In diabetes mellitus, structural and functional alterations of the heart can be already present at the time of first diagnosis. However, how early these alterations may occur has never been fully clarified. The present study aimed at investigating cardiac functional abnormalities in uncomplicated hypertensive or normotensive patients with a recent diagnosis of diabetes mellitus. We studied 40 diabetics (24 normotensives and 16 hypertensives) by means of routine echocardiography plus pulse tissue Doppler analysis. Data were compared with those obtained in healthy age- and sex-matched controls. Left ventricular remodelling was more evident in hypertensive diabetics than in normotensive diabetics vs controls. Diastolic function was altered in diabetic patients only when detected by pulse tissue Doppler analysis and not by conventional transmitral Doppler evaluation. Normotensive patients with type 2 diabetes with little or no evidence at standard echocardiography of alterations in cardiac structure and function, already displayed an alteration in diastolic function when the evaluation was based on the tissue Doppler approach. Patients with type 2 diabetes combined to hypertension showed more evident functional cardiac alterations at echocardiography. These findings support the conclusion that cardiac abnormalities are very early phenomena in type 2 diabetes.

Prevalence of left atrial enlargement (LAE) in hypertension has been mostly assessed in population-based samples and selected hypertensive groups. A few data are available in clinical practice. We examined LAE prevalence and severity in a cohort of hypertensive patients referred by general practitioners to a routine echocardiographic examination. A total of 2170 hypertensive individuals (mean age 62 years, 53% men) referred by practitioners to 17 outpatient echocardiographic laboratories across Italy for detection of hypertensive cardiac disease were included in the study. LAE was defined as: A) absolute LA diameter >4.0 cm in men and >3.8 cm in women; B) LA diameter normalized to body surface area (BSA) >2.3 cm/m(2) in both sexes. Left atrial enlargement was graded as mild, moderate, and severe according to Lang's report. Patients with LAE were 38% by criterion A, and 20% by criterion B. A moderate/severe increase in LA size was present in 34% (A) and 32% (B) of patients with LAE. Severe LAE was 3.3-fold (A) and 2.6-fold (B) more frequent in women than in men. Left ventricular mass was the strongest correlate of absolute LA diameter as well as of normalized LA diameter, after age. Left atrial enlargement defined either by absolute or normalized LA diameter is a frequent cardiac phenotype in hypertensive patients referred to echo-labs in clinical practice. This cardiac parameter is closely related to LV mass and its severity is highly prevalent in women.

BACKGROUND:In patients with myocardial ischemia and coronary atherosclerosis, arterial stiffness and endothelial function are impaired. Whether these alterations can be favorably affected by successful coronary revascularization is debated. METHODS:We studied 39 hospitalized patients 59.3 ± 3.2 years old (mean ± SEM). In 21 patients with angiographic evidence of significant coronary artery stenosis, revascularization procedures were performed (stenting n = 11 and bypass surgery n = 10). The remaining patients had no significant stenosis and thus served as controls. Prerevascularization measurements included carotido-femoral pulse wave velocity (PWV), radial artery flow-mediated vasodilatation and a complete echocardiographic examination. The same measurements were performed 6 months later. Pharmacological treatment consisted of different cardiovascular drugs and remained substantially unchanged over the 6-month follow-up period. RESULTS:With the exception of an increased left ventricular mass index (LVMI; 130 ± 5.3 versus 105.8 ± 7.2 g/m(2), P < 0.05) and a lower Em/Am (0.6 ± 0.01 and 0.8 ± 0.01 respectively, P < 0.05) observed in patients with coronary stenosis, all other hemodynamic, cardiac and vascular variables were similar in the two groups. Following the 6-month follow-up period, all variables remained substantially unchanged, with the exception, in revascularized patients, of a significant reduction in LVMI (-12%, P < 0.05) and an improvement in Tissue Doppler Imaging-measured diastolic function (Em/Am + 30%, P < 0.05). This was not associated, however, with any significant change in PWV and in flow-mediated vasodilatation. CONCLUSION:Cardiac revascularization has no effect on arterial function, assessed either as arterial stiffness or as flow-mediated vasodilatation. On the contrary, the improvement in coronary blood flow triggers local cardiac changes, namely, a reduction in LVMI and an improvement in diastolic function.

