Unrecognized myocardial infarction assessed by CMR is associated with hemodynamically significant stenosis at coronary angiography in patients with stable angina pectoris
P. Hammar, O. Duvernoy, B. Lindahl, H. Ahlstrom, A. M. Nordenskjold, N. Hadziosmanovic, L. O. Johansson, T. Bjerner
2013
European Heart Journal
818 Hypertension and comorbidities / Cardiovascular magnetic resonance in ischaemia present study we sought to investigate their potential associations with left ventricular function and vascular properties in essential hypertension. Methods: The study population consisted of 319 untreated patients, newly diagnosed stage I-II essential hypertension and a control group, consisted of 191 age-matched for classical cardiovascular risk factors. The gene mutations frequencies was determined using
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... merase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. In all participants, flow mediated dilation (FMD), pulse wave velocity (PWV), intima-media thickness (IMT), as well as the incidence and progression of retinopathy were evaluated. Left cardiac indices were assessed by echocardiography. Glomerular filtration rate (GFR) was estimated by Cockcroft-Gault formula. Results: 235TT homozygotes compared with M-carriers had significantly lower FMD in controls (p=0.038) and higher PWV values in hypertensive patients (p=0.025). Regarding other vascular properties no other significant associations were observed. TT homozygosity showed a trend towards lower GFR compared with MM+MT genotype in hypertensive patients (99.9±30.2 vs 106.8±35.3 mL/min/1.73 m 2 , p=0.067) but neither genotype was associated with increased creatinine. Notably, we observed higher values of IMT in -344TT homozygosity, in the group of hypertensives (781.6±33.5 vs 712.5±16.2 μm, p=0.039). Moreover, -344TT hypertensives exhibited higher values of left ventricular mass index compared to C-allele carriers (p=0.020) and higher prevalence of concentric hypertrophy (p<0.001). Conclusions: The present study suggests that aldosterone synthase is associated with left ventricular hypertrophy, while angiotensinogen is associated with endothelial dysfunction, increased IMT and arterial stiffness in untreated hypertension. These findings suggest that both variants play important role in the pathophysiology of hypertension. Purpose: The association of impaired kidney function with incidence of atrial fibrillation (AF) is still unclear. We investigated the predictive value of chronic kidney disease (CKD) for the development of AF in treated hypertensive patients. Methods: We followed 1651 treated hypertensive patients (47% males, aged 57±11 years) without a history of cardiovascular disease or AF episodes for a mean period of 3.9 years. At baseline, clinical data were collected, and transthoracic echocardiography and electrocardiography and routine blood testing were performed. Glomerular filtration rate (eGFR) was estimated with the Modification of Diet in Renal Disease equation and CKD was defined as an eGFR<60ml/min/1.73m 2 . Endpoint of interest was new-onset AF defined as hospitalization for AF or compatible ECG tracings. In case of multiple episodes of AF, only the first was recorded as an event Results: There were 48 cases of AF documented during follow-up. Patients with AF were older (by 9,1 years, p<0.001), had a larger waist (by 4.13cm, p=0.017), longer-standing hypertension (by 3.43 years, p=0.011), a larger left ventricular mass index (LVMI) (by 13.4g/m 2 , p=0.001) and left atrial diameter (by 4.0mm, p<0.001) and a lower eGFR (by 5.6ml/min/1.73m 2 , p=0.034). Unadjusted analysis revealed that CKD was associated with a higher risk of 1.99 (CI:1.02-3.90, p=0.045) for development of AF. However, this risk was attenuated and nonsignificant after controlling for established clinical and echocardiographic risk factors for AF. Conclusions: In treated hypertensive patients, CKD is associated with an almost double risk for new-onset AF, but this risk is non-significant after adjusting for other AF risk predictors. CARDIOVASCULAR MAGNETIC RESONANCE IN ISCHAEMIA | BEDSIDE Unrecognized myocardial infarction assessed by CMR is associated with hemodynamically significant stenosis at coronary angiography in patients with stable angina pectoris
doi:10.1093/eurheartj/eht310.4469
fatcat:pifx4k43p5eejivakmxkczvso4