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Background: We investigate whether peripheral arterial disease (PAD) detected by ankle brachial index (ABI)

Objective: To investigate predictors of increase in aortic pulse wave velocity (aPWV) in elderly subjects free from overt cardiovascular disease. Design and Method: The present study included 90 lecture attendees (“university of 3rd age”) who were examined at baseline and after a median follow-up of 9.5 years, including the aPWV measurement using Sphygmocor. At baseline, they were aged 66.9±5.1 years, 80.0% were women, 37.8% of subjects had arterial hypertension, 5.6% diabetes mellitus, and 82.2% hyperlipidemia. We used multiple linear regression analyses to assess predictors of change in aPWV. As independent covariates we considered: sex, age, body mass index, mean arterial pressure (MAP), heart rate, fasting glucose, total cholesterol, smoking, alcohol intake and observer. Results: The aPWV increased from 9.4 to 10.3m/s; P=0.022. While accounting for covariates, aPWV increased significantly with three factors: a 1–standard deviation change in heart rate (8.5bpm), in MAP (12.4mm Hg) and in fasting glucose (0.93mmol/l) were associated with increased aPWV amounting to 0.76m/s (95% CI: 0.23 to 1.30; P=0.0061), 0.71m/s (95% CI: 0.20 to 1.23; P=0.0079) and 0.57m/s (95% CI: 0.08 to 1.07; P=0.024), respectively. Conclusions: In elderly subjects without manifest cardiovascular disease, mechanical load, as demonstrated by the positive association with heart rate and MAP, plays a major role in the aortic stiffening. Among metabolic factors, glucose concentration but not lipid parameters is associated with increase in aortic stiffness, possible via glycation of connective tissue within arterial wall.

Ankle brachial index (ABI) has increasingly been used in general practice to identify patients with low ABI at high cardiovascular risk. However there is no consensus on the clinical significance of high ABI. The aim of our study was to compare large artery stiffness as a marker of cardiovascular risk in patients with low (1.4). Methods: 911 patients from the Czech post-MONICA study (a randomly selected 1% representative population sample, mean age 54±13.5 years, 47% of men) were examined. ABI was measured using a handheld Doppler and aortic pulse wave velocity (aPWV) using the Sphygmocor device. Results: Of 911 patients, 28 (3.1%) had low ABI and 23 (2.5%) high ABI. There was a U-shaped association between aPWV and ABI. aPWV was significantly higher in patients with low and high ABI compared with normal ABI group (11.1±2.8, 8.3±2.3, p

In this study, four ecotoxicological tests on Vibrio fischeri bacteria, Sinapis alba L. (white mustard), Daphnia magna S. (daphnia's) and earthworms were performed for three types of aqueous slag (ladle, blast furnace and converter) leachates with two-grain sizes (<4 mm, <10 mm). Concentrations of toxic elements and concentrations of Cr(VI), Ca, Na, Al, and other ions were determined. The raw slags were analyzed using X-ray fluorescence spectroscopy (XRFS), and major substances were determined by X-ray powder diffraction (XRD). The aqueous slag leachates passed ecotoxicological tests and met the required criteria, showing no toxicity to Vibrio fischeri and complying with white mustard test criteria. According to the results of the ecotoxicity tests with daphnia, the blast furnace slag samples were not ecotoxic, while two other slag samples were found to be entirely compliant. Characterization of the slags showed that the effect of element/ion leachability and slag grain size is essential. Biplot principal component analysis (PCA) showed that grain size does not significantly affect the separation of individuals on the plane. A positive correlation on toxicity was found with pH, conductivity, calcium content, dissolved content, salinity and fluoride concentration, whereas a negative correlation was found with magnesium concentration, dissolved organic carbon and potassium concentration. The effective concentration at 50% inhibition (EC 50 ) value for Vibrio fischeri correlated with the first dimension of bivariate assessment. In summary, it was found that the investigated slags can be effectively reused as they comply with regulations and do not endanger the environment., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Aims: We analyzed the mortality risk and its predictors in patients hospitalized for heart failure (HF)., Methods: Patients discharged from hospitalization for acute decompensation of HF in 2010-2020 and younger than 86 years were followed (n=4097). We assessed the incidence and trends of all-cause death, its main predictors, and the pharmacotherapy recommended at discharge from the hospital., Results: The 30 days all-cause mortality was in discharged patients 3.2%, while 1-year 20.4% and 5-years 55.4%. We observed a modest trend to decreased 1-year mortality risk over time. Any increase of year of hospitalization by one was associated with about 5% lower risk in the fully adjusted model. Regarding predictors of 1-year mortality risk, a positive association was found for age over 65, history of malignancy, and peak brain natriuretic peptide during hospitalization ≥10times higher than normal concentration. In contrast, as protective factors, we identified LDL ≥1.8 mmol/L, treatment with beta-blockers, renin-angiotensin axis blockers, statins, and implanted cardioverter in the same regression model. The ejection fraction category and primary etiology of HF (coronary artery disease vs. others) did not significantly affect the mortality risk in a fully adjusted model., Conclusions: Despite advances in cardiovascular disease management over the last two decades, the prognosis of patients hospitalized for heart failure remained highly unfavorable., Competing Interests: The authors report no conflicts of interest in this work.

