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ABSTRACT: Objective: Carotid intima-media thickness (IMT) may potentially supplement cardiovascular risk assessment in Turner syndrome (TS), where cardiovascular risk is high and appropriate risk stratification difficult. Knowledge of intima-media thickness in TS is scarce, and this study aimed to enhance insight into the cardiovascular risk marker. Design, Patients and Measurements: IMT was cross-sectionally assessed by ultrasonography of the common carotid artery (cIMT) and carotid bulb (bIMT) in TS (n=69, age 40 ± 10 years) and age-matched, healthy female controls (n=67). Additional prospective IMT assessment was performed in TS over 2.4 ± 0.3 years. Metabolic biomarkers and 24-hour ambulatory blood pressure were also assessed. Results: cIMT and bIMT (body surface area indexed) were increased in TS (P<0.05) with 17-18% having IMTs that exceeded the 95(th) percentile of the controls (P<0.05). Blood pressure, heart rate, HbA1c and high-density lipoprotein cholesterol were increased in TS, where 43% received antihypertensive treatment. cIMT decreased during follow-up, coinciding with intensified cardiovascular risk prophylaxis whereas bIMT was unchanged. In multiple regression analyses (R=0.52-0.69, P<0.05) baseline IMT in TS increased with age, blood pressure and cholesterol as well as in the presence of diabetes whilst IMT was inversely associated with duration of oestrogen replacement. In an analogue analysis, the prospective changes in cIMT (R=0.37, P<0.05) were beneficially influenced by antihypertensive treatment and oestrogen therapy and adversely by the presence of diabetes. Conclusion: Carotid IMT was abnormal in TS and negatively influenced by age, metabolic biomarkers, blood pressure and short duration of oestrogen treatment. Attention to common cardiovascular and endocrine risk markers over more than two years appeared to influence IMT beneficially. © 2012 Blackwell Publishing Ltd.
Clinical Endocrinology 01/2012; · 3.17 Impact Factor
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ABSTRACT: Childhood nonalcoholic fatty liver disease (NAFLD) associated with insulin resistance and obesity is a growing problem and increases the risk of cirrhosis, type 2 diabetes mellitus, and cardiovascular complications. We examined the effects of a 10-week "weight loss camp" residency in obese children on the prevalence and degree of NAFLD and insulin sensitivity with 12-month follow-up.
At the camp, 117 obese white children (body mass index 28.0 ± 3.6 kg/m, age 12.1 ± 1.3 years) exercised moderately for 1 hour/day and restricted their energy intake to induce weight loss. NAFLD was diagnosed and graded using ultrasound and transaminasemia. Insulin sensitivity and glucose tolerance were assessed using homeostasis model assessment and oral glucose tolerance test. We performed anthropometric measurements and determined body composition using bioimpedance. Data were collected from 71 of 117 children at entry, after the 10 weeks at the camp, and 12 months after the camp ended.
The children showed an average weight loss of 7.1 ± 2.7 kg during the camp. At baseline, 43% had ultrasonographic liver steatosis, 50% elevated transaminases (>25 IU/L), and reduced insulin sensitivity. These abnormalities were mutually related and improved significantly during the camp (P ≤ 0.05). Liver fat improvement was sustained at 12 months. At the 12-month follow-up, 17 of 71 (24%) children maintained the body weight.
This short-term diet and exercise program induced weight loss, markedly improved all aspects of the threatening condition of NAFLD, and reduced insulin sensitivity in childhood obesity; 24% of the children maintained weight loss at least until the 12-month follow-up.
Journal of pediatric gastroenterology and nutrition 07/2011; 54(2):223-8. · 2.18 Impact Factor
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ABSTRACT: The risk of aortic dissection is 100-fold increased in Turner syndrome (TS). Unfortunately, risk stratification is inadequate due to a lack of insight into the natural course of the syndrome-associated aortopathy. Therefore, this study aimed to prospectively assess aortic dimensions in TS.
Eighty adult TS patients were examined twice with a mean follow-up of 2.4 ± 0.4 years, and 67 healthy age and gender-matched controls were examined once. Aortic dimensions were measured at nine predefined positions using 3D, non-contrast and free-breathing cardiovascular magnetic resonance. Transthoracic echocardiography and 24-hour ambulatory blood pressure were also performed.
At baseline, aortic diameters (body surface area indexed) were larger at all positions in TS. Aortic dilation was more prevalent at all positions excluding the distal transverse aortic arch. Aortic diameter increased in the aortic sinus, at the sinotubular junction and in the mid-ascending aorta with growth rates of 0.1 - 0.4 mm/year. Aortic diameters at all other positions were unchanged. The bicuspid aortic valve conferred higher aortic sinus growth rates (p < 0.05). No other predictors of aortic growth were identified.
A general aortopathy is present in TS with enlargement of the ascending aorta, which is accelerated in the presence of a bicuspid aortic valve.
