•Mechanical valve thrombosis is a serious complication.•Echocardiography and fluoroscopy are cornerstones of diagnosis.•Echocardiography in more than two loops can identify intermittent valve obstruction.

Purpose: Erectile dysfunction (ED) confers an independent risk for cardiovascular events and total mortality. Central pressures and wave reflection indices independently predict cardiovascular events. Aim of this study is to investigate whether central haemodynamics predict major adverse cardiovascular events (MACEs) in ED patients beyond traditional risk factors. Methods: MACEs in relation to aortic pressures and Augmentation index (AIx) were analyzed with proportional hazards models in 398 patients (mean age, 56 years) without established cardiovascular disease (CVD). Results: During the mean follow-up period of 6.5 years, a total of 29 (6.5%) MACEs occurred. The adjusted relative risk (RR) of MACEs was 1.062 (95% CI 1.016–1.117) for a 10-mmHg increase of aortic systolic pressure, 1.117 (95% CI 1.038–1.153) for a 10-mmHg increase of aortic pulse pressure (PP), and 1.191 (95% CI 1.056–1.372) for a 10% absolute increase of AIx. The based on categories for 10-year coronary heart disease risk and adapted at 6.5 years overall net reclassification index (NRI) showed marginal and indicative risk reclassification for AIx (15.7%, P=0.12) and aortic PP (7.2%, P=0.20) respectively. Conclusions: Our results show for the first time that higher central pressures and wave reflections indices are associated with increased risk for a MACE in patients with ED without known cardiovascular disease. Considering the adverse prognostic role of central haemodynamics on outcomes, the present findings may explain part of the increased cardiovascular risk associated with ED.

Objective: Vascular age, as assessed by structural and functional properties of the arteries, is an important prognostic risk factor for cardiovascular events. Antihypertensive treatment has shown beneficial effects on prognosis through blood reduction. The aim of this study was to investigate the effect of different classes of antihypertensive drugs on the progression of vascular stiffening. Design and method: One hundred and forty-two subjects (mean age 51.9 ± 10.8 years, 94 men, 61 hypertensives) with no established cardiovascular disease were investigated in two examinations over a 2-year period (mean follow-up visit 1.84 years). All hypertensives were under treatment for at least 1 year and had well-controlled blood pressure. Subjects had at the beginning and end of the study determinations of carotid-femoral pulse wave velocity (PWV). Based on these measurements the annual absolute changes were calculated. Results: At baseline PWV was not statistically different between patients with and without hypertension (7.14m/s vs. 7.26m/s, P = 0.447). Subjects with hypertension had a gradual higher annual progression of PWV compared to subjects without hypertension [0.281 m/s/year (95% CI: 0.183–0.379) vs. 0.102 m/s/year (95% CI: 0.020–0.185), P = 0.013]. Treatment with angiotensin receptor blockers was associated with slower progression of arterial stiffening after adjustment for relevant confounders [0.03m/s/year (95% CI:-0.12 to 0.18) vs. 0.23m/s/year (95% CI: 0.15 to 0.30), P = 0.032]. Angiotensin converting enzyme inhibitors did not attenuate the hypertension-related progression of aortic stiffness [0.33m/s/year (95% CI: 0.15 to 0.50) under treatment vs. 0.15m/s/year (95% CI: 0.09 to 0.22), P = 0.08]. Neither beta-blockers [0.24m/s/year (95% CI:0.08 to 0.41) under treatment vs. 0.17m/s/year (95% CI:0.10 to 0.23), P = 0.42], calcium channel blockers [0.11m/s/year (95% CI:-0.04 to 0.27) under treatment vs. 0.20m/s/year (95% CI:0.13 to 0.27), P = 0.35] or thiazide diuretics [0.31m/s/year (95% CI:0.12 to 0.49) under treatment vs. 0.16m/s/year (95% CI:0.09 to 0.23), P = 0.16] showed beneficial effect on reversing progression of aortic stiffening. Conclusions: Angiotensin receptor blockers may slow down progression of vascular stiffening more effectively compared to other classes of antihypertensive drugs independently of blood pressure reduction. These results warrant further confirmation in larger outcome studies.

