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AIMS: SARS-CoV-2 infection may lead to endothelial and vascular dysfunction. We investigated alterations of arterial stiffness, endothelial coronary and myocardial function markers 4 months after COVID-19 infection. METHODS AND RESULTS: In a case-control prospective study, we included 70 patients 4 months after COVID-19 infection, 70 age- and sex-matched untreated hypertensive patients (positive control) and 70 healthy individuals. We measured (i) perfused boundary region (PBR) of the sublingual arterial microvessels (increased PBR indicates reduced endothelial glycocalyx thickness), (ii) flow-mediated dilatation (FMD), (iii) coronary flow reserve (CFR) by Doppler echocardiography, (iv) pulse wave velocity (PWV), (v) global left and right ventricular longitudinal strain (GLS), and (vi) malondialdehyde (MDA), an oxidative stress marker, thrombomodulin and von Willebrand factor as endothelial biomarkers. COVID-19 patients had similar CFR and FMD as hypertensives (2.48 ± 0.41 vs. 2.58 ± 0.88, P = 0.562, and 5.86 ± 2.82% vs. 5.80 ± 2.07%, P = 0.872, respectively) but lower values than controls (3.42 ± 0.65, P = 0.0135, and 9.06 ± 2.11%, P = 0.002, respectively). Compared to controls, both COVID-19 and hypertensives had greater PBR5-25 (2.07 ± 0.15 µm and 2.07 ± 0.26 µm, P = 0.8 vs. 1.89 ± 0.17 µm, P = 0.001), higher PWV (carotid-femoral PWV 12.09 ± 2.50 vs. 11.92 ± 2.94, P = 0.7 vs. 10.04 ± 1.80 m/s, P = 0.036) and impaired left and right ventricular GLS (-19.50 ± 2.56% vs. -19.23 ± 2.67%, P = 0.864 vs. -21.98 ± 1.51%, P = 0.020 and -16.99 ± 3.17% vs. -18.63 ± 3.20%, P = 0.002 vs. -20.51 ± 2.28%, P < 0.001). MDA and thrombomodulin were higher in COVID-19 patients than both hypertensives and controls (10.67 ± 0.32 vs 1.76 ± 0.03, P = 0.003 vs. 1.01 ± 0.05 nmol/L, P = 0.001 and 3716.63 ± 188.36 vs. 3114.46 ± 179.18 pg/mL, P = 0.017 vs. 2590.02 ± 156.51 pg/mL, P < 0.001). Residual cardiovascular symptoms at 4 months were associated with oxidative stress and endothelial dysfunction markers. CONCLUSIONS: SARS-CoV-2 may cause endothelial and vascular dysfunction linked to impaired cardiac performance 4 months after infection.

Objective The efficacy of renal sympathetic denervation (RDN) has been affirmed by a number of recent clinical studies, despite controversies in this field over the last five years. Therefore, it is of paramount importance that hypertension experts debate the merits of RDN by revealing and expressing their personal beliefs and perspectives regarding this procedure. Methods A cross-sectional survey was conducted among Greek leaders of the Hypertension Excellence Centers with the use of a closed-type questionnaire specifically designed to elicit information and evaluate the respondent's views and perspectives about RDN efficacy, safety and ideal target patient population. Results A total of 36 participants completed the survey. Based on the results, RDN was considered efficient (91.7%) and safe (94.5%), while the overwhelming majority of the participants felt confident in the long-term efficacy (88.9%) of the intervention and that it lacks reliable predictors of blood pressure response (94.5%). Patients with resistant (91.7%), ultra-resistant (94.4%), and uncontrolled hypertension (80.6%) were suggested as ideal candidates for RDN. Establishing a close co-operation between interventionalists and hypertension experts was considered essential to ensure the efficacy (97.2%) as well as the safety (97.3%) of the procedure. Conclusion The vast majority of Greek hypertension experts surveyed were convinced of the efficacy and safety of RDN based on the preponderance of available scientific and clinical data. Identification of the ideal patient group remains controversial. Respondents generally agreed on the necessity of building close collaborative relationships between interventionalists and hypertension experts in order to improve RDN clinical outcome.

