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Epicardial adipose tissue (EAT) thickness is a novel cardiovascular risk indicator, whereas carotid intima media thickness (CIMT) is a known marker of subclinical atherosclerosis. The aim of this study was to measure EAT thickness and CIMT in subclinical hypothyroid (SCH) patients and to determine the effect of restoration of the euthyroid state on these variables. The study included 43 patients with SCH (mean age: 35.2 ± 10.7 years; F–M ratio: 42:1) and 30 healthy controls (mean age: 34.5 ± 8.2 years; F–M ratio: 25:5). EAT thickness and CIMT were measured via conventional echocardiography and ultrasonography. Among the patients, 23 were followed up with l-thyroxine replacement until restoration of the euthyroid state and re-evaluated 6 months after baseline. Basal EAT thickness was higher in the SCH patients than in the controls (3.2 ± 0.7 vs. 2.3 ± 0.3 mm—p < 0.0001), whereas CIMT was similar in both groups (0.50 ± 0.09 vs. 0.48 ± 0.04 mm). EAT thickness was correlated with CIMT in the patient group (r = 0.39, p = 0.01), but this correlation was not evident based on multivariate analysis when corrected for age and body mass index (r 2 = 0.47 and p = 0.0001 for the model). In the follow-up patient subgroup, both EAT thickness and CIMT decreased significantly following l-thyroxine treatment, when normal TSH levels were attained (3.4 ± 0.7 vs. 2.3 ± 0.5 mm—p = 0.007 and 0.51 ± 0.09 vs. 0.46 ± 0.07 mm—p = 0.01, respectively). EAT thickness was greater in the SCH patients than in controls, whereas CIMT was similar in both groups. Restoration of the euthyroid state with l-thyroxine treatment was associated with significant decreases in EAT thickness and CIMT in the group of patients that received l-thyroxine treatment and, as such, might reduce the cardiovascular risk associated with SCH.

Adipokines are markers of insulin resistance and play a role in the atherosclerotic process. The association of adipokines with the macrovascular complications of type 1 diabetes mellitus (DM) needs to be determined. The aim of this study was to measure serum adiponectin, leptin, and resistin levels in type 1 DM patients and investigate their relationship with carotid intima media thickness (CIMT), a clinical marker of atherosclerosis.Seventy-five type 1 DM patients and 115 sex and age-matched healthy controls were included in the study. Serum adiponectin, leptin, and resistin levels were measured by the enzyme-linked immunosorbent assay (ELISA method). CIMT was assessed by Doppler ultrasonography.Adiponectin levels in diabetics were higher (25.8±14.8 μg/mL vs. 5.5±7.3 μg/mL; P0.0001) and leptin levels were lower than controls (9.4±6.2 ng/mL vs. 12.8±8.6 ng/mL; P=0.01). Resistin levels were also higher in the diabetic group compared to controls (2.1±1.4 ng/mL vs. 1.6±0.8 ng/mL; P=0.04). Adiponectin was correlated negatively with CIMT (r=-0.24, P=0.03), age (r=-0.30, P=0.02), BMI (r=-0.33, P=0.02), waist-to-hip ratio (WHR) (r=-0.38, P=0.01) and positively with creatinine (r=0.44, P=0.004). Leptin levels were correlated with total cholesterol (r=0.53, P=0.01) and high-density lipoprotein (HDL) (r=0.67, P=0.001). Resistin was correlated with CIMT (r=0.24, P=0.03) and systolic blood pressure (r=0.48, P=0.009). Multivariate analysis revealed resistin and creatinine to be independent predictors of CIMT among adiponectin, leptin, resistin, WHR, glycosylated hemoglobin (HbA1c), and creatinine.Increased adiponectin correlates negatively and resistin positively with CIMT in type 1 diabetic patients, but adjusting for other known predictors reveals only resistin to be associated with subclinical atherosclerosis in this group of patients.

Introduction Gender divergence on the impact of multiple cardiovascular risk factors on the femoral artery intima-media thickness (IMT) has not been studied in a biracial (black-white) community-based asymptomatic young adults. Methods Femoral IMT was measured by B-mode ultrasonography in 1080 individuals (age, 24–43 years; 71% white; 43% men) enrolled in the Bogalusa Heart Study. Results Femoral IMT showed a gender difference (men > women; P = 0.001), but no racial difference. In a multivariate model, age, cigarette smoking, systolic blood pressure and total cholesterol to high-density lipoprotein cholesterol ratio related independently, in that order, to IMT in women, and age and low-density lipoprotein cholesterol in men. In women, mean IMT increased with increasing number of risk factors defined as values above the age-, race- and gender-specific 75th percentile of systolic blood pressure, waist circumference, total cholesterol to high-density lipoprotein cholesterol ratio and insulin along with positive smoking status ( P for trend = 0.001), with respective mean IMT (mm) values of 0.61, 0.65, 0.72 and 0.77, for 0, 1 to 2, 3 and 4 to 5 risk factors. There was no such significant trend in men. Conclusions Although men versus women had thicker IMT, the observed increasing trend of femoral IMT with increasing number of risk factors in asymptomatic young women suggests that women may be relatively more susceptible to the burden of multiple risk factors.

Hypertension and left ventricular (LV) hypertrophy are both more common in blacks than in whites. The aim of the present study was to test the hypothesis that blood pressure (BP) has a differential effect on the LV geometry types in black versus white asymptomatic young adults. As a part of the Bogalusa Heart Study, echocardiography and cardiovascular risk factor measurements were performed in 780 white and 343 black subjects (aged 24 to 47 years). Four LV geometry types were identified as normal, concentric remodeling, eccentric, and concentric hypertrophy. Compared to the white subjects, the black subjects had a greater prevalence of eccentric (15.7% vs 9.1%, p < 0.001) and concentric (9.3% vs 4.1%, p < 0.001) hypertrophy. On multivariate logistic regression analyses, adjusting for age, gender, body mass index, lipids, and glucose, the black subjects showed a significantly stronger association of LV concentric hypertrophy with BP (systolic BP, odds ratio [OR] 3.74, p < 0.001; diastolic BP, OR 2.86, p < 0.001) than whites (systolic BP, OR 1.50, p = 0.037; and diastolic BP, OR 1.35, p = 0.167), with p values for the race difference of 0.007 for systolic BP and 0.026 for diastolic BP. LV eccentric hypertrophy showed similar trends for the race difference in the ORs; however, the association between eccentric hypertrophy and BP was not significant in the white subjects. With respect to LV concentric remodeling, its association with BP was not significant in either blacks or whites. In conclusion, elevated BP levels have a greater detrimental effect on LV hypertrophy patterns in the black versus white young adults. These findings suggest that blacks might be more susceptible than whites to BP-related adverse cardiac remodeling.