Introduction and Objectives: Cardiac involvement in systemic sclerosis (SSc) patients affects mortality. Cardiac magnetic resonance (CMR) is capable of detecting structural changes, including diffuse myocardial fibrosis that may develop over time. Our aim was to evaluate myocardial structure and function changes using CMR in patients with SSc without known cardiac disease during a 5-year follow-up and find possible correlations with selected biomarkers., Methods: A total of 25 patients underwent baseline and follow-up CMR examinations according to a pre-specified protocol. Standard biochemistry, five biomarkers (hsTnI, NT-proBNP, galectin-3, sST2, and GDF-15), and disease-specific functional parameters enabling the classification of disease severity were also measured., Results: After five years, no patient suffered from manifest heart disease. Mean extracellular volume (ECV) and T1 mapping values did not change significantly ( p ≥ 0.073). However, individual increases in native T1 time and ECV correlated with increased galectin-3 serum levels (r = 0.56; p = 0.0050, and r = 0.71; p = 0.0001, respectively). The progression of skin involvement assessed using the Rodnan skin score and a decrease in the diffusing capacity of the lungs were associated with increased GDF-15 values (r = 0.63; p = 0.0009, and r = -0.51; p = 0.011, respectively)., Conclusions: During the 5-year follow-up, there was no new onset of heart disease observed in patients with SSc. However, in some patients, CMR detected progression of sub-clinical myocardial fibrosis that significantly correlated with elevated galectin-3 levels. GDF-15 values were found to be associated with disease severity progression.

Patients with pulmonary embolism (PE) may have symptomatic or asymptomatic concomitant deep vein thrombosis (DVT). The reported prevalence of PE-associated DVT is variable, and thus, the utility of routine testing is controversial. The aim of our study was to analyze the prevalence of DVT and the factors associated with proximal DVT/whole-leg DVT in patients with symptomatic PE. In 428 consecutive patients (mean age: 59 ± 16.4 years; 52.3% men), we performed clinical examination and complete bilateral compression ultrasound and ascertained medical history and risk factors for DVT/PE. χ 2 and t tests were used. Deep vein thrombosis was found in 70.6%; proximal DVT in 49.5%. Sensitivity/specificity of DVT symptoms was 42.7%/93.7% for whole-leg DVT and 47.6%/83.3% for proximal DVT. Male gender significantly prevailed among those with whole-leg DVT and with proximal DVT (58.9% and 61.8%). Active malignancy was significantly more frequent in the patients with proximal DVT than without proximal DVT (10.4% vs 3.7%). In conclusion, the prevalence of PE-associated DVT is quite high but clinical diagnosis is unreliable. In our group, male gender and active malignancy were significantly associated with the presence of concomitant proximal DVT.

