https://vincentbourquin.files.wordpress.com/2009/11/broad-spectrum.pdf

Increased Central Venous Pressure Is Associated With Impaired Renal Function and Mortality in a Broad Spectrum of Patients With Cardiovascular Disease

Numerous studies addressed the predictive value of the nighttime blood pressure (BP) as captured by ambulatory monitoring. However, arbitrary cutoff limits in dichotomized analyses of continuous variables, data dredging across selected subgroups, extrapolation of cross-sectional studies to prospective outcomes, and lack of comprehensive adjustments for confounders make interpretation of the literature difficult. We reviewed prospective studies with total mortality or a composite cardiovascular end point as an outcome in relation to the level and the circadian profile of systolic BP. We analyzed studies in hypertensive patients (n=23 856) separately from those in individuals randomly recruited from populations (n=9641). We pooled summary statistics and individual subject data, respectively. In both patients and populations, in analyses in which nighttime BP was additionally adjusted for daytime BP and vice versa, nighttime BP was a stronger predictor than daytime BP. With adjustment for the 24-hour BP, both the night-to-day BP ratio and dipping status remained significant predictors of outcome but added little prognostic value over and beyond the 24-hour BP level. In the absence of conclusive evidence proving that nondipping is a reversible risk factor, the option whether or not to restore the diurnal blood pressure profile to a normal pattern should be left to the clinical judgment of doctors and should be individualized for each patient. Current guidelines on the interpretation of ambulatory BP recording need to be updated.

Predictive Role of the Nighttime Blood Pressure

Heart rate turbulence: standards of measurement, physiological interpretation, and clinical use: International Society for Holter and Noninvasive Electrophysiology Consensus.

Tortuous arteries and veins are commonly observed in humans and animals. While mild tortuosity is asymptomatic, severe tortuosity can lead to ischemic attack in distal organs. Clinical observations have linked tortuous arteries and veins with aging, atherosclerosis, hypertension, genetic defects and diabetes mellitus. However, the mechanisms of their formation and development are poorly understood. This review summarizes the current clinical and biomechanical studies on the initiation, development and treatment of tortuous blood vessels. We submit a new hypothesis that mechanical instability and remodeling could be mechanisms for the initiation and development of these tortuous vessels.

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Twisted Blood Vessels: Symptoms, Etiology and Biomechanical Mechanisms

OBJECTIVE To estimate and compare associations of alanine aminotransferase (ALT) and γ-glutamyltransferase (GGT) with incident diabetes. RESEARCH DESIGN AND METHODS ALT and GGT were studied as determinants of diabetes in the British Women9s Heart and Health Study, a cohort of 4,286 women 60–79 years old (median follow-up 7.3 years). A systematic review and a meta-analysis of 21 prospective, population-based studies of ultrasonography, which diagnosed nonalcoholic fatty liver disease (NAFLD), ALT, and GGT as determinants of diabetes, were conducted, and associations of ALT and GGT with diabetes were compared. RESULTS Ultrasonography-diagnosed NAFLD was associated with more than a doubling in the risk of incident diabetes (three studies). ALT and GGT both predicted diabetes. The fully adjusted hazard ratio (HR) for diabetes per increase in one unit of logged ALT was 1.83 (95% CI 1.57–2.14, I 2 = 8%) and for GGT was 1.92 (1.66–2.21, I 2 = 55%). To directly compare ALT and GGT as determinants of diabetes, the fully adjusted risk of diabetes in the top versus bottom fourth of the ALT and GGT distributions was estimated using data from studies that included results for both markers. For ALT, the HR was 2.02 (1.59–2.58, I 2 = 27%), and for GGT the HR was 2.94 (1.98–3.88, I 2 = 20%), suggesting that GGT may be a better predictor ( P = 0.05). CONCLUSIONS Findings are consistent with the role of liver fat in diabetes pathogenesis. GGT may be a better diabetes predictor than ALT, but additional studies with directly determined liver fat content, ALT, and GGT are needed to confirm this finding.

/pdf/alanine-aminotransferase-g-glutamyltransferase-and-incident-1gou57kogi.pdf

Alanine Aminotransferase, γ-Glutamyltransferase, and Incident Diabetes: The British Women's Heart and Health Study and meta-analysis

