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ABSTRACT: BACKGROUND: It was reported that many recognized cardiovascular risk factors were no longer valid in the very elderly and, sometimes, even act in the opposite direction. It remains unclear which cardiovascular risk factors are still vital for death prediction in the oldest-old population. METHODS: We assessed cardiac abnormalities and dysfunction by ultrasonography and electrocardiography, blood pressure and arterial stiffness by BP monitor and tonometry, and biochemical parameters by routine laboratory assay, and investigated their associations with all-cause mortality in 331 hospitalized elderly patients (mean age±standard deviation: 87±7years). After a mean follow-up of 378days, 110 deaths occurred. RESULTS: As compared with survivals, patients with all-cause mortality had significantly lower left ventricular ejection fraction (LVEF) (57.5±13.8% vs 62.4±11.2%, P=0.002), low-density lipoprotein (LDL) (3.13±0.98 vs 3.56±0.98mmol/L, P<0.001) and high-density lipoprotein (HDL) cholesterol (1.06±0.30 vs 1.14±0.32mmol/L, P=0.04), albumin (33.1±5.4 vs 35.1±4.5g, P=0.002), and creatinine clearance rate (Ccr) (42.4±19.4 vs 55.8±28.2mL/min, P<0.001), and higher incidence of atrial fibrillation (26.4% vs 12.7%, P=0.002). In multivariate Cox regression model, LVEF, atrial fibrillation, LDL cholesterol, albumin and Ccr were significant and independent death predictors with hazard ratios of 0.82 (0.70, 0.97), 1.74 (1.11, 2.74), 0.70 (0.57, 0.87), 0.66 (0.54, 0.82) and 0.57 (0.44, 0.75), respectively. CONCLUSIONS: In the last stage of lifespan, cardiac systolic dysfunction and atrial fibrillation, as well as malnutrition and renal insufficiency, are crucial risk factors, which should be fully considered in the risk assessment strategy of the hospitalized elderly with cardiovascular diseases.
International journal of cardiology 04/2013; · 7.08 Impact Factor
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ABSTRACT: Although many studies focus on patients with resistant hypertension, general practitioners (GPs) are more likely to face patients in clinical practice with not-at-goal hypertension, whose antihypertensive treatment needs to be modified. However, information regarding such patients is limited. In the present study, 710 GPs in France each included their first 10 not-at-goal hypertensive patients, ie, the patients for whom they decided to modify antihypertensive treatment. The study population was composed of 7032 patients (58% men, mean age 62.4±11.5 years). Anthropometric and biologic measurements and clinical data were collected, and vascular age and 10-year cardiovascular risk were estimated by standard formula. Of 7032 participants, cardiovascular risk factors were prevalent, with 15.1% current smokers, 26.1% obese, 22.8% with diabetes mellitus, 35.1% with dyslipidemia, 12.0% with left ventricular hypertrophy, and 4.9% with renal insufficiency. In the subgroup (n=4697) of patients aged between 30 and 74 years and undergoing primary cardiovascular prevention, vascular age was superior (13 to 28 years) when compared with chronological age in different subgroups. The patients' estimated 10-year cardiovascular global risk was 25.3±13.6%, with 16.0±10.5% for coronary heart disease, 8.7±6.8% for myocardial infarction, 5.8±4.5% for stroke, and 6.8±6.6% for cardiovascular mortality. Patients with not-at-goal hypertension in primary care bear a heavy burden of cardiovascular diseases.