Carotid intima-media thickness (CIMT) progression is predictive of future cardiovascular events in middle-age and older adults. However, information is scant on segment-specific CIMT progression by race (black vs white) and gender and its predictors during short-term follow-up in asymptomatic young adults. B-mode ultrasound images of the far walls of both carotid arteries were obtained in 842 subjects aged 24 to 43 years and enrolled in the Bogalusa Heart Study (70% whites and 42% men). The CIMT and cardiometabolic risk variables were measured at baseline and after an average of 2.4 years. The mean CIMT progression rates/year adjusted for age, race, and gender were greatest at the bulb, followed by the internal and common carotid segments (p

Background Right ventricular dysfunction and N-terminal proB-type natriuretic peptide (NT-proBNP) are established determinants of prognosis in acute pulmonary embolism (PE). The aim of the study was to investigate the prognostic value of C-reactive protein (CRP) in PE. Methods Fifty-six patients (mean age, 64.4 ± 14.8years; 22 male subjects) with acute PE were consecutively enrolled and followed for 36 months after discharge. Serum CRP, NT-proBNP, and troponin T levels were determined. Right ventricular function was evaluated by transthoracic echocardiography. Results Right ventricular dysfunction was present in 31 patients and was more frequent in patients with higher CRP and NT-proBNP levels ( P = 0.020 and P = 0.045, respectively). During the 36-month follow-up, there were 15 terminal events (death due to recurrent PE). The mortality rate was 41.2% in patients with NT-proBNP levels greater than 1000 pg/mL, whereas it was 5.9% in patients with less than 500 pg/mL ( P = 0.011). Mortality rates also were higher in patients with elevated CRP and troponin T levels, but the differences did not reach clinical significance. The survival rate of acute PE patients with lower NT-proBNP and CRP levels was better than that of patients with higher NT-proBNP and CRP levels. Receiver operating characteristic curve analysis demonstrated cutoff values for NT-proBNP as 1800 pg/mL (sensitivity, 93.3%; specificity, 68.2%; positive predictive values, 66.7%; and negative predictive values, 93.8%) and for CRP as 48mg/L (sensitivity, 72.7%; specificity, 61.9%; positive predictive values, 50.0%; and negative predictive values, 81.3%) to predict mortality in PE patients. Conclusions C-reactive protein is associated with right ventricular dysfunction, which is a predictor of prognosis in PE and may become a promising biomarker for risk stratification of PE, although CRP is not found superior to NT-proBNP.

ABS TRACT Objective: Left ventricular hypertrophy (LVH) is highly predictive of cardiovascular (CV) events in dialysis patients. The impact of different left ventricular (LV) geometric patterns on cardiovascular outcome has not been well established. The aim of this prospective observational study was to define the patterns of LVH and find out their impact on future cardiovascular events in patients on continuous ambulatory peritoneal dialysis (CAPD). Ma te ri al and Met hods: Patients we re followed up between 1999 and 2006 for cardiovascular events. Left ventricular mass and geometric patterns were determined by echocardiography. Kaplan-Meier method and Cox re gression analysis were used to evaluate the impact of LV geometric patterns on CV event free sur vival. Results: Sixty-five CAPD patients were enrolled in the study and were followed for 76 ± 15 months. There were a total of 16 (14 fatal, two non-fatal) CV events. Mean event-free survival time for patients without LVH was 79 ± 3 months (95% CI of 73 to 86 months). The mean CV event-free survival for the patients with concentric LV hypertrophy and eccentric hypertrophy was 75 ± 3 months (95% CI of 69 to 81 months), and 76 ± 3 months (95% CI of 69 to 82 months) respectively. Patients with eccentric [hazard ratio (HR): 20.2] and concentric (HR:18.7) LV hypertrophy had shorter time to CV event when compared to the patients without LV hypertrophy (p= 0.042). Conclusion: Left ventricular hypertrophy is a marker of poor cardiovascular prognosis irrespective of its pattern. Both eccentric and concentric LV hypertrophy are associated with shorter CV eventfree survival compared to normal geometry and concentric remodeling.

Femoral artery intima-media thickness (IMT), like carotid IMT, is a surrogate indicator of atherosclerotic coronary and peripheral vascular diseases. The Framingham risk score (FRS) is widely being used in the early prediction of coronary artery disease (CAD). However, the association between FRS and femoral artery IMT has not been studied in asymptomatic younger black and white adult population. Our objective was to examine the association between FRS and femoral artery IMT in asymptomatic younger adults.Subjects (n=1080; 71% white, 43% male) aged 24-43 years enrolled in the Bogalusa heart study. Femoral IMT was measured by B-mode ultrasonography. Age, gender, systolic blood pressure, diastolic blood pressure, low density lipoprotein cholesterol, high density lipoprotein cholesterol, cigarette smoking and type2 diabetes were used to calculate individual FRS.FRS was lower in females (p=0.001) than males. Age-adjusted femoral IMT showed gender differences (malesfemales, p=0.001) among whites only; and no race difference in both genders. A significant positive linear relationship between tertiles of FRS and IMT of femoral artery was noted in whites and blacks alike (p for trend0.0001). In a multivariate analysis that included FRS, race, body mass index (BMI), log insulin, log triglycerides, exercise and alcohol intake; FRS, insulin and BMI were significantly and independently associated in that order with femoral IMT.The findings support the use of FRS in both white and black younger adults and underscore the importance of prevention and control of FRS variables in youth.

Background/Aims: Atrial fibrillation (AF) is common among hemodialysis (HD) patients and is associated with high mortality. P wave dispersion (PWD) is a noninvasive electrocardiographic marker of paroxysmal AF. Our aim was to evaluate the effect of HD session on PWD. Methods: Twenty-five patients (mean age 63 years, 10 males) with sinus rhythm and undergoing chronic HD treatment were included. Blood samples were drawn and 12-lead electrocardiograms were recorded immediately before HD session, at the 2nd hour during HD and at the end of the HD session. The difference between maximum and minimum P wave durations was calculated as PWD. Results: PWD significantly increased during HD sessions compared with predialysis values (41 ± 12 vs. 21 ± 10 ms, respectively, p < 0.001), then decreased to a value of 24 ± 7 ms at the completion of HD, which was not significantly different from the predialysis values. PWD during HD was significantly correlated with predialysis systolic and diastolic blood pressure (r = 0.42, p = 0.037, and r = 0.59, p = 0.002, respectively) and predialysis serum potassium level (r = 0.44, p = 0.031). Linear regression model revealed that predialysis diastolic blood pressure (p = 0.002), predialysis serum potassium level (p = 0.037) and the amount of ultrafiltration (p = 0.048) were the significant predictors of prolonged PWD during HD. Conclusion: PWD increases significantly during HD sessions. This may increase the risk of AF episodes during HD. High diastolic blood pressure and serum potassium level before HD and ultrafiltration amount may predict prolonged PWD during HD.