Journal of Cardiovascular Magnetic Resonance 01/2011; 13:24. · 3.72 Impact Factor
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ABSTRACT: Ectatic aortopathy and arterial abnormalities cause excess morbidity and mortality in Turner syndrome, where a state of vasculopathy seemingly extends into the major head and neck branch arteries.
We investigated the prevalence of abnormalities of the major intrathoracic arteries, their interaction with arterial dimensions, and their association with karyotype.
Magnetic resonance imaging scans determined the arterial abnormalities as well as head and neck branch artery and aortic dimensions in 99 adult women with Turner syndrome compared with 33 healthy female controls. Echocardiography determined aortic valve morphology.
In Turner syndrome, the relative risk of any congenital abnormality was 7.7 (p = 0.003) and 6.7 of ascending aortic dilation (p = 0.02). A bovine aortic arch was seen in both Turner syndrome and controls. Other abnormalities were only encountered in Turner syndrome: elongated transverse aortic arch (47%), bicuspid aortic valve (27%), aortic coarctation (13%), aberrant right subclavian artery (8%), and aortic arch hypoplasia (2%). The innominate and left common carotid arteries were enlarged in Turner syndrome (p < 0.001). Significant associations were first, bicuspid aortic valve with aortic coarctation, elongated transverse aortic arch, and ascending aortic dilation; second, aortic coarctation with elongated aortic arch and descending aortic dilation; third, 45,X with aortic coarctation, elongated transverse aortic arch and ascending aortic dilation; and fourth, branch artery dilation with bicuspid aortic valve, aortic coarctation, elongated transverse aortic arch and 45,X.
An increased risk of arterial abnormalities, aortic dilation, and enlargement of the branch arteries was found in Turner syndrome without distinct patterns of co-segregation.
Cardiology in the Young 03/2010; 20(2):191-200. · 0.76 Impact Factor
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Britta E Hjerrild,
Kristian H Mortensen,
Keld E Sørensen,
Erik M Pedersen,
Niels H Andersen,
Erik Lundorf,
Klavs W Hansen, Arne Hørlyck,
Alfred Hager,
Jens S Christiansen,
Claus H Gravholt
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ABSTRACT: To investigate aortic dimensions in women with Turner syndrome (TS) in relation to aortic valve morphology, blood pressure, karyotype, and clinical characteristics.
A cross sectional study of 102 women with TS (mean age 37.7; 18-62 years) examined by cardiovascular magnetic resonance (CMR- successful in 95), echocardiography, and 24-hour ambulatory blood pressure. Aortic diameters were measured by CMR at 8 positions along the thoracic aorta. Twenty-four healthy females were recruited as controls. In TS, aortic dilatation was present at one or more positions in 22 (23%). Aortic diameter in women with TS and bicuspid aortic valve was significantly larger than in TS with tricuspid valves in both the ascending (32.4 +/- 6.7 vs. 26.0 +/- 4.4 mm; p < 0.001) and descending (21.4 +/- 3.5 vs. 18.8 +/- 2.4 mm; p < 0.001) aorta. Aortic diameter correlated to age (R = 0.2 - 0.5; p < 0.01), blood pressure (R = 0.4; p < 0.05), a history of coarctation (R = 0.3; p = 0.01) and bicuspid aortic valve (R = 0.2-0.5; p < 0.05). Body surface area only correlated with descending aortic diameter (R = 0.23; p = 0.024).
Aortic dilatation was present in 23% of adult TS women, where aortic valve morphology, age and blood pressure were major determinants of the aortic diameter.
Journal of Cardiovascular Magnetic Resonance 03/2010; 12:12. · 3.72 Impact Factor
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Britta Hjerrild,
Kristian Mortensen,
Keld Sørensen,
Erik Pedersen,
Niels Andersen,
Erik Lundorf,
Klavs Hansen, Arne Hørlyck,
Alfred Hager,
Jens Christiansen,
Claus Gravholt
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ABSTRACT: Abstract
Background
To investigate aortic dimensions in women with Turner syndrome (TS) in relation to aortic valve morphology, blood pressure, karyotype, and clinical characteristics.
Methods and results
A cross sectional study of 102 women with TS (mean age 37.7; 18-62 years) examined by cardiovascular magnetic resonance (CMR- successful in 95), echocardiography, and 24-hour ambulatory blood pressure. Aortic diameters were measured by CMR at 8 positions along the thoracic aorta. Twenty-four healthy females were recruited as controls. In TS, aortic dilatation was present at one or more positions in 22 (23%). Aortic diameter in women with TS and bicuspid aortic valve was significantly larger than in TS with tricuspid valves in both the ascending (32.4 ± 6.7 vs. 26.0 ± 4.4 mm; p < 0.001) and descending (21.4 ± 3.5 vs. 18.8 ± 2.4 mm; p < 0.001) aorta. Aortic diameter correlated to age (R = 0.2 - 0.5; p < 0.01), blood pressure (R = 0.4; p < 0.05), a history of coarctation (R = 0.3; p = 0.01) and bicuspid aortic valve (R = 0.2-0.5; p < 0.05). Body surface area only correlated with descending aortic diameter (R = 0.23; p = 0.024).