Journal of Clinical Hypertension 04/2013; 15(4):291-5. · 1.83 Impact Factor
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Journal of Hypertension 03/2013; 31(3):554-559. · 4.02 Impact Factor
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ABSTRACT: BACKGROUND:: Although aortic pulse wave velocity (PWV) has been accepted as gold standard of arterial stiffness, characteristics of PWVs in other arteries have never been reported. METHODS:: We measured carotid-femoral, carotid-pedis, carotid-radial, and femoral-pedis PWVs by a validated tonometry PulsePen, and assessed body fat percentage by bioelectrical impedance analyzer, carotid intima-media thickness (IMT) by ultrasonograph, and other cardiovascular risk factors, in 198 patients from our ambulatory cardiovascular department. RESULTS:: Carotid-femoral and carotid-pedis PWVs increased significantly and progressively with age in both men and women (P ≤ 0.03), whereas only in men, a slight increase and decrease in carotid-radial and femoral-pedis PWVs, respectively, were detected with aging (P ≤ 0.006). Carotid-femoral and carotid-pedis PWVs, but not carotid-radial and femoral-pedis PWVs, were significantly associated with age, body height and body fat percentage, brachial mean blood pressure (MBP), and pulse pressure (PP), carotid PP, PP amplification, carotid IMT, plasma glucose and taking antihypertensive agent (P ≤ 0.047). In full adjustment models, carotid-femoral PWV increased by 0.89 ± 0.21, 0.38 ± 0.13, 0.74 ± 0.26, 0.40 ± 0.16, 0.51 ± 0.23 m/s, with an increase of 10 years in age, of 1 mmol/l in plasma glucose, of 10 mmHg in brachial PP, of 100 μm in IMT, and of 10 mmHg in brachial MBP, respectively, whereas carotid-pedis PWV increased by 0.31 ± 0.11 and 0.33 ± 0.12 m/s with an increase of 10 years in age and of 10 mmHg in brachial MBP, respectively. CONCLUSION:: Arterial stiffness in elastic arteries, but not in muscular arteries, increased significantly and progressively with age, and was more closely correlated to BP, plasma glucose and arterial thickness.
Journal of hypertension 03/2013; 31(3):554-559. · 4.02 Impact Factor
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ABSTRACT: In clinical practice, general practitioners are likely to face hypertensives with uncontrolled blood pressure (BP), whose antihypertensive treatment need to be modified. In the present study, 710 general practitioners have each included the first 10 patients with not-at-goal hypertension, for whom they decided to modify their antihypertensive treatment with addition of a fixed combination of Perindopril and Amlodipine at either of its four dosages: 5/5, 5/10, 10/5, or 10/10 mg. In total, 6256 patients were included, with BP measured both at baseline and after 3 months. At the end of follow-up, a mean reduction of 20.3 ± 12.4 mm Hg in systolic BP and 11.3 ± 9.6 mm Hg in diastolic BP were observed, and 62.3% achieved successful BP control. Body mass index and waist circumference were significant determinants of both systolic and diastolic BP reductions (P ≤ .04). Moreover, in addition to baseline BP level, body mass index was the only significant determinant of BP control of systolic, diastolic BP, and of both (P ≤ .04). Addition of a fixed combination of Perindopril and Amlodipine to BP regimen was efficient, in terms of BP control, for 62.3% of those patients with not-at-goal hypertension. Furthermore, baseline BP level and obesity were important influential factors of BP control.
Journal of the American Society of Hypertension (JASH) 02/2013;
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ABSTRACT: BACKGROUND Although tonometry-based devices have been applied in several population studies and clinical trials, the agreement between them remains unclear. METHODS Carotid systolic blood pressure (SBP) and augmentation index (AI) were randomly measured from 3 devices, SphygmoCor, PulsePen, and A-Pulse, in 66 consecutive patients from our ambulatory cardiovascular department. The study contains 2 phases: in Study 1, SphygmoCor and PulsePen were performed on each participant by 2 experienced physicians (n = 66); in Study 2, A-Pulse was added after the measurements of SphygmoCor and PulsePen and performed by another technician on the last 34 patients. RESULTS Carotid SBP and AI measured by the 3 devices were strongly correlated (R ≥ 0.78; P < 0.001), but with significant discrepancies. Specifically, in 66 participants of Study 1, PulsePen estimated higher carotid SBP and AI by 5mm Hg and 5.7%, respectively, than SphygmoCor. In 34 patients of Study 2, A-Pulse estimated higher central SBP by 3.7mm Hg than SphygmoCor, and lower central SBP by 5.7mm Hg than PulsePen. However, no significant difference in interclass comparison was detected between the 3 devices (P ≥ 0.26). Furthermore, slopes of correlation plots of parameters between SphygmoCor and PulsePen were not significantly different from 1 (P ≥ 0.09), but were different in the case of A-Pulse (P ≤ 0.004). CONCLUSIONS Tonometry-based devices were not consistent in measurements of central BP and wave reflections in clinical practice, with considerable and significant differences among them. However, in contrast to A-Pulse, SphygmoCor and PulsePen can probably assess similar cardiovascular risk for individuals, with a systematical discrepancy.