The aim of this study was to determine the association between homocysteine and arterial wall stiffness in a biracial (black and white) community-based cohort of asymptomatic young adults. That increased plasma homocysteine was adversely associated with atherothrombosis was well recognized. However, findings about the association of homocysteine and arterial wall stiffness, an indicator of vascular damage, were conflicting. Plasma homocysteine and other cardiovascular disease risk-factor variables were measured in 735 white and 294 black subjects aged 24 to 44 years enrolled in the Bogalusa Heart Study. Large-artery stiffness was assessed in terms of aorta-femoral pulse wave velocity (af-PWV) using echocardiography Doppler. Men versus women had higher fasting homocysteine (8.85 vs 7.32 micromol/L; p0.01), and blacks versus whites had higher af-PWV (5.47 vs 5.24 m/s; p0.01). In bivariate analyses, log-transformed homocysteine significantly correlated with af-PWV (p = 0.0004). In multivariate stepwise regression analyses, systolic blood pressure, age, heart rate, log-homocysteine, log-Homeostasis Model Assessment of Insulin Resistance, and smoking, in that order, were independently and positively associated with af-PWV. In conclusion, plasma homocysteine was an independent correlate of arterial stiffness in asymptomatic black and white young adults and may be a potential marker for cardiovascular disease risk in this age group.

Differences in geometric adaptation of the left ventricle and associated cardiovascular risk may reflect the differential effects of classic risk factors and arterial stiffness on the left ventricle. In the present study, the influence of cardiovascular risk factors and arterial stiffness indexes on left ventricular (LV) geometry types were studied in a large community-based cohort of young adults. As part of the Bogalusa Heart Study, echocardiographic examinations of the heart were performed on 786 black and white adults (age range 24 to 43 years, average 36; 42% men, 70% white). Arterial stiffness indexes of the study cohort included aorta-femoral pulse wave velocity, carotid artery elastic modulus, and arterial compliance using tonometry. Pulse pressure in young adults with concentric LV hypertrophy (47 +/- 11 mm Hg) was significantly higher than in those with eccentric LV hypertrophy (40 +/- 8 mm Hg) and normal geometry (37 +/- 7 mm Hg). Multinomial logistic regression analysis showed that widened pulse pressure, the presence of diabetes mellitus, and increased body mass index were associated with concentric LV hypertrophy compared with normal geometry. Similarly, higher Peterson's and Young's elastic modulus of the carotid arteries and lower large- and small-artery compliance, in addition to increased body mass index, diabetes mellitus, and black race, were associated with concentric LV hypertrophy in young adults. In conclusion these data suggested that concentric LV hypertrophy was associated with widened pulse pressure, increased arterial stiffness, and decreased arterial compliance in young adults.

Background and Purpose— Vascular remodeling as depicted by increases in arterial lumen diameter occurs in response to development of atherosclerosis. However, data on the correlates of arterial lumen diameter in younger adults by race and sex are limited. Methods— The study cohort included 734 white and 306 black subjects, aged 20 to 43 years, enrolled in the Bogalusa Heart Study. The common carotid artery lumen diameter at diastole and intima media thickness (IMT) were measured by M- and B-mode ultrasonography, respectively. Results— As a group, blacks versus whites (3.44 mm/m versus 3.37 mm/m, P =0.002) and males versus females (3.45 mm/m versus 3.35 mm/m, P P =0.011 for mean arterial pressure; P =0.033 for IMT); interaction effects of body mass index and mean arterial pressure with sex on height-adjusted lumen diameter were also noted with males showing steeper slopes (difference in slopes: P =0.003 for body mass index; P =0.005 for mean arterial pressure). In addition, the lumen diameter–carotid IMT relationship was stronger in hypertensives than in normotensives (difference in slopes: P =0.038). Conclusions— Common carotid artery lumen diameter is influenced by carotid artery IMT, adiposity, and blood pressure in a race- and sex-specific manner in asymptomatic younger adults, which may have implications for preventive cardiology.

Direct coronary stenting without balloon predilatation may cause lower postprocedural minor myocardial injury in comparison to conventional stenting with balloon predilatation.Plasma brain natriuretic peptide (BNP) is increased in acute myocardial ischaemia. 40 patients with single vessel and single lesion coronary artey disease who underwent elective stent implantation were divided into Group I (n=20) treated with direct coronary stenting (DS) and Group II (n=20) with conventional stenting (CS). Blood samples for Troponin I and CK-MB measurement were obtained at baseline, just after the intervention procedure, 6 hours after and 12 hours after stenting and for BNP levels at baseline, 6 hours and 12 hours after stenting. In Group II there was a significant increase in Troponin I level 12 hours after the procedure (baseline 0.033 ± 0.028 ng/ml vs. 0.084 ± 0.085 ng/ml; p < 0.05).Plasma BNP level in Group I decreased significantly both in base line vs. 6 hours after procedure and baseline vs. 12 hours after procedure (105.2 ± 73.7 pg/ml vs. 81.3± 67.1 pg/ml; p < 0.05 and 105.2 ± 73.7 pg/ml vs. 89.9 ± 62.3pg/ml ; p < 0.05 respectively). With direct stenting BNP levels decreased significantly with no change in Troponin I level, while with conventional stenting Troponin I levels increased significantly. Key words: Brain natriuretic peptide, Direct stenting, Conventional stenting.  doi:10.3329/uhj.v4i2.2066 University Heart Journal Vol. 4 No. 2 July 2008 p9-15 Â

Patients with diabetes have an increased cardiovascular morbidity and mortality despite interventions to prevent these outcomes. Abnormalities in diurnal blood pressure patterns are also associated with excess cardiovascular mortality. The aim of this study was to determine the effects of diurnal blood pressure patterns on endothelial function and oxidative stress in patients with uncomplicated type 1 diabetes mellitus. Thirty-two normotensive and normoalbuminuric type 1 diabetic patients (21 dipper and 11 nondipper) and 37 healthy (27 dipper and 10 nondipper) volunteers underwent 24-h ambulatory blood pressure monitoring. Their endothelial functions were evaluated using flow mediated dilatation (FMD) and by measuring nitric oxide and thiobarbituric acid reactive substances (TBARS). Dippers were defined as subjects who exhibited an average reduction in both systolic and diastolic blood pressure of greater than 10% between day and night periods. Nondipper type 1 diabetic patients and controls had nighttime systolic and diastolic blood pressure values that were significantly higher than those of dipper diabetic patients (p