Background Isolated diastolic hypertension (IDH) usually remains untreated as it is considered benign compared to isolated systolic or combined systolic/diastolic hypertension. Hypertension mediated organ damage (HMOD) needs to be assessed in each individual hypertensive patient in order to estimate cardiovascular risk. We aimed to investigate the HMOD differences between first diagnosed and never treated patients with IDH compared to normotensive subjects. Methods From 550 first diagnosed and never-treated hypertensive and non-diabetic patients, we studied 81 patients with IDH (mean age = 49±9, 63% males, 26% smokers) and 53 normotensives (mean age = 51±13, 30% males, 28% smokers). Office and ambulatory blood pressure monitoring (24h ABPM), CV risk factors [smoking, obesity (BMI), hyperlipidemia and HMOD [aortic stiffness (PWV), left ventricular diastolic dysfunction (EEa), cardiac mass (LVMI) and cardiac hypertrophy (LVH), coronary arteries microcirculation (CFR), carotid intima-media thickness (cIMT) were estimated in each hypertensive patient as well as normotensive subject. Results IDH patients had similar age, BMI, lipid profile, central systolic BP and smoking habit, and increased systolic (139±12 vs. 133±18, p=0.03), diastolic (89±9 vs. 84±9 mmHg, p=0.02) and mean office BP (106±9 vs. 82±9 mmHg, p Conclusions The presence of HMOD in IDH in first diagnosed and never treated patients with arterial hypertension underscores the need for antihypertensive treatment (life style changes and medication). As HMOD may regress with successful antihypertensive treatment, there is still time for physicians to reduce future CV events in those patients. Funding Acknowledgement Type of funding sources: None.

Blood pressure variability (BPV) has been associated with the development, progression, and severity of cardiovascular (CV) organ damage and an increased risk of CV morbidity and mortality. We aimed to explore any association between short‐term BPV reduction and hypertension‐mediated organ damage (HMOD) regression in hypertensive patients 3‐year post‐treatment initiation regarding BP control. 24‐h ambulatory blood pressure monitoring (24 h ABPM) was performed at baseline in 180 newly diagnosed and never‐treated hypertensive patients. We measured 24 h average systolic (24 h SBP) and diastolic BP (24 h DBP) as well as 24 h systolic (sBPV) and diastolic BPV (dBPV). Patients were initially evaluated and 3 years later regarding arterial stiffness (PWV), left ventricular hypertrophy (LVMI), carotid intima‐media thickness (cIMT), 24 h microalbumin levels (MAU), and coronary flow reserve (CFR). Successful BP treatment was defined as 24 h SBP/DBP, In middle‐aged hypertensive patients, a 3‐year strictly successful antihypertensive treatment, confirmed by 24‐h ABPM, leads to CV risk reduction associated with sBPV and dBPV improvement.

Unattended automatic office blood pressure (BP) measurement has given new evidence regarding treatment goals. We aimed to explore any differences between unattended and conventional office BP measurements in different groups of patients visiting a European Society of Hypertension (ESH) Excellence Centre. We performed two unattended (Microlife Watch BP Home) followed by a single attended (mercury sphygmomanometer) BP measurement in 310 patients (mean age 62 ± 15 years, 151 males, 64% hypertensives and 36% normotensive individuals) visiting our ESH Centre for a scheduled follow-up. Office BP

BACKGROUND Episodes of suspected atrial fibrillation are particularly frequent in essential hypertension. This study aimed to investigate the incidence of new suspected atrial fibrillation cases detected through home blood pressure (BP) screening among hypertensive patients. Association of new suspected atrial fibrillation cases with arterial hypertension (AH) phenotypes and the CHA2DS2-VASc score was also investigated. METHODS The prospective study recruited hypertensive patients at least 50 years old from private and hospital hypertensive clinics. An ECG was performed during the first visit. Microlife BP A6 PC was used to measure office and home BP for at least 3 and preferably 7 consecutive days. RESULTS A total of 2408 AH patients were recruited. Suspected atrial fibrillation was detected by BP monitor in 12.5% of patients. CHA2DS2-VASc was greater in hypertensive patients with suspected atrial fibrillation detection, as compared with all other hypertensive patients (3.3 ± 1.4 vs. 2.8 ± 1.4, P