American Journal of Hypertension 01/2013; 26(1):34-41. · 3.18 Impact Factor
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ABSTRACT: BACKGROUND: Cardiac structure and function are well-studied in western countries. However, epidemiological data is still scarce in China. METHODS: Our study was conducted in the framework of cardiovascular health examinations for the current and retired employees of a factory and their family members. According to the American Society of Echocardiography recommendations, we performed echocardiography to evaluate cardiac structure and function, including left atrial volume, left ventricular hypertrophy and diastolic dysfunction. RESULTS: The 843 participants (43.0 years) included 288 (34.2%) women, and 191 (22.7%) hypertensive patients, of whom 82 (42.9%) took antihypertensive drugs. The prevalence of left atrial enlargement, left ventricular hypertrophy and concentric remodeling was 2.4%, 5.0% and 12.7%, respectively. The prevalence of mild and moderate-to-severe left ventricular diastolic dysfunction was14.2% and 3.3%, respectively. The prevalence of these cardiac abnormalities significantly (P [less than or equal to] 0.002) increased with age, except for the moderate-to-severe left ventricular diastolic dysfunction. After adjustment for age, gender, body height and body weight, left atrial enlargement was associated with plasma glucose (P = 0.009), and left ventricular hypertrophy and diastolic dysfunction were significantly associated with systolic and diastolic blood pressure (P [less than or equal to] 0.03). CONCLUSIONS: The prevalence of cardiac structural and functional abnormalities increased with age in this Chinese population. Current drinking and plasma glucose had an impact on left atrial enlargement, whereas systolic and diastolic blood pressures were major correlates for left ventricular hypertrophy and diastolic dysfunction, respectively.
BMC Cardiovascular Disorders 10/2012; 12(1):86. · 1.52 Impact Factor
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ABSTRACT: Obtaining pulse pressure non-invasively from applanation tonometry requires the calibration of pressure waveform with brachial systolic and diastolic blood pressure. In the literature, several calibration methodologies are applied, and clinical studies disagree about the predictive value of central hemodynamic parameters. Our aim was to compare 4 calibration methodologies and assess the usefulness of pulse pressure amplification as an index independent of calibration. We investigated 108 subjects with tonometry in carotid, femoral, brachial, radial and dorsalis-pedis arteries; pulse pressure amplification between arterial waveforms was calculated. Four methods to calibrate the waveforms were compared: the 1/3 rule, the 40% rule, the integral of radial and brachial waveforms. Pulse pressure amplification in 5 arterial territories (carotid-femoral, carotid-brachial, carotid-radial and carotid-pedis amplifications; femoral-pedis amplification) was studied. Pulse pressure was successfully measured non-invasively at the 5 arterial sites. Pulse pressure was markedly dependent on calibration, with differences up to 18 mmHg between methods. Calculation of pulse pressure amplification eliminated effects of calibration method. Furthermore, pulse pressure amplifications in the 5 arterial sites presented a distinct pattern of clinical/biological determinants: heart rate and body height were common determinants of carotid to brachial, radial and femoral amplifications; diabetes was related to carotid to brachial amplification and pulse wave velocity to femoral to pedis amplification. In conclusion, the calibration of pulse pressure will influence results of clinical trials, but calculation of pulse pressure amplification can avoid this. We also suggest that the alteration of amplification in each arterial territory might be considered as a signal of clinical/subclinical damage.