BACKGROUND:There is evidence for inverse association between endogenous testosterone and blood pressure. Furthermore, low plasma testosterone is associated with increased risk of major cardiovascular events in middle-aged hypertensive men. Central (aortic) blood pressures determine left ventricular hypertrophy and predict cardiovascular mortality. The aim of the present study was to assess the relationship of total testosterone (TT) with central haemodynamics and left ventricular mass in hypertensive men. METHODS:We investigated 134 non-diabetic, middle-aged, hypertensive men and 60 age-matched normotensive males. All participants were subject to measurement of aortic systolic (aoSBP) and pulse pressure (aoPP) by pulse wave analysis using the SphygmoCor device. Wave reflections were assessed by the measurement of heart rate corrected augmentation index (AIx75). Echocardiography was performed in all individuals and left ventricular mass (LVM) was calculated using the Devereux's formula. Plasma TT was measured by enzyme immunoassay. RESULTS:In hypertensive men, univariate analysis showed an inverse, significant correlation between TT and aoSBP (r = -20, p = 0.02), aoPP (r = -0.21, p = 0.01), AIx75 (r = -0.22, p = 0.01) and LVM (r = -0.19, p = 0.008). Multivariate regression analysis demonstrated an independent inverse association of TT with aoPP (b = -0.21, p = 0.02), AIx75 (b = -0.19, p = 0.03) and LVM (b = -0.28, p = 0.005) after adjustment for age, BMI, smoking, total cholesterol, triglycerides, fasting glucose, mean arterial pressure, antihypertensive treatment and statin use. Independent associations were retained even after inclusion of normotensive subjects in the analysis. CONCLUSIONS:In hypertensive men, TT is independently and inversely associated with central pulse pressure, wave reflections and left ventricular mass. Considering the adverse prognostic role of central blood pressures and LV hypertrophy on cardiovascular outcomes in hypertensive patients, the present findings might explain part of the increased cardiovascular risk associated with low testosterone. Whether measurement of central haemodynamics may improve risk stratification in hypertensive men with low testosterone warrants further investigation.

Increased arterial stiffness is a marker of cardiovascular disease and suggested to beassociated with impaired lung function in chronic obstructive pulmonary disease (COPD). However, whether patients with mild COPD have increased arterial stiffness and what factors are linked to is still not explicitly studied. We hypothesised that patients with mild COPD would have increased arterial stiffness than controls independent of lung function. As part of the ARCADE study, 70 patients with mild COPD and 150 controls free from lung disease were examined. Aortic pulse wave velocity (PWV), spirometry, body composition, blood pressure (BP), heart rate (HR) and C-reactive protein (CRP) were determined. Patients and controls were similar in age, body composition and gender. However, patients had greater aortic PWV 9.4 (1.96) m/s, systolic BP 147 (18) mmHg, HR 72 (12) bpm and CRP* 3.1 (1.7) mg/l compared with controls PWV 8.4 (1.8) m/s, BP 140 (18) mmHg, HR 67 (10) bpm and CRP* 1.7 (1.6) mg/l, all p<0.001. Aortic PWV was related to HR in patients (r = 0.39) and controls (r = 0.26), all p<0.001. A stepwise regression analysis adjusted for age and MAP showed heart rate was only predictor of increased aortic PWV (Adjusted R2 = 33

Childhood determinants of aortic pulse wave velocity [PWV] are poorly understood. We tested how factors measured twice previously in childhood in the MRC ‘DASH’ study, particularly body mass (BMI) components and BP, affected PWV in young adults. Of 6643 London children, aged 11e13 y, from 51 schools in samples of about 1000 in 6 ethnic groups, with markedly different adult cardiovascular risk, 4785 (72

