Zsuzsanna Jeremiás, Katalin Makó, Anca Bogdan, Ioana Miu, Alexandra Șerdean and Theodora Benedek
Introduction: The burden of coronary artery disease (CAD) and peripheral vascular pathologies caused by atherosclerosis is constantly increasing. There is continuous research aiming to develop new methods that can evaluate the extent of atherosclerotic disease in different vascular beds, thus estimating global risk. Similar to carotid artery thickness, which is an established marker for increased cardiovascular risk and cerebrovascular disease, femoral intima-media thickness (f-IMT) may have the same role in case of peripheral arterial involvement. The aim of the study was determine whether f-IMT, determined at the level of the superficial femoral artery, is related to traditional risk factors, markers of peripheral vascular atherosclerosis and inflammation.
Material and methods: Forty-six patients with known cardiovascular disease were included in the study. Demographical data, cardiovascular history, and risk factors were assessed. We determined metabolic parameters (uric acid, fasting glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides), renal function (creatinine and GFR), and inflammation status for all patients. Each patient underwent ultrasound examination of the superficial femoral artery, by which f-IMT was determined for right and left limbs. Ankle-brachial index was also calculated. Data from the low (f-IMT <0.75 mm) and high (f-IMT >0.75 mm) f-IMT groups were compared and correlation coefficients were determined in each groups for f-IMT in relation to the other parameters.
Results: Mean age was 71.08 ± 9.78 years. 86.95% of the patients suffered from hyper-tension, 56.62% had coronary heart disease, and 21.73% had a history of stroke. More females had history of hypertension and CAD. The most prevalent cardiovascular risk factors were dyslipidemia (68.86%), diabetes (21.73%), and smoking (21.73%). There were significant differences between gender groups for total cholesterol levels (161.36 ± 25.04 mg/dL, 95%CI 150.26–172.47 in males vs. 201.33 ± 52.73 mg/dL, 95%CI 170.07–223.60 in females, p = 0.02), creatinine values (1.04 ± 0.22 mg/dL, 95%CI 0.94–1.14 for males vs. 0.91 ± 0.23 mg/dL, 95%CI 0.81–1.00 for females, p = 0.018), and left f-IMT (0.87 ± 0.18 mm, 95%CI 0.79–0.95 for males vs. 0.75 ± 0.10 mm, 95%CI 0.70–0.79 for females, p = 0.0049). In the group with low f-IMT, a significant, reverse correlation was established between f-IMT, uric acid (r = −0.483, p = 0.042), and right ABI (r = −730, p = 0.0006). In the group with high f-IMT, age (r = 0.408, p = 0.031), fasting glucose (r = 0.407, p = 0.034), total cholesterol (r = 0.429, p = 0.02), HDL-cholesterol (r = −0.56, p = 0.0019), triglycerides (r = 0.45, p = 0.01), hs-CRP (r = 0.45, p = 0.01), and left ABI (r = −0.71, p <0.0001) showed a significant correlation to f-IMT.
Conclusions: Increased femoral intima-media thickness is related to age, cardiovascular risk factors, and markers of peripheral arterial disease. Patients with higher f-IMT have a more augmented inflammatory status. Based on these correlations, in patients with cardiovascular disease, f-IMT could become a marker for increased cardiovascular risk.
Mako Katalin, Ureche Corina and Jeremias Zsuzsanna
Ambulatory blood pressure monitoring (ABPM) became a subject of considerable scientific interest. Due to the increasing use of the ABPM in everyday clinical practice it is important that all the users have a correct knowledge on the clinical indications, the methodology of using the device including some technical issues and the interpretation of results. In the last years several guidelines and position papers have been published with recommendations for the monitoring process, reference values, for clinical practice and research. This paper represents a summary of the most important aspects related to the use of ABPM in daily practice, being a synthesis of recommendations from the recent published guidelines and position papers. This reference article presents the practical and technical issues of ABPM, the use of this method in special situations, the clinical interpretation of measured values including the presentation of different ABPM patterns, derived parameters, the prognostic significance and the limitations of this method.