Background: After the first episode of venous thromboembolism (VTE), the guidelines recommend selective thrombophilia testing and suggest not to test the patients older than 40 years with a provoked event and all patients above 60., Methods: We compared thrombophilia workup results in 544 patients, meeting or not meeting the selection criteria. Homozygous factor V Leiden or prothrombin gene mutation, natural anticoagulant deficiencies, antiphospholipid syndrome or combination of ≥2 disorders were considered a strong thrombophilia., Results: Thrombophilia was detected in 28.5% and strong thrombophilia in 6.6% of patients. In the subgroup aged 40-60 years, in men with unprovoked cases the prevalence of thrombophilia was 35.7% and that of strong thrombophilia 12.5%; in provoked cases it was 19.5% and 4.9%, respectively. In women aged 40-60 with unprovoked events, thrombophilia was found in 18.8%, in cases provoked solely by estrogens or pregnancy in 40.9%, and in those with another trigger in 9.1%. Comparing the patients above and under 60, thrombophilia was detected in 27.6% and 29.2%, respectively (P=0.67) and strong thrombophilia in 9.1% and 4.7%, respectively (P=0.041). Factors significantly associated with positive thrombophilia testing were family history of VTE (including superficial vein thrombosis) - OR 1.80; 95% CI 1.71-2.77 and proximal location of deep vein thrombosis - OR 1.94; 95% CI 1.25-3.02., Conclusions: Of VTE patients not meeting selection criteria for testing, the prevalence of thrombophilia and even strong thrombophilia was high in those older than 60 years. Selection criteria for testing should be respected but in some cases an individual approach might be considered.

Background: Peripheral arterial disease (PAD) has the risk equivalent of coronary heart disease. The biochemical parameters associated with functionally significant coronary artery stenosis were investigated in asymptomatic patients with PAD who were scheduled for major vascular intervention., Methods: A total of 50 PAD patients asymptomatic for coronary heart disease were examined using coronary computed tomography angiography (CTA). A stress myocardial CT perfusion (CTP) test was performed in patients who exhibited coronary stenosis >40%. In patients with stress-induced perfusion defects, the severity of stenosis was assessed using invasive coronary angiography including fractional flow reserve assessment. The CT findings were correlated with both classical and more recently developed parameters of atherosclerosis., Results: According to the combined CT examination (CTA and stress CT perfusion), 36% of patients exhibited significant coronary stenosis. Stress-induced hypoperfusion was observed in 95.7% of severe stenotic lesions. After adjustment for confounders, the level of high-sensitivity troponin I was associated with severe coronary stenosis (OR 1.260 [95% CI 1.054 to 1.505]). Other biochemical parameters did not correlate with coronary stenosis. The annual mortality rate was 4%., Conclusions: The results of the present study confirm a significant diagnostic contribution of a complex cardiac CT examination in patients scheduled for major vascular surgery. A high prevalence of asymptomatic coronary heart disease was observed in this particular patient group. High-sensitivity measurements of troponin I correlated with the extent of the coronary stenosis.