Left ventricular (LV) structural alterations were associated with increased cardiovascular morbidity and mortality in a middle-aged and older population. The aim of this study was to determine childhood and adulthood cardiovascular risk predictors of LV geometric remodeling in a biracial (black-white) population of young adults. As part of the Bogalusa Heart Study, echocardiographic examinations of the heart were performed in 824 adults (age range 24 to 44 years, average 36; 41% men, 69% white) who had risk-factor variables in their childhood. Eccentric LV hypertrophy and concentric remodeling were the most commonly encountered LV geometric changes in this young adult population (4.7% vs 1.8% for concentric LV hypertrophy). In adulthood, subjects with eccentric and/or concentric LV hypertrophy compared with normal geometry were more likely to be obese and/or diabetic and had significantly increased body mass index, waist circumference, systolic and diastolic blood pressures, glucose, insulin, hemoglobin A1c, total/high-density lipoprotein cholesterol ratio, triglycerides, and urinary albumin-creatinine ratios. In multinomial logistic regression analyses, both adulthood and childhood body mass index were significant determinants of eccentric LV hypertrophy (odds ratios [ORs] 1.15 and 1.19). The presence of diabetes mellitus in adulthood (OR 8.25) and diastolic blood pressure in childhood (OR 1.14) were significant predictors of concentric LV hypertrophy. In adults, blacks had higher ORs for concentric LV hypertrophy and related to diabetes and systolic blood pressure. In conclusion, in this community-based study of young adults, eccentric LV hypertrophy was more frequent and obesity since childhood was the only consistent and significant determinant of this type of adverse cardiac remodeling.

Background. Changes in left ventricular (LV) geometry are frequent in patients with continuous ambulatory peritoneal dialysis (CAPD). Geometric adaptation of LV to various stimuli was reported to have adverse prognosis. This study aimed to identify independent risk factors, which contribute to the development of LV geometric remodelling in CAPD patients. Methods. The left ventricles of 69 CAPD patients were classified echocardiographically into four different geometric patterns on the basis of LV mass and relative wall thickness. With respect to volume factor, we measured inferior vena cava (IVC) diameter and its decrease on deep inspiration [collapsibility index (CI)] by echocardiography. We modelled a stepwise multiple regression analysis to determine the predictors of LV geometry. Results. All four geometric models of LV were identified in our group of 69 CAPD patients. Eccentric left ventricular hypertrophy (eLVH) was observed in 32 (46%), concentric LVH (cLVH) in 19 (28%), normal geometry (NG) in 10 (14%) and concentric remodelling (CR) in eight (12%) CAPD patients. Mean IVC index of the eLVH group (10.72 +/- 2.19 mm/m(2)) was significantly higher than corresponding indexes of NG (7.90 +/- 1.54 mm/m(2)), CR (8.51 +/- 1.28 mm/m(2)) and cLVH (8.04 +/- 2.00mm/m(2)) groups (P < 0.001 for each comparisons). The eLVH group also had significantly lower mean CI value (0.48 +/- 0.11) than CR (0.58 +/- 0.09) and cLVH (0.57 +/- 0.07) groups (ANOVA P=0.008). Stepwise multiple regression analysis revealed that IVC index, CI and haemoglobin were the independent predictors of LV geometric stratification (R-2 =0.36, P < 0.001). Conclusion. Hypervolaemia, identified by IVC index and CI, and anaemia contribute independently to LV geometry in CAPD patients. Echocardiography as a non-invasive tool is not only useful to determine LV geometry, but also to assess the volume status of CAPD patients.

The absence of nocturnal fall in blood pressure (BP) is named as nondipper status, which has been shown to be an additional risk factor for the development of left ventricular hypertrophy and cardiovascular events in several high-risk groups. The aim of this study was to determine the influences of the nondipper status and nocturnal blood pressure loads on left ventricular mass index (LVMI) in renal transplant recipients. A total of 35 nondiabetic renal transplant recipients were included into the study. A 24-h ambulatory blood pressure monitoring (ABPM) was performed for all recipients. The nondipper status was defined as either an increase in night-time mean arterial pressure (MAP) or a decrease of no more than 10% of daytime MAP. LVMI was measured by using two-dimensional guided M-mode echocardiography. The night-time systolic blood pressure (SBP) load was defined as the percentage of the time, during which SBP exceeded 125 mmHg during night time. The nondipping was common among renal transplant recipients, of whom 60% were nondipper in our study. LVMI was significantly higher in the nondipper group vs the dipper group (133 +/- 35 g/m(2) vs 109 +/- 26 g/m(2), P = 0.04). A fall in MAP at night time was 14.5 +/- 4.3% in the dipper group, while it was 1.4 +/- 6.1% in the nondipper group (P < 0.001). On stepwise multiple regression analysis, night-time SBP load and haemoglobin were independent predictors of LVMI (R(2) = 0.53). In conclusion, nondipping is common after renal transplantation. Night-time SBP load and low haemoglobin are closely related to the increase in LVMI in renal transplant recipients. ABPM may be a more useful tool in optimizing treatment strategies to reduce cardio-vascular events in renal transplant recipients.

Hodgkin\"s disease very rarely presents clinically, initially with a paraspinal mass, but this should be considered in the differential diagnosis. A patient presenting with back pain was diagnosed to have Stage IV Hodgkin\"s disease. MRI revealed an extradural and intraspinal soft tissue mass with bone infiltration. The importance of MRI in the early evaluation of a paraspinal mass and in determining the extent of the disease is emphasized.