Background Obesity and arterial hypertension in children represent well recognized risk factors for future cardiovascular (CV) events during early adult life. We aimed to investigate any changes regarding several parameters affecting the CV status of children aged 6–16 years after a 10-year follow-up period. Methods A cohort of 143 children 6–16 years old (79/64 boys/girls, mean age 9±2 years) was evaluated regarding food habits (fish/chicken/vegetables/fruit per week), obesity (BMI), office blood pressure (SBP/DBP), aortic stiffness (PWV), lipid profile (HDL, LDL) and sports activity (hours of exercise/week). After a 10-years follow-up period, we managed to re-evaluate 62/143 (43%) young adults (33/31 boys/girls, mean age 20±2 years) for the same parameters plus endothelial function estimated by endothelial glycocalyx integrity (PBR5–25). Results We found that after 10 years, young adults compared to themselves had increased BMI, SBP/DBP and PWV (p95th percentile in 7% of the children (50% of children had finally white coat hypertension) while just one young adult (2%) had BP >140 mmHg). Conclusions After 10 years, children became young adults with an improved status regarding obesity, normal BP levels, favorable lipid profile as for LDL levels, almost healthy food habits who also spend more hours in sport activities. However, HDL was decreased, aortic stiffness was increased while there are no comparable data regarding endothelial glycocalyx integrity. Overall, the profile of young adults seems protective against future CV events. Funding Acknowledgement Type of funding sources: None. Figure 1

We investigated whether disturbance of glycocalyx integrity is related with increased cardiovascular risk. In 600 healthy subjects, we measured perfused boundary region (PBR), a marker of glycocalyx integrity, in sublingual microvessels with diameter ranging 5-25 µm using a dedicated camera (Sideview Darkfield Imaging). Increased PBR indicates reduced glycocalyx thickness. We prospectively monitored the occurrence of cardiovascular events (MACE-death, myocardial infarction, and stroke) during a 6-year follow-up. Fifty-seven MACE were documented. Increased values of PBR5-25 predicted higher risk for MACE in a model including sex, age, hyperlipidemia, diabetes, hypertension, smoking, family history of coronary disease, treatment with ACEi/ARBs, or lipid-lowering agents (hazard ratio (HR), 6.44, p = 0.011; net reclassification improvement (NRI), 28%; C-statistic: 0.761). PBR5-25 was an independent and additive predictor of outcome when added in a model including the European Heart SCORE, diabetes, family history of CAD, and medication (HR, 4.71; NRI: 39.7%, C-statistic from 0.653 to 0.693; p lt; 0.01).Glycocalyx integrity is an independent and additive predictor to risk factors for MACE at 6-year follow-up in individuals without cardiovascular disease. ClinicalTrials.govIdentifier:NCT04646252. PBR5-25 was an independent and additive predictor of adverse cardiovascular events in a model including the European Heart SCORE, diabetes, family history of coronary disease, and medication (HR: 4.71, NRI: 39.7%, C-statistic from 0.653 to 0.693; p lt; 0.01, NRI:37.9%).

Background: Cardiopulmonary exercise testing (CPET) is the most comprehensive technique which allows a holistic approach to cardiopulmonary diseases. Summary: This article provides basic information addressed to the Clinical Cardiologist regarding the utility and the indications of the CPET technique in the everyday clinical practice. Clinical application of CPET continues to evolve and protocols should be adapted to each specific patient to obtain the most reliable and useful information. Key Messages: Clinical Cardiologists with an interest over CPET may become familiar with this exercise method and its main measured variables, refresh their knowledge regarding the underlying pathophysiological mechanisms of oxygen transport chain, learn how to interpret the CPET results and promote appropriate patient referrals to experts.

Idiopathic pulmonary arterial hypertension (IPAH) initial evaluation and follow-up, a rare and incurable disease if left untreated, is based on a multiparametric approach (functional status of the patient, biomarkers, hemodynamic parameters and imaging evaluation of right heart impairment). Arterial stiffness (AS) and endothelial glycocalyx are indices of systemic circulation. We present the 3-years follow-up of a female IPAH patient. We propose aortic stiffness and endothelial glycocalyx indices as non-invasive markers of either improvement or deterioration of IPAH disease.