Background: Factor V Leiden (FVL) supposedly carries relatively higher risk of deep vein thrombosis (DVT), compared to the risk of pulmonary embolism (PE)., Aim: To prove this paradox in a group of patients with various clinical presentation of venous thromboembolism (VTE)., Materials and Methods: We retrospectively evaluated clinical pattern of VTE in patients who had been referred to vascular clinic shortly after an acute VTE event. In FVL positive and FVL negative groups we compared the prevalence of isolated symptomatic DVT (proximal or distal) and symptomatic PE with/without DVT, and, moreover, asymptomatic DVT or PE., Results: Of 575 patients (mean age 57 years, 50.1% women), 120 were FVL positive and those had significantly higher prevalence of isolated symptomatic DVT, compared to symptomatic PE with/without DVT. Proximal DVT location was significantly more frequent in FVL carriers. The prevalence of asymptomatic PE did not differ between the two groups. The rate of asymptomatic DVT tended to be higher in FVL negative group. In a multivariate analysis, we confirmed FVL to be positively associated with isolated DVT presentation (odds ratio OR 1.757; 95% confidence interval (CI) 1.148-2.690). On the contrary, increasing age and unprovoked nature of VTE event carried a higher risk of symptomatic PE., Conclusions: We confirmed FVL to be significantly associated with isolated symptomatic DVT despite higher prevalence of proximal DVT in FVL carriers. The fact of relatively lower risk of PE in FVL positive patients might have clinical implication. However, mechanisms of FVL paradox remain to be elucidated., (© The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Objective: Increased aortic stiffness may be one of the mechanisms by which obesity increases cardiovascular risk independently of traditional risk factors. While body mass index (BMI) is generally used to define excess adiposity, several studies have suggested that measures of central obesity may be better predictors of cardiovascular risk. However, data comparing the association between several measures of central and general obesity with aortic stiffness in the general population are inconclusive., Methods: In 1031 individuals (age 53 ± 13 years, 45% men) without manifest cardiovascular disease randomly selected from population, we tested the association between parameters of central obesity (waist circumference - WC, waist-to-hip-ratio - WHR, waist-to-height ratio - WHtR) and general obesity (BMI) with carotid-femoral pulse wave velocity (cfPWV)., Results: In univariate analysis, WC and WHtR were more strongly associated with cfPWV than BMI in both genders, while WHR showed a stronger association with cfPWV only in women. WHtR was more closely associated with cfPVW than WHR. This difference between obesity measures remained after multivariate adjustment. When the fully adjusted hierarchical regression was used, among central obesity measures, WHtR had the largest additive value on top of BMI, while there was no additive value of BMI on top of WHtR., Conclusion: Central obesity parameters are more closely associated with aortic stiffness than BMI. Of central adiposity measures, WHtR has the strongest association with aortic stiffness beyond body mass index and cardiovascular risk factors. Our results suggest that WHtR may be the best anthropometric measure of excess adiposity in the general population., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Aim: The aim of this paper was to assess the prevalence of concurrent deep vein thrombosis (DVT) and/or pulmonary embolism (PE) in the patients with superficial vein thrombosis (SVT) of the legs and to find factors significantly and independently associated with coincident DVT/PE., Methods: In the setting of a tertiary referral hospital, patients with SVT, attending vascular clinic, underwent physical examination, laboratory testing and leg vein ultrasound (in the case of clinically suspected PE also perfusion/ventilation lung scan or/and helical CT pulmonary angiography). In statistical analysis, we used unpaired t-test, non-parametric Wilcoxon rank sum test, stepwise logistic regression and multivariable logistic regression model., Results: We examined 138 patients (age 61.4 ± 13.9 years, 36.2% men), with ST mostly on varicose veins (89.9%). The prevalence of concurrent DVT/PE was 34.1%. Neither the clinical manifestation nor SVT localization differed significantly between the group with isolated SVT and that with coincident DVT/PE. Of all the assessed patients characteristics (age and sex, BMI, history of SVT, DVT or PE, hypercoagulable states, cardiovascular risk factors) only two factors were significantly and independently associated with the presence of concurrent DVT/PE. Log BMI was significantly higher in the patients with isolated SVT. Factor V Leiden (FVL) was proved as an independent risk factor for concomitant DVT/PE with odds ratio 2,531 (95% CI 1,064-6,016)., Conclusion: The prevalence of concurrent DVT/PE in patients with SVT, referred to hospital vascular clinic was 34.1%. Lower BMI (log BMI, respectively) and the presence of FVL were significantly and independently associated with concurrent DVT/PE. Our results should be further investigated in a larger prospective study.

Essential hypertension is a multifactorial disorder and is the main risk factor for renal and cardiovascular complications. The research on the genetics of hypertension has been frustrated by the small predictive value of the discovered genetic variants. The HYPERGENES Project investigated associations between genetic variants and essential hypertension pursuing a 2-stage study by recruiting cases and controls from extensively characterized cohorts recruited over many years in different European regions. The discovery phase consisted of 1865 cases and 1750 controls genotyped with 1M Illumina array. Best hits were followed up in a validation panel of 1385 cases and 1246 controls that were genotyped with a custom array of 14 055 markers. We identified a new hypertension susceptibility locus (rs3918226) in the promoter region of the endothelial NO synthase gene (odds ratio: 1.54 [95% CI: 1.37-1.73]; combined P=2.58 · 10(-13)). A meta-analysis, using other in silico/de novo genotyping data for a total of 21 714 subjects, resulted in an overall odds ratio of 1.34 (95% CI: 1.25-1.44; P=1.032 · 10(-14)). The quantitative analysis on a population-based sample revealed an effect size of 1.91 (95% CI: 0.16-3.66) for systolic and 1.40 (95% CI: 0.25-2.55) for diastolic blood pressure. We identified in silico a potential binding site for ETS transcription factors directly next to rs3918226, suggesting a potential modulation of endothelial NO synthase expression. Biological evidence links endothelial NO synthase with hypertension, because it is a critical mediator of cardiovascular homeostasis and blood pressure control via vascular tone regulation. This finding supports the hypothesis that there may be a causal genetic variation at this locus.