Conclusions
Aortic dilatation was present in 23% of adult TS women, where aortic valve morphology, age and blood pressure were major determinants of the aortic diameter.
Journal of Cardiovascular Magnetic Resonance. 01/2010;
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ABSTRACT: We have previously demonstrated renal enlargement in pigs treated with ciclosporin A (CsA) 10 mg/kg/day orally for 6 months. The aim of the study was to investigate the effect of oral CsA (10 mg/kg/day) for 12 months on kidney structure and function and the potential renoprotective role of angiotensin II (Ang II) receptor blocker telmisartan on chronic CsA nephrotoxicity in pigs.
Fourteen Göttingen minipigs aged 12-14 months were included: pigs received either CsA 10 mg/kg/day (n = 7) or CsA 10 mg/kg/day + telmisartan 40 mg/day (n = 7) orally for 12 months. At week 0, 12, 31, 38, 47 and 54, we measured body weight, mean arterial blood pressure (MAP), serum creatinine, whole blood trough CsA, plasma Ang II, haemoglobin and liver function parameters. Magnetic resonance imaging was used to estimate kidney length, volume, relative glomerular filtration rate (rGFR) and renal blood flow (RBF). Kidney tissue biopsies were used for conventional histological examination.
Plasma Ang II levels were significantly higher during telmisartan treatment. Interstitial fibrosis and glomerulosclerosis occurred in both groups, but were attenuated in the telmisartan-treated pigs (P = 0.064). A significant increase in renal volume was seen in both groups, but tended to be lower in the CsA + telmisartan pigs at 54 weeks (P = 0.097). Telmisartan did not reduce MAP, RBF or rGFR.
Long-term CsA treatment causes histopathological changes in the porcine kidney similar to those observed in humans and results in renal enlargement. Telmisartan attenuates the CsA-induced histopathological changes and enlargement in the pig kidney.
Nephrology Dialysis Transplantation 03/2007; 22(2):369-75. · 3.40 Impact Factor
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ABSTRACT: To evaluate the role of renal resistive index (RI) measures in the diagnostic work up of congenital hydronephrosis.
Seventeen neonatal pigs were randomized to either left-sided partial unilateral ureteral obstruction (n=12) or sham operation (n=5) at 2 weeks of age. Serial investigations including B-mode ultrasound, RI measures and combined clearance/renographic evaluations were performed at 4, 12 and 24 weeks of age under light sedation. Results were analysed statistically, and receiver operating characteristic (ROC) curves were generated in order to evaluate the diagnostic efficacy of RI.
In all, 15 animals completed the study protocol. In the obstructed group, hydronephrosis and significant compromise of renal function developed on the subject side, whereas sham-operated pigs had stable renal morphology and function throughout the study. There were however no significant differences in RI or DeltaRI between the two groups at any age, or between right and left RIs in the obstructed group at any point. RI and DeltaRI had no prognostic or diagnostic value as judged by ROC curve analysis.
RI and DeltaRI were not affected by partial unilateral ureteral obstruction induced in the immature neonatal porcine kidney. The results of this study do not support the clinical use of Doppler ultrasound studies in the diagnostic work up of congenital hydronephrosis.
Journal of pediatric urology 09/2006; 2(4):316-22. · 1.38 Impact Factor
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ABSTRACT: To study the effects of acute complete unilateral ureteral obstruction (UUO) and release on porcine renal resistive index (RI).
Under general anesthesia, UUO was induced in six pigs. RI was measured bilaterally at predetermined intervals for 4 hours of UUO and 1 hour of release. Additionally, measures of renal blood flow (RBF), glomerular filtration rate (GFR), arterial blood pressure, renal vascular resistance (RVR), and ipsilateral renal intrapelvic pressure (IPP) were obtained.
UUO and resultant progressive IPP increase caused prompt and significant ipsilateral RI elevation, and contralateral RI decrease. Concomitantly, ipsilateral RVR increased significantly while RBF and GFR declined, both significantly. Release of obstruction saw an almost immediate normalization of ipsilateral RI, RVR and RBF while ipsilateral GFR assumed 80% of baseline value 15 minutes postobstruction. Throughout the experiment, ipsilateral RI correlated significantly with changes in IPP, GFR, RBF, and RVR with correlation coefficients of 0.844, -0.851, -0.898, and 0.836 respectively ( < 0.001).
UUO causes a divergent RI response that is instantly reversed upon release. IPP seems to be the principal effector of these changes in the early phases of UUO.
Investigative Radiology 04/2003; 38(3):153-8. · 4.59 Impact Factor