Background: The evaluation of right ventricular (RV) dysfunction by echocardiography is one of the most important established determinants of the prognosis of acute pulmonary embolism. The aim of the study was to investigate possible association between diameter of right descending pulmonary artery on chest X-rays and RV dysfunction by echocardiography in hemodynamically stable pulmonary embolism patients. Methods: Eighty-nine patients with the diagnosis of hemodynamically stable pulmonary embolism were included. Results: The frequency of RV dysfunction was signifi cantly higher in patients with an enlarged right descending pulmonary artery on chest X-rays (p = 0.001). There was a signifi cant positive correlation between the diameter of the right descending pulmonary artery on postero-anterior chest X-rays and the diameter of the RV (r = 0.469; p = 0.002). Diameter of right descending pulmonary artery on chest X-rays was also found as a signifi cant predictor of RV dysfunction besides the troponin-T levels and systolic pulmonary arterial pressure (p < 0.05). Conclusions: Diameter of right descending pulmonary artery on chest X-rays may provide information about the risk for pulmonary embolism patients and may be used as a prognostic radiological parameter for the appropriate management of acute pulmonary embolism. (Cardiol J 2013; 20, 2: 184–189)

Background Conflicting information exists regarding the association between hsCRP and the progression of early stages of atherosclerosis. The purpose of the study was to investigate the association of high sensitiviy c-reactive protein (hsCRP) along with major cardiovascular (CV) risk factors on early carotid atherosclerosis progression in a large, population-based cohort study. Methods The study cohort included 839 young adults (aged 24 to 43 years, 70% white, 42% men) enrolled in Bogalusa Heart Study, who in 2001-2002 attended baseline examination with measurements of CV risk factors. Progression of carotid artery intima-media thickness (IMT) was assessed during a mean follow-up of 2.4 years. Results Carotid artery IMT progression rates were as follows: composite carotid artery = 9.2 ± 52 μm/y, common carotid artery = 0.0 ± 51 μm/y, carotid bulb = 8.8 ± 103 μm/y, and internal carotid artery = 18.9 ± 81 μm/y. Elevated baseline hsCRP, reflecting an inflammatory state, showed independent association with composite carotid artery IMT progression. Increased age, systolic blood pressure, fasting glucose, LDL cholesterol, and current smoking were other risk associates of carotid artery IMT progression in young adults, indicating an underlying burden on the CV system by multiple risk factors. Conclusion In this population-based study, we observed independent categorical association of increased hsCRP with carotid artery IMT progression in young adults. This study underlines the importance of assesssing hsCRP levels along with smoking and traditional CV risk factor profiles in asymptomatic young adults.

Background. Inflammation is one of the main contributors to atherosclerosis in haemodialysis (HD) patients. Activation of Toll-like receptors (TLRs) leads to inflammatory response. In this study, we aimed to evaluate the expression of TLRs on monocytes and relate their expression with inflammation in chronic kidney disease (CKD) and HD patients. Methods. Thirty-four age- and gender-matched controls and stage 3-4 CKD patients and thirty-two HD patients were included in each study group. The effect of HD on the expression of Toll-like receptor-2 (TLR-2) and Toll-like receptor-4 (TLR-4) on CD14(+) monocytes was determined at the beginning (baseline), during (120 min) and following (300 min and 24 h) HD and compared with control and stage 3-4 CKD groups. The HD procedure was performed by using low-flux polysulphone dialysers. In addition, serum IL-6 levels were evaluated in both groups at baseline and after a HD session. Results. The percentage of CD14(+) monocytes expressing TLR-2 were similar in all of the study groups, whereas the percentage of CD14(+) monocytes expressing TLR-4 were significantly lower in both stage 3-4 CKD and HD patients at baseline than in controls. The mean fluorescence intensities (MFI) of TLR-2 were significantly lower in controls than in stage 3-4 CKD and HD patients at baseline. The MFI of TLR-4 was similar in all of the groups. The percentage of CD14(+) monocytes expressing TLR-2 did not change during and after HD. The MFI of TLR-2 decreased at 120 min of HD compared with baseline (1837 +/- 672 vs 1650 +/- 578, P < 0.05), and recovered back to baseline values at 300 min and at 24 h post-HD. MFI of TLR-4 increased at 24 h compared with baseline (941 +/- 294 vs 1087 +/- 441, P < 0.05). Serum IL-6 levels correlated with MFI of TLR-2 and TLR-4 in stage 3-4 CKD patients and in HD patients at baseline and after HD in univariate analysis. Stepwise multiple regression analysis revealed that MFI of TLR-2 was an independent determinant of serum IL-6 concentrations in stage 3-4 CKD and in HD patients at baseline, at 300 min and at 24 h post-HD. Conclusions. Our study demonstrates that TLR-2 is associated with the inflammatory response of non-dialysed and dialysed CKD patients.

Diabetic cardiomyopathy is an important complication of type 1 diabetes mellitus. Diastolic heart failure is an early manifestation of diabetic cardiac disease. Nt-proBNP is a valuable marker of ventricular dysfunction. The aim of this study was to determine Nt-proBNP concentrations in type 1 diabetic patients and determine their relationship with ventricular diastolic dysfunction (DD) and carotid artery intima media thickness (CIMT) measurements. Sixty-seven type 1 diabetic patients (30.2 ± 8.0 years; W/M: 24/43) without known cardiovascular disease and 48 healthy controls (30.5 ± 6.4 years; W/M: 19/29) were recruited. Nt-proBNP levels were measured. Conventional and tissue Doppler echocardiography were used to evaluate left ventricular diastolic function and CIMT. Nt-proBNP in diabetic patients was significantly higher than in controls (38 ± 34.8 vs. 15.1 ± 12.7 pg/ml) (P = 0.004). Ea level was higher (12.3 ± 3 vs. 10.3 ± 4 cm/s, P = 0.003) and E/Ea ratio was lower in patients (6.6 ± 2.5 vs. 9.7 ± 5.9, P = 0.001) compared with controls. Ratio of DD was higher in patients than controls (11.1 vs. 2.1%, P = 0.01). CIMT measurements in diabetic patients were higher than controls (0.54 ± 0.11 vs. 0.48 ± 0.05 mm, P = 0.02). Logistic regression revealed age and HbA1c to be independently associated with the presence of DD. Nt-proBNP levels are elevated in type 1 diabetic patients without overt cardiovascular disease and the presence of DD is increased in diabetic patients in comparison with controls. Nt-proBNP levels do not seem to be related to the presence of DD and subclinical atherosclerosis in this group of patients.