Katalin Makó, Corina Ureche and Zsuzsanna Jeremiás
A hypertensive crisis is an abrupt and severe rise in the arterial blood pressure (BP) occurring either in patients with known essential or secondary hypertension, or it may develop spontaneously. The most frequent cause for the severe and sudden increase in BP is inadequate dosing or stopping antihypertensive treatment in hypertensive patients. Severe hypertension can be defined as either a hypertensive emergency or an urgency, depending on the existence of organ damage. In hypertensive urgencies, there are no signs of acute end-organ damage, and orally administered drugs might be sufficient. In hypertensive emergencies, signs of acute end-organ damage are present, and in these cases, quickly-acting parenteral drugs must be used. The prompt recognition, assessment, and treatment of hypertensive urgencies and emergencies can decrease target organ damage and mortality. In this review, the definitions and therapeutic recommendations in a hypertensive crisis are presented in the light of the 2017 ACC/AHA Hypertension Guidelines.
Norbert A. Szekeres, Zsuzsánna Jeremiás, Árpád Olivér Vida, Orsolya Mártha and Daniel Porav-Hodade
It is estimated that erectile dysfunction (ED) affects more than 150 million people worldwide and this number is expected to double by the year 2025. Vascular component represents the most important etiological cause of erectile dysfunction. ED shares almost all risk factors, such as hypertension, diabetes mellitus, hyperlipidaemia and smoking, with arteriosclerosis. Moderate to severe ED is associated with a considerably increased risk for coronary heart disease (CHD). This review was conducted in May 2016, when the PubMed database was searched using the combination of the terms “erectile dysfunction” and “cardiovascular diseases”, “coronary artery diseases” and “risk factors”. In this review, we analyzed the published literature, regarding the predictive role of ED in CVD and the association of ED risk factors with CVD risk factors, aiming to draw particular attention on the role of sexual inquiry of all men to prevent or decrease major cardiovascular events. In conclusion, the early detection of ED can prevent major cardiovascular events with early management of cardiovascular risk and permits to include patients in a risk stratification group. Erectile function should be evaluated using questionnaires in all male patients to prevent and decrease the rates of major cardiovascular events.
Zsuzsanna Jeremiás, Katalin Makó, Norbert Szekeres, Emese Rapolti, Imre Benedek and Theodora Benedek
Background: Atherosclerosis has a systemic impact, producing gradual stenoses of the main vessels, and many imaging techniques have been developed in order to detect and quantify the atherosclerotic lesions. Peripheral artery disease has been shown to be associated with the presence of coronary heart disease, at the same time with carotid artery involvement. The utility of the carotid artery intima-media thickness (IMT) in predicting cardiovascular events caused by atherosclerosis, led to the idea that assessing the femoral artery IMT could have a similar impact.
Study aim: We sought to determine the correlations between the femoral IMT, the degree of left ventricular systolic dysfunction and cardiovascular risk factors in patients with established diagnosis of ischemic heart disease.
Material and methods: We prospectively included 27 patients with diagnosed ischemic heart disease. The ankle-brachial index (ABI) was assessed for the anterior and posterior tibial arteries. The left ventricular ejection fraction (LVEF) was determined by echocardiography. The femoral IMT was measured by peripheral vascular ultrasound, at the common femoral artery, 1 cm proximally from the bifurcation. The patients were divided into 2 groups: Group 1 – patients with IMT<0.9mm, and Group 2: patients with IMT >0.9 mm.
Results: The mean age of the study population was 65.52 ± 11.44 years, and 77.77% were males. The mean glycemia levels were 99.89 ± 30.34 mg/dl, total cholesterol: 176.81 ± 43.09 mg/dl and the mean triglyceride level 140 ± 65.12mg/dl. The mean LEVF was 49.98% ± 12.73%, and femoral IMT 0.75 mm ± 0.25 mm. IMT significantly correlated with cholesterol levels (R = 0.383, p = 0.048), anterior and posterior tibial artery pressures (R = 0.450, p = 0.018, R = 0.418, p = 0.029 respectively) and ABI (R = 0.623, p = 0.005). There was no significant correlation between the LVEF and the IMT (R = −0.143, p = 0.475). There was a significant difference between the 2 groups regarding the minimum anterior tibial artery pressure (95.57 mmHg vs. 63.5 mmHg, p = 0.0011) and the minimum ABI (0.85 vs. 0.5, p = 0.015), and the femoral IMT (p = 0.0001). For patients with a femoral IMT >0.9 mm, a significant correlation was found between ABI and femoral IMT (R = −0.710, p <0.0001).
Conclusion: The femoral intima-media thickness, assessed with peripheral vascular ultrasound, could be a new marker in evaluating the global cardiovascular risk in patients with ischemic heart disease. Femoral IMT could become a new marker for systemic atherosclerosis.