Wave reflection at central arteries consists of a major component of left ventricular afterload. Central augmentation index (AIx) is the most widely used surrogate of wave reflection. Recent technological developments now provide the ability to obtain, non‐invasively, aortic, or carotid pressure waves and measure AIx based on various algorithms of pulse wave analysis. The aim of this study was to compare AIx measurements performed by the Arteriograph, Complior, and Mobil‐O‐Graph apparatuses. Recordings by each device in randomized order were performed with 5‐minute interval at 211 individuals (age 55.1 ± 14.1 years, 67.8% males) who underwent diagnostic cardiovascular assessment. All measurements were obtained at the supine position, and AIx was calculated using the formula AIx = 100 × (Augmentation pressure)/(Pulse Pressure). Bland‐Altman analysis was performed. Mean difference (bias) ± one standard deviation of difference (with limits of agreement) of AIx between different devices was as follows: (a) Mobil‐O‐Graph vs Complior: −2.1 ± 14.8% (−31.1% to 26.9%), (b) Arteriograph vs Complior: 12.9 ± 14.6% (−15.7% to 41.5%), and (c) Mobil‐O‐Graph vs Arteriograph: −10.8 ± 16.9% (−43.9% to 22.3%). The three examined devices exerted significant differences in central AIx estimation which makes the three devices non‐interchangeable for wave reflection assessment. However, the Mobil‐O‐Graph device showed the highest agreement (lowest bias) with the Complior system as regards to the AIx measurement.

Anakinra, an interleukin-1 receptor antagonist and tocilizumab, an interleukin-6 receptor blocker, are used for the treatment of rheumatoid arthritis. We investigated the differential effects of anakinra and tocilizumab on myocardial and vascular function in an atherosclerosis model of patients with rheumatoid arthritis. 120 patients with rheumatoid arthritis were randomized to anakinra (n = 40), tocilizumab (n = 40) or prednisolone (n = 40) for 3 months. Primary outcome measure was the change of left ventricular longitudinal strain after 3 months of treatment. Additionally, we measured coronary flow reserve, flow-mediated dilatation of the brachial artery, carotid-femoral pulse wave velocity, malondialdehyde and protein carbonyls as oxidative stress markers and C-reactive protein blood levels at baseline and post-treatment. At baseline, patients among the three treatment arms had similar age, sex, disease activity score and atherosclerotic risk factors. Compared with baseline, all patients had improved longitudinal strain (− 16% vs. − 17.8%), coronary flow reserve (2.56 vs. 2.9), malondialdehyde (2.0 vs. 1.5 µM/L), protein carbonyls (0.0132 vs. 0.0115 nmol/mg), and C-reactive protein post-treatment. In all patients, the percent decrease of malondialdehyde was correlated with percent increase of longitudinal strain (p

Pulse wave velocity (PWV) is a marker of arterial stiffness with major prognostic value. We compared Arteriograph and Complior devices with the Mobil-O-Graph for assessment of PWV and central systolic blood pressure (cSBP).We studied 316 consecutive subjects (age: 55 ± 14 years). For each individual, we measured PWV and cSBP with Arteriograph, Complior and Mobil-O-Graph and compared the readings. Differences in values among three devices were calculated for each measurement. We used Bland-Altman analysis, intraclass correlation coefficient (ICC) and coefficient of variation (CV).Bland-Altman analysis indicated a mean difference for PWV: i.0.5 m/s (limits of agreement -1.4-2.4) between Complior and Mobil-O-Graph, ii.0.6 m/s (limits of agreement -1.4-2.6) between Arteriograph and Mobil-O-Graph. cSBP mean difference was 3.8 mmHg between Complior and Mobil-O-Graph (limits of agreement -12.5-20.1) and 9.2 mmHg between Arteriograph and Mobil-O-Graph (limits of agreement -7.6-26). ICC for PWV was 0.86 between Arteriograph and Mobil-O-Graph, 0.87 between Complior and Mobil-O-Graph and for cSBP 0.92 and 0.91 respectively. CV for PWV was 9.5% between Arteriograph and Mobil-O-Graph, 8.8% between Complior and Mobil-O-Graph. Respective values for cSBP were 6.8% and 5.1%.Our study shows acceptable agreement among the three devices regarding pulse wave analysis markers though Mobil-O-Graph appears to underestimate the values of these markers. Further studies are needed to explore the agreement between the 3 devices in various clinical settings and patient populations.