Elevated serum phosphorus has been associated with increased mortality from cardiovascular (CV) disease. However, information is scant regarding the influence of serum phosphorus within the normal range on vascular risk in terms of subclinical atherosclerosis in asymptomatic young adults. Serum phosphorus along with other CV risk factor variables were measured in 856 white and 354 black subjects without known CV disease or renal disease. Carotid intima-media thickness (IMT) was measured by B-mode ultrasonography. Significant race and sex differences were noted for serum phosphorus (blacks>whites) and carotid IMT (black females>white females; males>females). In bivariate analyses, serum phosphorus was correlated with carotid IMT (p

Epicardial adipose tissue has shown to be related to cardiovascular risk. The aim of this study is to investigate the relationship between epicardial adiposity and endothelial function in metabolic syndrome.Fifty patients with metabolic syndrome were recruited. Anthropometric measurements, fasting blood glucose, insulin, lipid profile, high-sensitivity C-reactive protein (hsCRP), fibrinogen, apolipoprotein A (Apo A), Apo B1, and lipoprotein (a) [Lp(a)] were determined. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Epicardial fat thickness was measured via two-dimensional M-mode echocardiography. Endothelial function was assessed as flow-mediated dilatation at the brachial artery.Epicardial fat tissue thickness was shown to be correlated negatively with FMD and positively with age, diastolic blood pressure, hsCRP, fibrinogen, HOMA-IR, and lipid parameters. Multiple regression analysis showed epicardial fat tissue thickness to be an independent factor influencing the endothelial function.Epicardial fat tissue may be a useful parameter in the assessment of patients with metabolic syndrome.

Introduction. Angiotensin-converting enzyme inhibitors prevent atrial fibrillation episodes by effective control of blood pressure and improving electrical and structural remodelling in the atria. Increased P wave dispersion (PWD) is a non-invasive electrocardiographic marker for paroxysmal atrial fibrillation. The aim of the study was to evaluate the effect of perindopril treatment on PWD in hypertensive patients. Methods. Forty-eight hypertensive patients (mean age 57.4±11.8 years, 18 men) were included. Blood pressure values were determined and 12-lead electrocardiograms were recorded at the beginning and at the first week, first month, third month and sixth month of the perindopril treatment.The difference between maximum and minimum P wave durations was calculated as PWD. Results. PWDs were significantly shortened at the first, third and sixth months (41.7±8.8 ms, 39.1±6.9 ms and 38.3±7.1 ms, respectively) compared with baseline and first-week measurements (54.3±9.2 ms and 49.0±9.1 ms, respectively, p Conclusion. Perindopril treatment significantly reduced PWD in hypertensive patients.

Objective The aim of this study was to examine the association of prehypertension with measures of cardiovascular disease risk in a biracial (black-white) population of young adults. Methods As part of the Bogalusa Heart Study, echocardiography and carotid ultrasonography were performed along with cardiovascular risk factor measurements in 1379 young adult participants (age range 20-44 years, average 36 years; 43% men, 70% white). Participants were categorized as normotensives (60%), prehypertensives (27%) and hypertensives (13%). Results The prevalence of prehypertension was significantly higher among men than women (35 vs. 22%) and among blacks than whites (29 vs. 27%). Compared with normotensives, prehypertensives had a greater adverse cardiovascular risk factor profile. Male sex and BMI equally and significantly contributed to the prehypertension status in both whites [odds ratio (OR) and 95% confidence interval 2.66 (1.88-3.74) and 1.10 (1.07-1.14)] and blacks [OR: 2.56 (1.51-4.33) and 1.05 (1.01-1.09)]. Additionally, prehypertensives compared with normotensives had significantly higher left ventricular (LV) mass index, LV internal diameter, and carotid artery intima-media thickness. Conclusion The condition of prehypertension in young adults shows men>women and black women >white women, and participants with prehypertension already have adverse profiles of risk factors and indices of subclinical cardiovascular disease. A greater percentage of blacks at a relatively young age fall into the hypertensive category. These findings underscore the need for aggressive management of cardiovascular risk in youth at levels below those considered as hypertension.

That plasma homocysteine is elevated markedly in renal dysfunction is well recognized. But whether the increased homocysteine is an independent correlate of glomerular filtration rate, a marker of renal function, in asymptomatic younger individuals is not clear. The aim of this study was to determine the association between plasma homocysteine and renal function in a biracial (black-white) community-based cohort of asymptomatic young adults. Plasma homocysteine along with cardiovascular disease risk factor variables were measured in 805 white and 330 black subjects, ages 24-44 years, enrolled in the Bogalusa Heart Study. Modification of Diet in Renal Disease Study equation was used to calculate the estimated glomerular filtration rate (eGFR) from serum creatinine level. Males versus females showed higher homocysteine levels (8.83 +/- 3.16 vs. 7.35 +/- 2.84 micromol/L, p0.0001) and lower eGFR (99.1 +/- 17.6 vs. 102.5 +/- 21.0 mL/min/1.73 m(2), p = 0.024). Whites versus blacks had lower eGFR (97.3 +/- 18.0 vs. 110.0 +/- 20.6 mL/min/1.73 m(2), p0.0001). In a multivariate regression analysis that included age, race, sex, body mass index, blood pressure, lipoprotein variables, insulin resistance index and homocysteine, white race, age and homocysteine, in that order, were independently and negatively associated with eGFR. The odds ratio (95% confidence interval) of individuals in the homocysteine quintiles II, III, IV and V vs. I for having the risk of impaired eGFR defined as10th percentile was 2.28 (0.95-5.50, p = 0.065), 2.97 (1.24-7.12, p = 0.015), 3.32 (1.45-7.60, p = 0.005) and 6.99 (3.06-15.94, p0.0001), respectively. Homocysteine is an independent correlate of renal function in asymptomatic black and white young adults.

Exogenous subclinical hyperthyroidism is associated with cardiovascular and metabolic changes. The aim of this study was to evaluate the effect of levothyroxine (LT4) suppression on endothelial function and insulin sensitivity in euthyroid nodular goiter patients.Twenty-two euthyroid patients with multinodular goiter (MNG) and 22 matched healthy controls were studied. LT4 was administered in doses ranging from 50 to 150 microg/day to reach target serum thyroid-stimulating hormone (TSH) levels0.5 mIU/L. Patients were studied before and after 8 weeks after the target TSH level0.5 mIU/L. The control group was studied twice, 16 weeks apart. Flow mediated vasodilatation (FMD), insulin sensitivity index (ISI), lipid peroxidation, and high-sensitivity C-reactive protein (hsCRP) were the outcome measures.LT4 treatment significantly suppressed TSH levels to 0.2 +/- 0.1 mIU/L (minimum and maximum range was 0.05-0.3 mIU/L). FMD decreased from 10.7 +/- 2.7% to 5.4 +/- 1.7% (p0.001) and mean ISI decreased from 2.56 +/- 1.10 to 1.41 +/- 0.50 (p0.001) with LT4 treatment in the MNG group. Lipid peroxidation measured as thiobarbituric acid reactive substances (Tbars) (p0.05), and hsCRP (p0.001) levels significantly increased compared to the baseline in the MNG group. FMD measurement inversely correlated with free T4 (p = 0.008) and Tbars (p = 0.004), and positively correlated with ISI (p = 0.004). Serum Tbars and hsCRP were independent predictors of FMD (p = 0.004) in multivariate analysis. All results expressed as mean +/- SD.TSH suppression therapy with LT4 leading to subclinical hyperthyroidism may cause impaired endothelial function, increased oxidative stress, and decreased insulin sensitivity in euthyroid nodular goiter patients.

