ABI ≤0.90, indicating that it may represent a simple and cheap method to better define the prevalence of vascular disease in NVAF.

Published
2013

46. CORRELAZIONE TRA ALDOSTERONE E PARATORMONE PLASMATICI NELL’IPERTENSIONE ARTERIOSA ESSENZIALE

Author

COTTONE, Santina, MULE', Giuseppe, ARSENA, Rosalia, TORNESE, Francesca, VACCARO, Francesco, ANDRONICO, Giuseppe, SCAZZONE, Concetta, GUARNERI, Marco, AJELLO, Elena, CERASOLA, Giovanni, Cottone, S, Mulè, G, Arsena, R, Tornese, F, Vaccaro, F, Andronico, G, Scazzone, C, Guarneri, M, Ajello, E, and Cerasola, G.

Subjects
Settore MED/09 - Medicina Interna, ALDOSTERONE, PARATORMONE, IPERTENSIONE ARTERIOSA ESSENZIALE
Abstract

Studi sperimentali e clinici hanno indotto ad ipotizzare una interazione fisiopatologica tra aldosterone (PAC) e paratormone (PTH) nello sviluppo dell’ipertensione arteriosa e delle alterazioni cardiovascolari . Scopo di questo studio è stato di valutare il rapporto tra PAC e PTH nell’ipertensione essenziale (EH) e le eventuali interazioni con FGF23, proteina modulatrice della secrezione di PTH. In 105 H ed in 50 controlli sani sono stati analizzati i livelli plasmatici di PAC, PTH, FGF23 Vitamina D. L’analisi di correlazione multipla condotta considerando PAC come variabile dipendente ha mostrato una correlazione di PAC con FGF23 (β = 0.337; p = 0.0021) e con PTH (β = 0.241; p = 0.039) indipendente da pressione arteriosa 24h, Vitamina D, funzione renale. I nostri dati suggeriscono che sia PTH che FGF23 siano coinvolti nella fisiopatologia dell’ipertensione arteriosa, anche in assenza di malattia renale cronica

Published
2013

47. RELATIONSHIP BETWEEN SERUM URIC ACID AND AORTIC STIFFNESS IN UNTREATED HYPERTENSIVE SUBJECTS

Author

MULE', Giuseppe, CUSIMANO, Paola, CASTIGLIA, Antonella, VIOLA, Tiziana, FORACI, Anna Carola, RINI, Giovam Battista, CERASOLA, Giovanni, COTTONE, Santina, Mulè, G, Cusimano, P., Castiglia, A, Viola, T, Foraci, AC, Rini, GB, Cerasola, G, and Cottone, S.

Subjects
Pulse Wave velocity, Essential Hypertension, Arteriosclerosi, Uric Acid, Cardiovascular Risk
Abstract

Recent studies have reported an association between serum uric acid (SUA) and reduced arterial elasticity. However, in these studies arterial elastic properties have been assessed chiefly by measuring brachial-ankle pulse wave velocity (PWV) or peripheral PWV and only sometimes by using aortic PWV. Moreover, the relationships between SUA and arterial stiffness have never been statistically adjusted for albuminuria. Furthermore, the studies exploring the influence of uric acid on aortic distensibility in subjects with arterial hypertension yielded conflicting results. The aim of our study was to evaluate the relationships between SUA and aortic stiffness in a group of essential hypertensive patients, attending our Hypertension Centre. We enrolled 222 untreated hypertensive patients (mean age: 44 ± 10 years; 60 % males), without cardiovascular complications and without severe renal insufficiency. In all subjects routine blood chemistry, including SUA determination (by uricase/peroxidase method) and albumin excretion rate (AER) assay were obtained. Moreover, measurement of carotid-femoral pulse wave velocity (c-f PWV), by an automatic computerised method (Complior) and 24-h ambulatory blood pressure (BP) monitoring were performed. Patients with c-f PWV > 12 m/sec (n = 44) showed SUA levels significantly higher than those with lower values of PWV (5.9 ± 1.2 vs 5.3 ± 1.1 m/sec; p = 0.002). This difference held after correction by ANCOVA for age, gender, mean arterial pressure (MAP), body mass index, and serum creatinine (p = 0.02), but not after further adjustment for AER. Univariate analysis of correlation disclosed a significant association of SUA with c-f PWV (r = 0.23; p = 0.001). This correlation lost statistical significance when AER was added in a multiple regression model including, as covariates, age, gender, MAP, serum creatinine, metabolic syndrome and SUA. The results of our study show that, in essential hypertensive subjects, a positive relationship between SUA and aortic stiffness exists This association may be mediated by endothelial dysfunction, as suggested by the loss of its statistical significance, after adjustment for albumin excretion rate.