Levosimendan is a relatively new cardiac inotropic agent with calcium sensitizing activity. This study was conducted to investigate the effects of levosimendan (L) and dobutamine (D) on renal function in patients hospitalized with decompensated heart failure (HF). The present study included 88 consecutive patients hospitalized with acutely decompensated HF (New York Heart Association (NYHA) Class 3–4) requiring inotropic therapy. Patients were randomized 2:1 to either L or D for intravenous inotropic support. Diuretic therapy was kept constant during infusions. Renal function values, including serum creatinine (CR), blood urea nitrogen, 24-h urinary output levels and calculated glomerular filtration rate (GFR) were measured just prior to and 24 h after the infusions in all patients, and 48 and 72 h after the infusions in every second patient in both groups. The pre and post-infusion values of renal function and left ventricular ejection fraction (LVEF) were evaluated. LVEF increased significantly in both groups. Those in L showed a significant improvement in calculated GFR after 24 h, whereas those in D showed no significant change (median in change in L:+15.3%, median change in D: −1.33%). Furthermore, in the L group a significant improvement was observed in calculated GFR after 72 h compared to baseline levels, whereas in D no significant change (median change in L:+45.45%, median change in D: +0.09%) was seen. Both agents improved 24-h urinary output. Levosimendan seems to provide beneficial effects in terms of improvement in renal function compared to dobutamine in patients with heart failure who require inotropic therapy.

Levosimendan improves renal function in patients with acute decompensated heart failure: comparison with dobutamine.

Severe heart failure represents a major source of morbidity and mortality. Poor right ventricular function is an independent prognostic marker for mortality in patients with chronic heart failure. In this study, levosimendan (L) and dobutamine (D) in patients with severe chronic biventricular failure were compared. Forty consecutive patients, who were judged for inotropic therapy by their primary physicians, with acutely decompensated systolic heart failure and having moderate-to-severe right ventricular dysfunction with right ventricular fractional area change of ≤24%m were randomized to L and D in a 2:1 fashion. Echocardiographic parameters including tricuspid annular motion and clinical issues were considered. Mean age and sex distribution were not different between the two groups. After the infusion, ejection fraction improved and systolic pulmonary artery pressure decreased significantly in both arms. Longitudinal systolic function of tricuspid annulus improved significantly better in patients with L compared to patients with D (15% ± 12% vs. 2% ± 6% improvement, P < 0.001). Furthermore, L improved both 24-h urine output and creatinine, whereas D showed only a small, but significant improvement in urine output without any improvement in the creatinine levels. Levosimendan seems to offer more beneficial effects compared to dobutamine in a specific group of patients with biventricular failure.

Comparative effects of levosimendan and dobutamine on right ventricular function in patients with biventricular heart failure

Background. Sleep is a basic physiological process. Normal sleep yields decrease in sympathetic activity, blood pressure (BP) and heart rate. Those, who do not have expected decrease in their BP are considered “non‐dippers”. We aimed to determine if there was any association between the non‐dipping status and sleep quality, designed a cross‐sectional study, and enrolled and evaluated the sleep quality of relatively young patients with an initial diagnosis of hypertension. Methods. Seventy‐five consecutive patients, diagnosed to have stage 1 hypertension by their primary physicians, were referred to our study. Patients had newly diagnosed with stage 1 hypertension. Patients with a prior use of any anti‐hypertensive medication were not included. Eligible patients underwent the Pittsburgh Sleep Quality Index (PSQI), which has an established role in evaluating sleep disturbances. All patients underwent ambulatory BP monitoring. Results. There were 42 non‐dipper patients (mean age = 47.5±11.9 years, 24 male/18...

Sleep quality among relatively younger patients with initial diagnosis of hypertension: dippers versus non-dippers.

Objective
To investigate the relationship between coronary tortuosity and impaired left ventricular relaxation.

Tortuosity of coronary arteries: an indicator for impaired left ventricular relaxation?

Gamma-glutamyltransferase (GGT), regarded as a marker of excessive alcohol consumption or liver disturbances, is an enzyme catalyzing the first step in the extracellular degradation of the antioxidant glutathione (GSH) and may take part in atherogenesis. The marked relationship between GGT and the atherosclerotic process has shifted attention to the issue of whether its serum levels can aid in the detection of individuals at high risk for incident cardiovascular events. It is likely that the process entails the oxidation of low-density lipoprotein through GSH/GGT-dependent iron reduction within the plaque. In this context, oxidative stress is a probable mediator. Recent insights into the pathophysiological background of GGT in the precipitation and progression of atherosclerosis appear to be supported by relevant epidemiological observations as a cardiovascular risk predictor. Further understanding is, nevertheless, warranted to ameliorate the prognostic stratification of patients through GGT.

Okan Onur Turgut

Papers

Levosimendan improves renal function in patients with acute decompensated heart failure: comparison with dobutamine.

Comparative effects of levosimendan and dobutamine on right ventricular function in patients with biventricular heart failure

Sleep quality among relatively younger patients with initial diagnosis of hypertension: dippers versus non-dippers.

Tortuosity of coronary arteries: an indicator for impaired left ventricular relaxation?

Gamma-glutamyltransferase to Determine Cardiovascular Risk: Shifting the Paradigm Forward