Background and aim. Aortic root dilatation (ARD) is a cardiovascular phenotype of adverse prognostic value; its prevalence has been mostly investigated in population-based samples and selected hypertensive cohorts. Data from clinical practice are rather scant. Thus, we examined the prevalence and correlates of ARD in a large sample of hypertensive patients referred by general practitioners for a routine echocardiographic examination. Methods. A total of 2229 untreated and treated hypertensive subjects (mean age 62 years) referred to 17 outpatient echocardiographic laboratories across Italy for detection of hypertensive subclinical cardiac damage were included in the study. ARD was defined by aortic diameter exceeding 3.7 cm in women and 3.9 cm in men. Results. ARD was found in 263 patients, with an overall prevalence of 11.8% (16.9% in men and 6.2% in women, p < 0.05). In multivariate regression analyses, body surface area (BSA), left ventricular (LV) mass and age were in ranking order the most important correlates of aortic root size in the whole population study as well as in men. In women, LV mass and its derivative indexes were the most important independent variables associated to aortic root size. Conclusions. This multicenter nationwide survey indicates that ARD is a frequent cardiovascular phenotype in hypertensives referred to echo-labs for detection of hypertensive organ damage. BSA, LV mass and age are the most important correlates of this phenotype. The hierarchical order of these factors differs between genders, LV mass being the strongest independent variable in women.

Giannattasio, C.1; Cesana, F.2; Soriano, F.2; Alloni, M.2; Cairo, M.2; Colombo, G.2; Pozzi, M.2; Menni, C.3; Trocino, G.4; Fontana, A.2; Capra, A.2; Canova, P.2; Grassi, G.1; Mancia, G.1 Author Information

Background and aim. The prevalence of left ventricular hypertrophy (LVH) in human hypertension has been mostly documented in population-based samples and selected hypertensive cohorts. Rather scant data are available from clinical practice. Thus, we examined the prevalence of LVH in a large group of hypertensive patients referred by general practitioners to a routine echocardiographic examination. Methods. A total of 2249 hypertensive subjects (mean age 62 years, 52.3% men, 84.5% treated) referred by their practitioners to 17 outpatient echocardiographic laboratories across Italy for detection of hypertensive early cardiac damage were included in the study. LVH was defined as left ventricular mass (A) >= 225/163 g, (B) >= 116/96 g/m(2), (C) >= 49/45 g/m(2.7) in men/women, respectively; LVH was graded as mild, moderate and severe according to Lang's report. Results. Overall, patients with LVH were 58%, 58% and 65% by criteria A, B and C, respectively. LVH was mild in 33% (A), 36% (B) and 29% (C), moderate in 31% (A), 28% (B) and 27% (C), and severe in 36% (A), 36% (B) and 44% (C). Conclusions. Data provided by this multicentre nationwide survey support the view that, despite therapeutic interventions, LVH remains a highly frequent phenotype in human hypertension and that severe LVH is present in a large fraction of hypertensives.

Arterial stiffness and cardiac hypertrophy are independent cardiovascular risk factors. Aim of this study was to describe the relationship between these organ damages in a large cohort of essential hypertensive (EH) treated patients. We performed standard trans-thoracic echocardiography to measure anatomical (left ventricular mass indexed by body surface area [LVMI] and relative wall thickness [RWT]) and functional (ejection fraction, diastolic function [E/A] and deceleration time) cardiac parameters on 827 treated EH patients. Carotid-femoral pulse wave velocity (PWV) was used to estimate arterial stiffness. Data were analyzed by linear regressions or ANOVA and post-hoc Bonferroni test. Patients were 53±14 years old (Mean ± SD)and 50