Aim: Residual thrombotic occlusion (RTO) after deep vein thrombosis (DVT) is considered as a risk factor of recurrent venous thromboembolism (VTE). We searched for risk factors associated with RTO after proximal DVT at the lower extremities., Methods: Using compression ultrasound, we evaluated the presence of RTO at 6 months after DVT (RTO defined as a residual thrombus occupying, at maximum compressibility, >/=20% of the vein lumen before compression)., Results: We examined 126 Czech patients: mean age 57.5 years; 50.0% women, 68.3% femoral location of DVT (otherwise popliteal), RTO found in 45.2%. While accounting for covariates, in the whole population, RTO was significantly associated with following factors: (OR; 95% confidence limit; p value): male sex (2.01; 1.27-3.19; P=0.003), femoral location (2.76; 1.59-4.78; P=0.0003). In women, but not in men, an association was demonstrated for: concurrent pulmonary embolism (PE) (18.51; 1.85-185.7; P=0.0131), diabetes mellitus (4.62; 1.38-15.51; P=0.0133) and statin use (0.11; 0.02-0.62; P=0.0125). In contrast, in men RTO was associated with an unprovoked DVT (2.6; 1.26-5.34; P=0.0094)., Conclusion: In the whole study population, male sex and femoral location of DVT were positively associated with RTO. In women, concurrent PE and diabetes mellitus were risk factors for RTO, while the use of statins was a protective factor. There was a positive association between RTO and unprovoked DVT in men. These findings deserve further evaluation in a larger study.

The objective of our study was to evaluate the significance of extended antiphospholipid profile in patients with venous thromboembolism without any systemic autoimmune disease. In 140 patients (age 18-69 years; 47.1% men) with venous thromboembolism and 136 control participants we tested anticardiolipin antibodies, anti-beta 2 glycoprotein I (anti-beta2-GPI) and also non-criteria antiphospholipid antibodies: antiphosphatidic acid, antiphosphatidylethanolamine, antiphosphatidylglycerol, antiphosphatidylinositol, antiphosphatidylserine. Commercial and in-house enzyme-linked immunosorbent assays were used. The antibodies with significantly higher prevalence in patients (compared to controls) were: immunoglobulin (Ig) M-anticardiolipin antibodies (12.9%; P = 0.035), IgG-anti-beta2-GPI (16.4%; P = 0.0032), IgM-antiphosphatidylethanolamine (14.3%; P = 0.014). In most cases, these three antibodies did not overlap. In conclusion, of non-criteria antiphospholipid antibodies, only antiphosphatidylethanolamine were significantly more prevalent in patients with venous thromboembolism, with only minor overlapping with the criteria antiphospholipid antibodies. Our results suggest the possible utility of searching for antiphosphatidylethanolamine in the clinical suspicion of antiphospholipid syndrome and the absence of criteria antiphospholipid antibodies.

Objective: To assess, in a population-based approach, sympathetic nervous system activity by the use of power spectral analysis of heart rate variability, in normotension, white-coat hypertension, masked hypertension and sustained hypertension., Methods: The electrocardiographic RR interval was registered in the supine and standing positions and the low-frequency and high-frequency components of its variability were quantified. Cut-off values of 140/90 mmHg for conventional blood pressure and 135/85 mmHg for daytime ambulatory blood pressure were used to define the four blood pressure groups., Results: After exclusion of patients with diabetes, myocardial infarction or treated hypertension, 1485 subjects with complete data remained for the analysis in the supine position. Age averaged 39 +/- 14 years; 54% were women. Conventional and ambulatory blood pressure averaged, respectively, 122 +/- 16/79 +/- 11 mmHg and 124 +/- 12/77 +/- 8 mmHg. After adjusting for demographic, anthropometric and lifestyle characteristics, the low-frequency to high-frequency ratio (geometric mean) averaged 0.81 in normotension and was significantly higher in white-coat hypertension (1.11; P < 0.001), based on a higher low-frequency component and a lower high-frequency component (P < 0.01). This ratio was not significantly different between normotension, masked hypertension (0.97) and sustained hypertension (0.93). The adjusted standing-to-supine ratio of the high-frequency component (geometric mean) was significantly higher in sustained hypertension (0.50) than in normotension (0.39; P < 0.01), but not in white-coat (0.40) and masked hypertension (0.45)., Conclusion: The findings at rest are compatible with increased sympathetic activity and decreased parasympathetic modulation in white-coat hypertension, with normal autonomic cardiac regulation in masked and sustained hypertension. In addition, sustained hypertension is characterized by a blunted decrease of the high-frequency component on standing.