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Basic Research I1 Apr 2014MP43-16 CAROTID ATHEROSCLEROSIS EXPRESSED BY INCREASED INTIMA MEDIA THICKNESS IS ASSOCIATED WITH LOW ADHERENCE TO MEDITERRANEAN DIET IN ERECTILE DYSFUNCTION PATIENTS A. Rempelakos, Ch Vlachopoulos, K. Makarounis, N. Ioakimidis, A. Katevatis, A. Aggelis, D. Karagiannis, and Ch Fasoulakis A. RempelakosA. Rempelakos More articles by this author , Ch VlachopoulosCh Vlachopoulos More articles by this author , K. MakarounisK. Makarounis More articles by this author , N. IoakimidisN. Ioakimidis More articles by this author , A. KatevatisA. Katevatis More articles by this author , A. AggelisA. Aggelis More articles by this author , D. KaragiannisD. Karagiannis More articles by this author , and Ch FasoulakisCh Fasoulakis More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1173AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives The Mediterranean type of diet, rich in fruits, legumes, vegetables and nuts, is a healthy dietary pattern, gaining widely recognition as a non-pharmaceutical mean for cardiovascular disease prevention due to its antioxidant components and anti-inflammatory properties. Endothelial dysfunction and subclinical inflammation are important pathophysiologic mechanisms underlying both vasculogenic erectile dysfunction (ED) and atherosclerosis in other vascular beds. Increased carotid IMT (>0,9mm) relates to traditional risk factors and associates with an unfavorable cardiovascular outcome. Purpose of our study is to investigate the association of Mediterranean type of diet with structural changes in large arteries in ED patients, a relation which has not been defined yet. Methods Forty-five ED patients (aged 56±11 years) underwent carotid ultrasound for evaluation of intima medial thickness (IMT) in the common carotid artery. Overall assessment of dietary habits was evaluated through a special diet score (the Med-DietScore, theoretical range 0–55), which assesses adherence to the Mediterranean dietary pattern. Higher values on the score indicate greater adherence to this pattern and, consequently, healthier dietary habits. Results Med-diet score was significantly associated with age (r=-0.215, P<0.05) systolic and pulse pressure (r=-0.198 and r=-0.277, respectively, all P<0.05). In univariate analysis Med-DietScorewas inversely associated with carotid IMT (r=-0.43, P<0.001, figure). In order to further evaluate the impact of Mediterranean diet on carotid wall thickness, multiple linear regression analysis was applied, which revealed that MedDiet Score was inversely associated with IMT after adjustment for history and treatment of hypertension, hypercholesterolemia, diabetes mellitus, as well as use of statinsand smoking (b = -0.305, p<0.01). Patients with a mean IMT >0.9 mmhad significantly lower Med-Diet Score as compared to subjects with lower IMT values (27±4 vs 33±5, P<0.05). Conclusions The inverse association between Med-Diet Score and carotid IMT indicates an unhealthy dietary life style in ED patients that contributes to an adverse cardiovascular profile and may help in preventing further vascular damage by adapting healthier dietary habits. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e484 Advertisement Copyright & Permissions© 2014MetricsAuthor Information A. Rempelakos More articles by this author Ch Vlachopoulos More articles by this author K. Makarounis More articles by this author N. Ioakimidis More articles by this author A. Katevatis More articles by this author A. Aggelis More articles by this author D. Karagiannis More articles by this author Ch Fasoulakis More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Chronic obstructive pulmonary disease (COPD) is highly prevalent worldwide. Its morbidity and mortality are increasing and it is predicted to be the third leading cause of death by 2020. COPD and cardiovascular disease (CVD) are chronic conditions that share many risk factors and a complex pathophysiology. Current literature has closely focused on the relationship between these two diseases and today COPD is considered to be an independent risk factor for CVD, which is the leading cause of death in approximately 50% of COPD patients. Coronary artery disease, congestive heart failure, pulmonary hypertension, cardiac arrhythmias, peripheral artery and cerebrovascular disease have been documented to present more frequently in COPD patients than in individuals without COPD. Moreover, despite the fact that the exact pathophysiologic mechanism linking COPD to CVD is not yet found, systemic inflammation is one of the most likely protagonists of this connection, as atherosclerosis is directly associated with inflammation. Finally, the aim of this review is to assess the prevalence of cardiovascular comorbidities on COPD patients, to detect the possible pathophysiological mechanisms and to discuss the available therapeutic options aimed at managing these comorbidities and reducing the COPD associated cardiovascular risk.