Antiretroviral therapy (ART) has dramatically reduced AIDS—related mortality, but it has been associated to an increased cardiovascular risk, even in absence of hypertension. The aim of this study was to describe the influence of renal damage (RD) and ART on arterial function and structure. We studied 4 groups of normotensive, normocholesterolemic, euglycemic patients; one of HIV+ on ART with RD (A; n = 25; age 50.2±10.4 years; means±SD), one of HIV+ on ART without RD (B; n = 25; 49.4±6.2 years), one of HIV+not on ART and without RD (C; n = 13; 40±8.3 years) and one of healthy controls (D; n = 25; 50±6.8years). RD was defined by microalbuminuria and/or eGFR < 60 ml/min. Arterial stiffness was measured by aorto-femoral Pulse Wave Velocity (PWV), central BP by tonometry (Sphygmocor), carotid IMT and distensibility were measured by semi-automatic echotracking. Group A showed higher aortic SBP and PP than other groups and their aortic SBP was not significantly different from systemic one. PWV was higher in both therapy groups compared to others. Aortic distensibility was significantly impaired in A compared to B and C groups (no data for D group). IMT didn’t show any difference among groups. HIV+ patients are characterized by arterial functional abnormality that might account for their increased cardiovascular risk due to either ART and/or presence of RD.

Aims and Methods: Aim of our study was to define in a large number of treated EH patients the impact of different echocardiographic criteria (ACC 2006 versus ESH ESC guidelines) on the prevalence of LVH. An additional aim was to see how closely LVH, as defined by the two criteria, reflected diastolic dysfunction. Results: Data were obtained in 827 patients (age 53 ± 13.7 year, means ± SE) 50 percent of which were male. Systolic(S) blood pressure (BP) and diastolic (D) BP were142.3 ± 18.6/86.7 ± 10.6mmHg, respectively. Left ventricular mass index (LVMI) was 111.36 ± 32.7 g/m2 when indexed by the body surface area(BSA) and 50.6 ± 15.4 g/m 2.7 when indexed by height(h)2.7. The prevalence of LVH was significantly and markedly greater (49.4 vs. 36.0%, p < 0.05) when calculated with ACC vs. ESH-ESC criteria. This was the case also when prevalence of cardiac remodelling was compared (14.6% vs. 13.6%, p < 0.05) although the difference was much less pronounced. LVMI showed a correlation with diastole (E/A ratio, r = 0.3) but not with systolic function. Conclusion: Prevalence of LVH is much greater with the ACC than with ESH ESC criteria; therefore, following the ACC criteria we may overestimate cardiac damage, with thus an excessive labelling of hypertensive patients as at high risk

We examined the difference between self-reported and measured body size values and their impact on detection of left ventricular hypertrophy (LVH) by echocardiographic LV mass indexation. A total of 1963 subjects referred by their practitioners for routine echocardiographic examination to nine outpatient echocardiographic laboratories across Italy were included in the study. Left ventricular hypertrophy was defined according to two gender- specific criteria as: A) Left ventricular mass (LVM) index ≥49 g/h(2.7) in men and ≥45 g/h(2.7) in women; B) LVM index ≥125 g/m(2) in men and ≥110 g/m(2) in women. Prevalence of LVH was calculated by indexing LVM to both self-reported and measured anthropometric values. In the whole population, LVH tended to be underestimated by self-reported values by 5.4% according to criterion A (48.5% vs. 53.9%, p < 0.001) and by 1.2% according to criterion B (29.6% vs. 30.8%, p < 0.01); similar findings were observed in the hypertensive subgroup encompassing one-half of the sample. Underestimation of LVH was more pronounced in older patients than in younger patients: 8.6% vs. 3.2% (p < 0.001) by criterion A, 3.1% vs. 0.1% (p < 0.001) by criterion B, in women than in men (8.6% vs. 3.3% (p < 0.001) by criterion A and 1.8% vs. 0.5% (p < 0.01) by criterion B. In a sample of outpatients attending echocardiographic laboratories, LVH is misclassified when left ventricular mass is normalized to self-reported weight and height. The error is related to the clinical characteristics of patients and is more pronounced when LVM is normalized to height(2.7).