The perception that women represent a low-risk population for cardiovascular (CV) disease (CVD) needs to be reconsidered. Starting from risk factors, women are more likely to be susceptible to unhealthy behaviors and risk factors that have different impact on CV morbidity and mortality as compared to men. Despite the large body of evidence as regards the effect of lifestyle factors on the CVD onset, the gender-specific effect of traditional and non-traditional risk factors on the prognosis of patients with already established CVD has not been well investigated and understood. Furthermore, CVD in women is often misdiagnosed, underestimated, and undertreated. Women also experience hormonal changes from adolescence till elder life that affect CV physiology. Unfortunately, in most of the clinical trials women are underrepresented, leading to the limited knowledge of CV and systemic impact effects of several treatment modalities on women's health. Thus, in this consensus, a group of female cardiologists from the Hellenic Society of Cardiology presents the special features of CVD in women: the different needs in primary and secondary prevention, as well as therapeutic strategies that may be implemented in daily clinical practice to eliminate underestimation and undertreatment of CVD in the female population.

Dipping phenomena is defined as nocturnal BP fall >10% during 24-h ambulatory blood pressure (BP) monitoring (ABPM) which carries a favorable cardiovascular risk (CVR) prognosis due to reduced 24-h hypertension burden. To date, extreme dipping phenotype (defined as BP decrease ≥20%) has led to controversial prognostic results regarding CVR. We aimed to explore hypertension-mediated organ damage (HMOD) in extreme dippers compared to the other dipping phenotypes (nondipping, dipping). From 490 consecutive patients with newly diagnosed never-treated arterial hypertension (mean age 51 ± 11 years, 294 males) subjected to 24-h ABPM, we studied 52 extreme dippers, 52 age- and gender-matched nondippers, and 52 age- and gender-matched dippers. All patients were subjected to arterial stiffness (PWV), 24-h microalbumin levels, carotid intima-media thickness (cIMT), diastolic dysfunction (E/Ea), and left ventricular mass index (LVMI) evaluation. ANOVA analysis found no differences regarding HMOD between groups. Multiple regression analysis revealed the following independent direct relationships between: (i) office SBP and PWV in nondippers (β = 0.35, p = 0.01) and extreme dippers (β = 0.49, p

We obtained directly measured maximal oxygen uptake (VO2 max) by open-circuit spirometry in 1,453 patients with chronic heart failure (HF) who completed a treadmill test (n = 1,453) or cycle ergometry (n = 1,838), as participants in The Fitness Registry and the Importance of Exercise National Data Base (FRIEND) dataset. We developed a new equation to predict measured VO2 max in those using a treadmill by randomly sampling 70% of the participants from each of the following age categories: 70 and used the remaining 30% for validation. Multivariable linear regression analysis was applied to identify the most relevant variables and construct the best prediction model for VO2 max. Treadmill speed and treadmill speed * grade were considered in the final model as predictors of measured VO2 max and the following equation was generated: VO2 max in ml O2 kg/min = speed (m/min) * (0.17 + fractional grade * 0.32) +3.5. To assess the efficacy of the equation, we applied it to 1,612 patients in the HF-ACTION cohort. To assess the efficacy of the FRIEND cycle ergometry equation developed for healthy individuals we applied it to 1,838 HF patients in the FRIEND cohort and 306 patients in a Greek population of HF patients with directly measured VO2 max. The FRIEND equations were superior to ACSM equations in predicting VO2 max regardless of the cohort or exercise mode used (treadmill or cycle ergometry) to access VO2 max.