Background: Erectile dysfunction (ED) is an early manifestation of a generalized arterial disease. The association between penile vascular disease progression and total atherosclerotic burden was investigated using a classification that incorporates ultrasonographic assessments of intima media thickness (IMT) and plaques from both the carotid and femoral arteries.Methods: Sixty-five ED patients (mean age, 56 +/- 10 yrs) were evaluated for cavernous vascular disease severity using penile Doppler ultrasound. Ultrasonographic assessments of IMT, lumen diameter, and plaques in the carotid and femoral arteries were evaluated, and patients were classified according to an ultrasound-based morphological system.Results: Based on the results of ultrasonic assessments, patients were divided into two groups-a high-score group and a low-score group. Patients in the high-score group had increased intima-media (>1.0 mm) and/or plaque in any of the four arteries. Patients in the low-score group had normal carotid and femoral IMT and an absence of plaques in all four arteries. While the two groups did not differ in blood pressure parameters, metabolic profile, and smoking status, high-score patients (n = 31) had significantly decreased age-adjusted peak systolic velocity (25.2 cm versus 32.3 cm/s, P < 0.01) and a longer duration of ED (3.8 years versus 2 years, P < 0.05), compared with low-score patients (n = 34). In the high-score group, score level was inversely correlated with peak systolic velocity after adjusting for age and systolic blood pressure (b = -0.322, P = 0.025). There also was a positive linear relation of ED duration with prevalence of high score (P < 0.05).Conclusions: In patients with vasculogenic ED, ultrasound findings of penile vasculature damage and long-standing ED correlate significantly with increasing carotid and femoral atherosclerotic burden. These data suggest a close interrelationship between progression of vasculogenic ED and peripheral atherosclerosis.

Purpose: Hypertension is associated with increased left ventricular (LV) hypertrophy mass and aortic stiffness, which are both predictors of cardiovascular risk. Renal dysfunction is an essential cardiovascular risk factor with pathophysiological link to both aortic stiffness and LV hypertrophy. We investigated the possible effect of renal dysfunction on LV mass and aortic stiffness in never treated hypertensives. Methods: We enrolled 1223 consecutive essential hypertensives (mean age 53.0±11.6 years, 726 males) without known cardiovascular disease (CVD). We assessed renal function using the Modification of Diet in Renal Disease (MDRD) formula to estimate the glomerular filtration ratio (GFR). We classified our population as hypertensives with moderate to severe renal dysfunction (GFR<60 ml/min/1.73m2, n=132) and hypertensives mild renal dysfunction or normal renal function (GFR≥60 ml/min/1.73m2, n=1091). Left ventricular mass index (LVMI) was assessed by echocardiography. M-mode imaging was used for wall-thickness measurements. LVMI was calculated using the Devereux formula. Aortic stiffness and wave reflections were assessed with pulse wave velocity (PWV) and augmentation index (AIx) that were estimated with the Complior and Sphygmocor device, respectively. Ten-year cardiovascular risk was estimated with Framingham Risk score. Statistical analyses were performed by means of 1-way ANOVA and ANCOVA. Results: After adjustment for age, gender, mean blood pressure, body-mass index, diabetes mellitus, low-density lipoprotein and C-reactive protein the abovementioned confounders hypertensives with GFR<60 ml/min/1.73m2 compared to hypertensives with GFR≥60 ml/min/1.73m2 had higher PWV levels (8.86 m/s vs. 7.92 m/s, p=0.014), higher LVMI (119.5 g/m2 vs. 114.9 g/m2, p=0.012) and higher AIx (31.1% vs. 27.4% g/m2, p=0.05). On the contrary, hypertensives with GFR<60 ml/min/1.73m2 had similar 10-year cardiovascular risk compared to hypertensives with GFR≥60 ml/min/1.73m2 (17.3% vs. 13.0%, p=0.323). Conclusions: Renal dysfunction is associated with LVMI and arterial stiffness. Hypertensives with moderate to severe renal dysfunction despite having similar 10-year cardiovascular risk with hypertensives with normal renal function or mild renal dysfunction, demonstrate higher aortic stiffness and LV mass, implying a possible underestimation of risk by Framingham. Thus, measurement of aortic stiffness and LV mass could improve risk stratification in hypertensives with renal dysfunction.