Objective: The use of combination antiretroviral therapy has decreased AIDS–related mortality. It has been observed that treated AIDS patients now have a greater cardiovascular mortality and early organ damage even without hypertension. Goals of our study have been to determine whether 1) in normotensive AIDS patients with or without renal damage there are functional (arterial stiffening) and structural (carotid wall thickening) large artery alterations and whether 2) this leads to alterations in an important predictor of cardiovascular events, i.e. central blood pressure (BP). Design and Methods: We studied 40 treated, normotensive, normocholesterolemic, euglycemic AIDS patients, with (n = 20, age 52.0 ± 2.6 years; BP 131/77 ± 4/2 mmHg, means ± SE) or without (n = 20, age 44.0 ± 2.0 years; BP 130/76 ± 2/1 mmHg) renal damage, and 20 healthy controls (C, age 52.0 ± 1.0 years; BP 124/77 ± 2/1 mmHg). Renal damage was defined by microalbuminuria and/or glomerular filtration rate < 60 ml/min. Arterial distensibility was measured by aorto-femoral Pulse Wave Velocity (PWV), central systolic BP by tonometry (Sphygmocor) and carotid artery intima-media thickness (IMT) by semi-automatic echotracking (WTS). Results: Compared to C AIDS patients without renal damage showed similar values of carotid IMT (543 ± 26 vs 554 ± 24 μm), PWV (11.0 ± 0.5 vs 10.3 ± 0.4 m/sec) and central BP (117 ± 2/77 ± 1 vs 115 ± 2/70 ± 3 mmHg). In contrast, all values were greater in AIDS patients with renal damage (IMT: 608 ± 26 μm, PWV: 11.0 ± 0.5 and central BP130 ± 3/77 ± 2 mmHg), the difference being statistically significant (+ 13 mmHg, p < 0.05) for central systolic BP. In AIDS patients, PWV showed a not significant correlation with creatinine (r = 0.3) and filtration rate, both when measured by Cokroft-Gault and by MDRD (r = 0.35 and 0.31) formula, while automatically calculated IMT and systolic BP significantly correlated between each other (r = 0.4). Conclusion: In normotensive AIDS patients with no major cardiovascular risk factors there is no apparent alteration in arterial structure and function. This alteration is evident in AIDS patients with renal damage, leading to a greater central BP value that might account for their increased cardiovascular risk.

Little information is available about the burden of hypertension on echo-lab activity in current practice. The aim of the present nation-wide survey in outpatient echo-labs was to investigate the prevalence rates of (1) echo examinations performed for the evaluation of hypertensive cardiac damage; (2) reports providing quantitative data on left ventricular (LV) structure and geometry; (3) LV hypertrophy (LVH) in hypertensives referred to echo labs. The study was carried out in 14 outpatient echo-labs across Italy. Prescriptions written by general practitioners were used to identify the indications for the examinations. Estimates of LVH were derived from original echo reports or were calculated from LV primary measures, when available, with Devereux's formula in a post-analysis. Echo examination was performed in 2449 subjects (1245 men and 1204 women); hypertension was the indication for echo in 745 (30.4%) cases. In this subgroup, LV mass (LVM), LVM indexed to body surface area, LVM indexed to height2.7 and relative wall thickness ratio were reported in 58, 59, 54 and 52%, respectively. LVH was present in 53% of untreated hypertensives and, among treated patients, in 45 and 65% of those with and without blood pressure control, respectively. Our findings show that (1) hypertension accounts for approximately one-third of echo examinations performed in clinical practice; (2) a large fraction of echo reports do not provide quantitative data on LVM and LV geometry, (3) LVH is highly prevalent in hypertensives referred to echo labs for assessment of cardiac damage.