Published
2013

48. Vitamin D, blood pressure and intima media thickness in essential hypertension

Author

TORNESE, Francesca, ARSENA, Rosalia, SCAZZONE, Concetta, MOGAVERO, Manuela, GUARNERI, Marco, MULE', Giuseppe, CERASOLA, Giovanni, COTTONE, Santina, Tornese, F, Arsena, R, Scazzone, C, Mogavero, M, Guarneri, M, Mulè, G, Cerasola, G, and Cottone, S

Subjects
Vitamin D, essential hypertension
Published
2012

49. PLASMA ENDOTHELIN-1 IS ASSOCIATED WITH AORTIC STIFFNESS IN ESSENTIAL HYPERTENSION

Author

MULE', Giuseppe, COTTONE, Santina, CUSIMANO, Paola, PALERMO, Alessandro, FORACI, Anna Carola, COSTANZO, Miriam, NARDI, Emilio, CERASOLA, Giovanni, Mule’, G, Cottone, S, Cusimano, P, Palermo, A, Foraci, AC, Costanzo, M, Nardi, E, and Cerasola, G.

Subjects
Settore MED/14 - Nefrologia, Settore MED/09 - Medicina Interna, Arteriosclerosis, essential hypertension, endothelin, Settore MED/11 - Malattie Dell'Apparato Cardiovascolare
Abstract

Background: Experimental studies documented that endothelin-1 (ET-1) contributes to arterial stiffness and recently, in patients with chronic kidney diseases, it has been observed that selective endothelin-A receptor antagonism reduces arterial stiffness, in part independently of blood pressure lowering. Little is known about the relationships between ET-1 plasma levels and aortic distensibility in subjects with essential hypertension. Objective: The aim of our study was to analyse the relationships between plasma concentrations of ET-1 and carotid-femoral pulse wave velocity (c-f PWV), as an index of aortic stiffness, in a group of hypertensive patients without overt renal insufficiency [estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 ]. Methods: We enrolled 216 pharmacologically untreated hypertensive patients (mean age 46 ± 10 years, males 62%). In all the subjects routine biochemical parameters and ET-1 plasma values, measured by a solid-phase specific sandwich enzyme-linked immunosorbent assay (Amersham kits), were obtained. Moreover, ambulatory blood pressure monitoring and measurement of c-f PWV, by a computerized automatic method (Complior), were performed. Results: The patients (n = 41) with elevated values of c-f PWV (> 12 m/sec) showed significantly higher ET-1 plasma levels than those of subjects with PWV < 12 m/sec (3.43 ± 0.43 vs 3.18 ± 0.42 pg/ml; p = 0.001 and p = 0.01, before and after adjustment for age and mean arterial pressure). A statistical significant correlation was found between ET-1 and c-f PWV in the whole study population (r = 0.29; p < 0.001). This association held even after adjustment for age, gender, mean arterial pressure, smoking, total cholesterol, glicaemia, waist circumference, HLD cholesterol, triglycerides and eGFR (beta = 0.17; p = 0.01). The correlation between ET-1 and aortic stiffness was equally significant in both sexes and stronger in diabetic patients (n = 17; r = 0.60) when compared to non diabetic subjects (r = 0.26). Conclusions: Our results seem to suggest that in hypertensive men and women, and especially in those with diabetes, an independent relationship exists between ET-1 plasma levels and aortic stiffness.

Published
2011

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