Background: Compared to atrioventricular sequential pacing, ventricular demand pacing is known to have somewhat more deleterious hemodynamic effects, which probably arise from increased sympathetic tonus and inappropriate baroreceptor activation. Endothelial function is affected by various local and systemic factors including baroreceptor activity. The aim of this study was to explore whether cardiac pacing would have any effect on endothelial functions. Methods: Twelve patients (six male, mean age: 75 ± 9 years) with previously implanted DDD or VDDcardiac pacemakers were included. All patients had stable atrial rhythms during the study. Patients were randomized to either atrial-based pacing mode (VDD or DDD) or ventricular demand pacing mode (VVI) first, and then cross-over was performed with the other pacing mode. Endothelial function was assessed by brachial artery ultrasonography. Basal diameter of the brachial artery, and both flow-mediated dilation (FMD) and endothelium-independent vasodilation with nitroglycerin were measured 1 hour after each pacing mode. Results: Compared to atrial-based pacing mode, ventricular demand pacing was associated with a significantly worse FMD both as absolute and percentage values (0.17 ± 0.09 mm vs 0.28 ± 0.11 mm, P = 0.015 and 4.84 ± 2.37 % vs 7.00 ± 2.88 %, P = 0.028, respectively). However, there was no significant difference in nitroglycerin-mediated vasodilation values between the two pacing sessions. Conclusions: Acute ventricular demand pacing (VVI pacing) is clearly associated with attenuation of FMD in patients with atrial-based pacing systems. The attenuation of endothelial vasodilation might have a role in hemodynamic and clinical deterioration in patients with VVI pacemakers.

Rheumatoid arthritis (RA) is associated with increased cardiovascular mortality. However, cardiovascular findings are mostly subtle, and diastolic function abnormalities are one of the earliest manifestations. The aim of this study was to determine diastolic function abnormalities in RA patients and to make a reevaluation of diastolic function after 5 years of follow-up. Seventy-two RA patients (mean age: 48+/-11 years, F/M: 62/10) without any known cardiac disease and 67 controls (mean age: 46+/-11 years; F/M: 53/14) were recruited. Disease activity score (DAS), lipid values, and C-reactive protein (CRP) levels were determined. Left ventricular mass, isovolumetric relaxation time, mitral annular early (E), and late (A) diastolic filling rate were determined by M-mode two-dimensional color Doppler echocardiography. Mitral annular early (E') and late (A') diastolic velocities were also evaluated by tissue Doppler echocardiography. Twenty-four RA patients were reevaluated after 5 years of follow-up with DAS, biochemical variables, and echocardiography. Fifty five of 72 (76%) RA patients and 12 of the 67 (18%) controls had diastolic dysfunction (DD). Seven of ten patients with DD at baseline continued to have DD, whereas three did not show DD at 5 years. Six of 14 patients without DD at baseline developed DD at follow-up, while eight patients sustained normal diastolic function. Although DAS and lipid values were not altered during the course of 5 years, CRP levels decreased significantly (P0.05). In conclusion, RA patients have diastolic function abnormalities compared to healthy controls. Five-year follow-up of a subgroup of our patients showed that, although clinical response was unsatisfactory, cardiac function was conserved without a major deterioration. Moreover, DMARDs, such as anti-TNFalpha agents, do not seem to have a major adverse effect on cardiac findings in these patients.

To evaluate the effects of postmenopausal hormone therapy (HT) with or without the addition of folic acid (FA) on serum homocysteine levels in a randomized, placebo-controlled design. Additionally, a non-randomized control group with no treatment was included.Forty non-hysterectomized healthy postmenopausal women were randomly allocated to receive either oral continuous combined HT (0.625 mg conjugated equine estrogen with 2.5 mg medroxyprogesterone acetate daily) and oral folic acid (5 mg/day, n = 20) or HT and placebo (n = 20) for 3 months. A control group (n = 15) did not receive any study medication and was followed in the same manner. The fasting total serum homocysteine level was measured by fluorescence polarization immunoassay with a sensitivity of0.5 micromol/l. Serum levels of folate, estrogen and lipid profile were also followed.The mean age of the postmenopausal women was 52 +/- 6 years. Baseline homocysteine level was the highest in the HT + FA group (9.96 +/- 2.82 micromol/l), compared to HT + placebo (9.64 +/- 1.89 micromol/l) and control groups (9.01 +/- 1.83 micromol/l) (ANCOVA, p = 0.022). Low baseline folate and vitamin B12 levels contributed significantly to the high level of baseline homocysteine in the HT + FA group. The addition of FA to HT led to a significant decrease in the serum homocysteine level from the baseline level of 9.96 +/- 2.82 micromol/l to the final level of 8.92 +/- 2.53 micromol/l (p = 0.023). On the other hand, HT alone (HT + placebo group) significantly increased the serum homocysteine level from 9.64 +/- 1.89 micromol/l to 10.22 +/- 1.77 micromol/l without a decline in serum folate level (p = 0.045). The serum homocysteine level in the control group did not change significantly (from 9.01 +/- 1.83 micromol/l to 9.58 +/- 2.05 micromol/l, p = 0.29).Three months of oral continuous combined HT increased the fasting total serum homocysteine level without affecting the serum folate level. Lowering the homocysteine level in postmenopausal woman on HT is achievable by folic acid supplementation.

Introduction Evidence suggests an association between insulin resistance, hypertension and impaired endothelial function. Studies have shown that insulin resistance precedes the development of hypertension. By improving insulin sensitivity, it may be possible to improve hypertension and the subsequent damage to vessel walls. Some data indicates beneficial effects of angiotensin-converting enzyme (ACE) inhibitors on insulin sensitivity and endothelial function. We aimed to investigate these effects of ACE inhibition in the same group of patients with essential hypertension. Materials and methods Nine non-smoking, untreated hypertensive patients (38.3 9 years, 4/5 male/female) and 12 age-matched healthy subjects (35.2 6.7 years, 5/7 male/female) were included in the study. Hypertensive patients were given enalapril maleate (5—40 mg/day) for six months. The following parameters were studied at baseline and at the end of treatment period. Whole body insulin sensitivity was measured by a formula derived from an oral glucose tolerance test and named I as the insulin sensitivity index (ISI). Insulin was measured by chemiluminescence and glucose by a glucose oxidase method. Endothelial function was evaluated as flow-mediated dilatation (FMD) of the brachial artery by ultrasonography and expressed as a percentage change relative to baseline diameter. Endothelialindependent vasodilatation was measured after sublingual nitroglycerine. Results FMD was impaired in the hypertensive group compared with healthy subjects (7.3 3.1% vs. 15.3 4.8%, p Conclusions Patients with essential hypertension have impaired endothelial function and decreased whole body insulin sensitivity compared with healthy subjects. Treatment for six months with enalapril maleate seems to improve both FMD and ISI. This study confirms the beneficial effects of ACE inhibition on both endothelial function and insulin sensitivity tested in the same group of essential hypertensive patients. The mechanism of these favourable effects of ACE inhibition needs to be clarified.