Background Remote ischemic post-conditioning attenuates ischemia-reperfusion injury in patients with STEMI. However, its biochemical mechanisms, including micro-RNA expression, and effects on cardiac remodeling have not been defined. Methods We examined 80 patients with STEMI and 20 healthy controls. All patients had been evaluated by cardiac echocardiography. The conditioning protocol utilised a single ischemic stimulus by brachial cuff inflation of both arms at 200mmHg for 5 minutes, while 20 patients underwent a sham conditioning procedure by way of cuff inflation omission after its placement. Blood samples were taken before and after the conditioning protocol; thus, the expression of microRNA-144,-150,-499 (cardioprotective action), -21, and -208 (remodeling stimuli) was quantified at baseline and after the ischemic conditioning procedure, by polymerase chain reaction. Additionally, cardiac remodeling was evaluated by repeat echocardiography after a 2-year follow-up period, in 40 patients. Results Our conditioning protocol resulted in a statistically significant increase in miR-144,-150, -499, -21, and -208 expression (55.9 vs 7.4/U6sn, p Conclusion Remote ischemic conditioning may prevent adverse myocardial remodelling within 2 years of the index ischemic event, likely by up-regulation of cardio-protective microRNAs expression.

Background MicroRNAs have been recognised as important modulators of cardiovascular function. However, their profiling in ischemic heart disease and contribution to cardiac remodeling has not been defined. Methods We examined 40 patients with STEMI and 20 healthy controls. MicroRNA expression profiling was carried out within 48 hours of the index ischemic event, measuring the expression of microRNA-144,-150,-499 (cardioprotective action), -21, and -208 (remodeling stimuli). In addition, every patient was evaluated by echocardiography, which was repeated after a 2-year follow-up period. Results Left-ventricular end-systolic volume (LVESV) and left-ventricular end-diastolic volume (LVEDV) decreased (from 57.7± 6.3 to 48.6± 5.2, p 15%) with satisfactory specificity (0.82). Conclusion Mir- 208 and -499 expression may contribute to cardiac remodeling after STEMI, while mir-499 could be used as a prognostic marker of reverse remodeling.

We investigated the association of endothelial glycocalyx damage with arterial stiffness, impairment of coronary microcirculatory function, and LV myocardial deformation in 320 untreated hypertensives and 160 controls. We measured perfused boundary region (PBR) of the sublingual microvessels, a marker inversely related with glycocalyx thickness, coronary flow reserve (CFR), and Global Longitudinal strain (GLS) by echocardiography, pulse wave velocity (PWV), and central systolic blood pressure (cSBP). Hypertensives had higher PBR, PWV cSBP, and lower CFR and GLS than controls (P

The electronic cigarette (e-cig) has been proposed as a safer alternative than tobacco cigarettes (con-cigs)1,2 and as a bridge to smoking cessation. We aimed to examine its effects (1) on aortic stiffness as assessed by pulse wave velocity (PWV) and augmentation index (AIX75), (2) exhaled CO concentration, and (3) oxidative stress as assessed by malondialdehyde (MDA) plasma concentrations, both acutely and after 1 month of use. We studied 70 current smokers (age: 48±5 years, 56% female, 24±8 cigarettes/d, 30±7 pack-years, no other atherosclerotic risk factors or any medication) attending the hospital’s smoking cessation unit. Of those, 35 were assigned to use nicotine-free e-cig fluid (NOBACCO eGo Epsilon BDC 1100, eGo battery, 1100 mAh, operating at 3.9 V) during the acute-phase protocol, whereas the remaining 35 were assigned to an e-cig fluid with nicotine concentration of 12 mg/mL (propylene glycol 74.3%, glycerin 20%, flavoring 4.5%, nicotine 1.2%). All subjects underwent a baseline sham smoking for 7 minutes (inhaling on a nonlighted cigarette) and then were randomly assigned to smoke a single con-cig or vape an e-cig for 7 minutes (simulating the duration of a normal cigarette smoking). …

