Inter-arm difference of systolic blood pressure measured by automated double-cuff device is associated with arterial stiffness in patients with hypertension.
- 作者列表："Iida M","Ishiguro Y","Ueda N","Honjo H
PURPOSE:Inter-arm differences of SBP ≧5 mmHg have been associated with all-cause and cardiovascular mortalities in hypertensive subjects. Inter-arm differences of SBP appears to be mediated by arterial stiffness. We hypothesized inter-arm differences of SBP ≧5 mmHg may be related to higher pulse pressure/stroke volume index, a surrogate marker of arterial stiffness. MATERIALS AND METHODS:To obtain inter-arm differences of SBP (the absolute difference of right and left arm) and ankle-brachial index, bilateral blood pressures were measured simultaneously at the four limbs using an automated oscillometric device in patients with treated hypertension (n = 234) and in normotensive subjects (n = 40). Pulse pressure was calculated as SBP-DBP. Stroke volume was obtained by time-velocity integral method using echocardiography. Left ventricular mass and relative wall thickness were calculated by the conventional methods. RESULTS:All hypertensive patients were medically treated and had average blood pressure levels of 135/85 mmHg. Inter-arm differences of SBP ≧5 mmHg was detected in 26.5% of hypertensive patients. Hypertensive patients with inter-arm differences of SBP ≧5 mmHg had higher pulse pressure/stroke volume index, lower ankle-brachial index, higher BMI, and higher relative wall thickness, higher prevalence of female than those with inter-arm differences of SBP <5 mmHg. Multiple linear regression analysis confirmed inter-arm differences of SBP ≧5 mmHg was associated with higher pulse pressure/stroke volume index, higher relative wall thickness, and lower ankle-brachial index. CONCLUSION:Inter-arm difference of SBP measured by automated double-cuff device was related to large artery stiffness in patients with hypertension.
目的: 收缩压 ≥ 5 mmhg的臂间差异与高血压受试者的全因和心血管死亡率相关。SBP的臂间差异似乎是由动脉僵硬度介导的。我们假设SBP ≥ 5 mmhg的臂间差异可能与较高的脉压/每搏输出量指数 (动脉僵硬度的替代指标) 有关。 材料和方法: 采用自动示波仪对治疗的高血压患者 (n = 234) 在四肢同时测量双侧血压，以获得SBP (右臂和左臂的绝对差值) 和踝臂指数的臂间差异。和在正常血压受试者 (n = 40)。脉压计算为SBP-DBP。利用超声心动图通过时间-速度积分法获得每搏输出量。用常规方法计算左心室质量和相对室壁厚度。 结果: 所有高血压患者均接受药物治疗，平均血压水平为135/85 mmHg。在26.5% 的高血压患者中检测到SBP ≥ 5 mmhg的臂间差异。臂间差异SBP ≥ 5 mmhg的高血压患者脉压/每搏输出量指数较高，踝臂指数较低，BMI较高，相对壁厚度较高，女性患病率高于臂间差异SBP <5 mmhg者。多元线性回归分析证实SBP ≥ 5 mmhg的臂间差异与较高的脉压/每搏输出量指数、较高的相对壁厚度和较低的踝肱指数相关。 结论: 自动双袖套装置测量的收缩压臂间差异与高血压患者大动脉僵硬度有关。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.