Background. Hypertension (HT) is common in patients on continuous ambulatory peritoneal dialysis (CAPD) and is responsible for increased cardiovascular morbidity and mortality. In this study, we aimed to determine the prevalence of 'uncontrolled HT' during background therapy in CAPD patients by using office measurements and ambulatory blood pressure monitoring (ABPM). We further determined whether intravascular volume status, assessed by inferior vena cava diameter (IVCD) index, contributes to higher blood pressure (BP) and increased left ventricular mass index (LVMI). Methods. Seventy-four CAPD patients were included in the final analysis. All patients underwent echo-cardiographic examination and received ABPM. Patients undergoing CAPD were categorized into two groups: 'uncontrolled HT' (Group A) and 'normotensive and controlled HT' (Group 13). Intravascular volume status was determined using the IVCD index and collapsibility index (CI) on the same day as ABPM. Results. The prevalence of HT was 84% when using office measurements and 82% when using daytime ABPM. Daytime BP was 147/92 mm Hg by office measurements and 145/91 mm Hg by ABPM (P>0.05). The prevalence of 'uncontrolled HT' measured by ABPM was 73% (n = 54). Patients with uncontrolled HT (Group A) were taking more antihypertensive medications than patients with 'normotension and controlled HT' (Group B, n = 20; 1.0+/-0.8 vs 0.5+/-0.7, P=0.008). The IVCD index was higher in Group A 2 than in Group B (9.2+/-2.1 vs 7.7+/-1.9 mm/m(2), P=0.007). There was no correlation between IVCD index and office BP, ABPM measurements or LVMI. The LVMI was also higher in Group A than in Group B (145+/-39 vs 118+/-34g/m(2), P

An increased QT dispersion (QTd) is associated with a variety of cardiac diseases and predicts sudden death. Although chronic renal failure patients and patients on hemodialysis are shown to have an increased QTd, evidence of increased QTd in renal transplant patients is scarce. In this study, renal transplant patients were evaluated to find out if they had an increased QTd. Thirty-four renal transplant recipients aged 35 +/- 8 years and 34 healthy control subjects aged 34 +/- 8 years were included in the study. The mean time after transplantation was 51.8 +/- 40.4 (range 5-154) months. The QT interval was measured by 12-lead electrocardiogram, and the QTd was defined as the difference between the maximum and minimum QT interval. Bazett's formula was used to correct for the heart rate (QTc). Both QTd and QTc dispersion (QTcd) in renal transplant patients were compared with those of control subjects. All patients underwent transthoracic echocardiographic assessment and 24-hour ambulatory blood pressure monitoring. Renal transplant recipients had similar QTd (37 +/- 15 vs. 39 +/- 17 ms) and QTcd (50 +/- 18 vs. 55 +/- 20 ms) compared to control subjects. QTd and QTcd were similar in patients with and without left ventricular hypertrophy (QTd 37 +/- 14 vs. 36 +/- 17 ms and QTcd 50 +/- 14 vs. 49 +/- 21 ms, respectively). No association was found between QTd and left ventricular mass index or blood pressure measurements. The QTd was not found to be increased in renal transplant recipients as compared with that of healthy controls in this study. Normalization of the QTd after renal transplantation may be through the correction of several factors responsible for increased QTd in uremic patients.

Background. Patients with end-stage renal disease have a high risk of premature death, which is due mainly to cardiovascular (CV) events. Elevated cardiac troponin T (cTnT) is related to increased left ventricular mass index (LVMI) and predicts poor outcome in chronic haemodialysis patients. We investigated the prognostic value of cTnT and its relationship with left ventricular mass in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods. Sixty-five CAPD patients (mean age: 56±12 years; 36% males) with no evidence of acute coronary syndrome in 28 days prior to the study were examined prospectively. After 48 months of follow-up, we evaluated total and CV mortality. Results. During follow-up, 23 patients (35%) died (70% CV causes, 22% infection, 4% tumour, 4% unknown). In univariate analysis, concentrations of cTnT � 0.035 ng/ml, increased LVMI, diabetes, serum albumin and age were all strong predictors of total mortality. In multivariate logistic regression analysis, cTnT � 0.035 ng/ml and age independently predicted total mortality [odds ratio (OR): 4.31; 95% confidence interval (95% CI): 1.16–16.04; P ¼ 0.008 and OR: 1.08; 95% CI: 1.02–1.15; P ¼ 0.002, respectively]. cTnT level � 0.035 ng/ml was the only independent predictor of CV mortality in multivariate logistic regression analysis (OR: 8.94; 95% CI: 2.23–35.88; P

Glycosaminoglycans (GAGs) are major components of the basement membranes and play a key role in their molecular organization and function (1)(2)(3). Some authors have proposed that increased loss of proteoglycan from glomerular basement membrane (GBM) alters glomerular charge selectivity, which contributes to urinary loss of albumin (4)(5)(6)(7)(8). Several clinical studies have shown that the GAG content of human GBM is significantly decreased and that urinary loss of GAG is markedly increased in diabetic patients (7)(8)(9). Among the possible mechanisms of diabetic microalbuminuria are decreased synthesis (10) and/or increased loss of GAGs (9)(11) from the GBM. Although the importance of microalbuminuria is unclear in hypertensive patients, it may be an early marker of glomerular functional and structural changes (12)(13). Because hypertension is considered a systemic disease, basement membrane changes should be widespread. Whether basement membranes from other tissues are also affected and whether these changes are the result of hypertension remains to be determined. Therefore, in our study, we examined the effects of hypertension on basement membrane anionic charges in newly diagnosed, untreated essential hypertensive patients. Twelve nonsmoking, essential hypertensive patients, stage I or II according to the sixth report of Joint National Committee (14), and 12 age- and sex-matched healthy normotensive controls were included in the study. All patients gave informed consent, and the institutional local ethics committee approved the …