Background Incretin-based therapies are used in the treatment of type 2 diabetes mellitus (T2DM) and obesity. We investigated the changes in arterial stiffness and left ventricular (LV) myocardial deformation after 6-month treatment with the GLP-1 analogue liraglutide in subjects with newly diagnosed T2DM. Methods We randomized 60 patients with newly diagnosed and treatment-naive T2DM to receive either liraglutide (n = 30) or metformin (n = 30) for 6 months. We measured at baseline and after 6-month treatment: (a) carotid-femoral pulse wave velocity (PWV) (b) LV longitudinal strain (GLS), and strain rate (GLSR), peak twisting (pTw), peak twisting velocity (pTwVel) and peak untwisting velocity (pUtwVel) using speckle tracking echocardiography. LV untwisting was calculated as the percentage difference between peak twisting and untwisting at MVO (%dpTw–UtwMVO), at peak (%dpTw–UtwPEF) and end of early LV diastolic filling (%dpTw–UtwEDF) (c) Flow mediated dilatation (FMD) of the brachial artery and percentage difference of FMD (FMD%) (d) malondialdehyde (MDA), protein carbonyls (PCs) and NT-proBNP. Results After 6-months treatment, subjects that received liraglutide presented with a reduced PWV (11.8 ± 2.5 vs. 10.3 ± 3.3 m/s), MDA (0.92 [0.45–2.45] vs. 0.68 [0.43–2.08] nM/L) and NT-proBNP (p MVO (31 ± 10 vs. 40 ± 14), %dpTw–UtwPEF (43 ± 19 vs. 53 ± 22) and FMD% (8.9 ± 3 vs. 13.2 ± 6, p Conclusions Six-month treatment with liraglutide improves arterial stiffness, LV myocardial strain, LV twisting and untwisting and NT-proBNP by reducing oxidative stress in subjects with newly diagnosed T2DM. ClinicalTrials.gov Identifier NCT03010683

In this article, we present the case of a 38-year-old female who suffered from serious respiratory distress. After an extensive pulmonary artery imaging diagnostic work-up (CTPA, MRA and PET), we were unable to differentiate between chronic thromboembolic pulmonary hypertension (CTEPH) vs. pulmonary artery sarcoma (PAS) due to extensive filling defects and extraluminal findings. Although surgery was postponed for nine months due to the COVID-19 pandemic, CTEPH diagnosis, due to a high-thrombus burden, was finally confirmed after pulmonary endarterectomy (PEA). Conclusively, imaging findings of rare cases of CTEPH might mimic PAS and the surgical removal of the lesion are both needed for a final diagnosis. What is Already Known about This Topic? Pulmonary artery sarcoma (PAS) is a rare but aggressive malignancy, which originates from the intimal layer of the pulmonary artery (PA); Chronic thromboembolic pulmonary hypertension (CTEPH) is based on chronic, organized flow-limiting thrombi inside PA circulation and subsequent pulmonary hypertension. What Does This Study Contribute? Since radiological findings of CTEPH cases might rarely mimic PAS, pulmonary artery endarterectomy and subsequent histopathologic study are needed for a final diagnosis.

The effects of medically-aided smoking cessation on vascular function and oxidative stress are not fully clarified.One hundred eighty-eight current smokers were randomized to varenicline or nicotine replacement treatment (NRT) for a 3-month period. We assessed: (a) augmentation index (Aix) and pulse wave velocity (PWV); (b) perfusion boundary region (PBR) of sublingual microvasculature (range:5-25 μm), an index of the endothelial glycocalyx thickness, using Sideview, Darkfield imaging; (c) the exhaled CO; and (d) the malondialdehyde (MDA) and protein carbonyls (PC) plasma levels, as markers of oxidative stress, at baseline and after 3 and 12 months.After 3 months of treatment, CO, MDA, PC and Aix were decreased in all subjects (median CO: 25 vs. 6 ppm, MDA: 0.81 vs. 0.63 nmol/L, PC: 0.102, vs. 0.093 nmol/mg protein, Aix: 13% vs. 9%, p 0.05) while PWV remained unchanged. Endothelial glycocalyx integrity showed a greater improvement in the varenicline than the NRT treatment (PBR range 5-9 μm: 1.07 ± 0.02 vs. 1.17 ± 0.02 μm, p = 0.03) in parallel with the greater CO reduction (5 vs. 7 ppm, p = 0.02). At 1-year follow-up, MDA, PC, Aix and PBR at 5-25 μm range were further improved in subjects who abstained from smoking (n = 84 out of 188), while the above markers and PWV deteriorated in relapsed smokers (p 0.05).A smoking cessation program using varenicline or NRT for 3 months resulted in a decrease of CO, oxidative stress, arterial stiffness and restored endothelial glycocalyx. These effects were more evident after varenicline treatment, likely because of a greater CO reduction, and were maintained after 1 year only in subjects who abstained from smoking.

Given that patients with prior myocardial infarction and features of high ischemic and low bleeding risk may benefit by extending dual antiplatelet therapy beyond 1 year, we aimed of assessing platelet reactivity provided by ticagrelor 60 mg bid versus prasugrel 5 mg od in 20 such patients participating in a randomized, crossover study. The primary end point of platelet reactivity at the end of the two treatment periods (by VerifyNow, in PRU) was significantly lower for ticagrelor (31.9 PRU [95% CI 12.3–51.4]) compared with prasugrel (132.1 PRU [111.9–152.3]) with a least squares mean difference of –100.2 PRU (72.1–128.3, P < .001). This dedicated pharmacodynamic study showed that in post-myocardial infarction patients with high atherothrombotic risk and receiving P2Y12 receptor antagonist beyond 1 year, low-dose ticagrelor results in a significantly lower platelet reactivity compared to low-dose prasugrel.

Background In patients with prior myocardial infarction (MI) and features of high ischemic and low bleeding risk, extending dual antiplatelet therapy beyond 1 year or reinitiating treatment is reasonable. A lower than the standard dose, namely ticagrelor 60mg bid instead of 90mg bid and prasugrel 5mg od instead of 10mg od, may be associated with reduced bleeding risk. In the Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin–Thrombolysis in Myocardial Infarction 54 (PEGASUS-TIMI 54) trial, ticagrelor 60mg bid reduced the ischemic events, at the cost of increased bleeding events. There is no data on the pharmacodynamic efficacy of ticagrelor 60mg bid over low dose prasugrel (5mg od). Purpose To compare platelet reactivity (PR) between prasugrel 5mg od and ticagrelor 60 mg bid in the chronic phase of stable post-MI patients. Methods The ALTIC-2 was a prospective, single-center, randomized, crossover study involving patients on aspirin 100mg od and PEGASUS-TIMI 54 characteristics: >50 years old with MI 1–3 years earlier and at least one high risk feature (age >65 years, diabetes mellitus, a second MI, multivessel disease, or renal dysfunction). After a 14-day washout period–if on P2Y12 receptor antagonist therapy-, patients were randomized to either ticagrelor 60mg bid or prasugrel 5mg od for 14 days, with a crossover directly to the alternate treatment for another 14 days. PR was assessed by the VerifyNow P2Y12 reaction assay in PRU at baseline, pre and post-crossover, 2 hours post last study-drug dose. Statistical analysis was performed with STATA13.0. Results We recruited 20 eligible patients (80% men, 40% diabetics, 65% smokers, 70% multivessel disease, with a mean age of 64.8±6.3 years) for participation in the study (10 in each treatment sequence). During pre-crossover period, in the group allocated first in prasugrel PR levels (mean ± standard deviation) decreased from 238.4±50 to 128±47 (p208 PRU) rate was 0% for ticagrelor and 5.0% for prasugrel. No patient exhibited a major bleeding event at either treatment group. Conclusions In patients with previous MI and at least one other high-risk feature, low dose of ticagrelor results in a significantly lower PR compared to prasugrel 5mg od. Acknowledgement/Funding National and Kapodistrian University of Athens

Pulmonary arterial hypertension (PAH) is a heterogenous clinical entity with poor prognosis, despite recent major pharmacological advances. To increase awareness about the pathophysiology, epidemiology, and management of the disease, large national registries are required. The Hellenic pulmOnary hyPertension rEgistry (HOPE) was launched in early 2015 and enrolls patients from all pulmonary hypertension subgroups in Greece. Baseline epidemiologic, diagnostic, and initial treatment data of consecutive patients with PAH are presented in this article. In total, 231 patients with PAH were enrolled from January 2015 until April 2018. At baseline, about half of patients with PAH were in World Health Organization functional class II. The majority of patients with PAH (56.7%) were at intermediate 1-year mortality risk, while more than one-third were low-risk patients, according to an abbreviated risk stratification score. Half of patients with PAH were on monotherapy, 38.9% received combination therapy, while prostanoids were used only in 12.1% of patients. In conclusion, baseline data of the Greek PAH population share common characteristics, but also have some differences with other registries, the most prominent being a better functional capacity. This may reflect earlier diagnosis of PAH that in conjunction with the increased proportion of patients with atypical PAH could partially explain the preference for monotherapy and the limited use of prostanoids in Greece. Nevertheless, early, advanced specific therapy is strongly recommended.