Atherosclerosis 07/2012; 224(1):108-12. · 3.79 Impact Factor
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ABSTRACT: Chronic hepatitis B virus (HBV) infection is commonly considered to occur as a result of disturbance of the immune system. T-box expressed in T cells (T-bet) is an essential transcription factor for T helper (Th) cell differentiation and function. The aim of this study was to investigate the effect of T-bet overexpression on Th cell differentiation and the possible mechanism in chronic hepatitis B (CHB) patients. CD4+ T cells from the peripheral blood of 23 CHB patients, 8 acute hepatitis B (AHB) patients and 10 healthy controls were isolated. T-bet mRNA expression of CD4+ T cells was detected by quantitative real-time polymerase chain reaction (PCR). The T-bet DNA fragment was subcloned into the pGC-FU vector containing GFP to generate a recombinant lentiviral vector, pGC-FU-T-bet, while a no-load pGC-FU vector was used as the negative control. After transduction into CD4+ T cells from another 22 CHB patients, the induction of Th1- and Th2-type cytokines was assayed by an enzyme-linked immunosorbent assay (ELISA), and RT-PCR and western blot analysis were used to measure the mRNA and transcription levels of H2.0-like homeobox (HLX1), GATA-3 and STAT-6. T-bet mRNA expression in CD4+ T cells from AHB patients was enhanced compared with CHB patients and healthy controls. Th1-type cytokines and HLX1 expression was upregulated, while Th2-type cytokines and GATA-3 and STAT-6 expression was repressed after lentiviral introduction of T-bet. In conclusion, lentivirally overexpressed T-bet regulates Th cell lineage commitment in CHB patients, which may be mediated by regulating HLX1, GATA-3 and STAT-6 expression.
Molecular Medicine Reports 05/2012; 6(2):361-6. · 0.42 Impact Factor
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ABSTRACT: It is known that the prognostic value of cardiovascular risk factors differed between men and women, but data in the elderly are very limited.
We assessed cardiovascular structural and functional measurements (intima-media thickness, pulse pressure, pulse wave velocity, left atrial dimension (LAD), arrhythmia, deceleration time of transmitral early diastolic flow and left ventricular ejection fraction (LVEF)), by ultrasonography, blood pressure monitor, electrocardiography and applanation tonometry, as well as conventional cardiovascular risk factors (age, body mass index, smoke, total to high density lipoprotein (HDL) cholesterol ratio, and plasma glucose), and investigated their associations with all-cause mortality in men and women, separately, in 331 consecutive patients (87±7years, 74.0% female) with a history of cardiovascular disease from the geriatric departments. After a mean follow-up of 378days, 110 deaths were recorded.
In the full adjusted models, we found that increased LAD (hazard ratio [HR]=2.24 per 1-standard deviation [SD]; 95% confidential interval [CI]: 1.23-4.09), reduced LVEF (HR=0.60 per 1-SD; 95% CI: 0.38-0.96), and increased total-to-HDL cholesterol ratio (HR=1.99 per 1-SD; 95% CI: 1.05-3.78) were significant predictors of all-cause mortality in men, whereas the presence of arrhythmia (HR=2.47; 95% CI: 1.28-4.78), increased plasma glucose (HR=1.32 per 1-SD; 95% CI: 1.06-1.64) and decreased body mass index (HR=0.60 per 1-SD; 95% CI: 0.44-0.83) could significantly predict all-cause mortality in women.
Even in the last stage of lifespan, risk factors for all-cause death still differ significantly in men and women with cardiovascular disease.
International journal of cardiology 02/2012; 155(1):144-8. · 7.08 Impact Factor
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ABSTRACT: Data are limited with regard to the association of central blood pressure (BP) components with cardiac structure and function.
Our study was conducted in the framework of cardiovascular health examinations for the current and retired employees of a factory and their family members. We measured central BP by SphygmoCor and cardiac structure and function by echocardiography.
The 826 participants (mean age 43.0 years) included 285 (34.5%) women and 184 (22.3%) hypertensive patients, of whom 78 (42.4%) took antihypertensive drugs. After adjustment for age, sex, body weight, body height, antihypertensive treatment, current smoking and alcohol intake, left atrial volume and left ventricular mass were significantly associated with brachial and central BP components (r = 0.09-0.21, P ≤ 0.01), whereas left ventricular diastolic dysfunction, evaluated by E/A ratio and deceleration time of E wave (DTE), was only significantly associated with brachial and central SBP (r = 0.14-0.18, P < 0.001). However, these correlation coefficients were quantitatively but nonsignificantly different between brachial and central BP (P ≥ 0.06). In regression models with similar adjustments, with 1-SD increase in central SBP (16.7 mmHg), E/A ratio significantly decreased by 5.5 ± 1.2% and DTE significantly increased by 4.66 ± 1.22 ms (P < 0.001). Sensitivity analyses in men and women separately and after exclusion of patients on antihypertensive medication were confirmatory.
Cardiac structure was significantly and comparably associated with central BP components, but left ventricular diastolic dysfunction was only significantly associated with central SBP.
Journal of hypertension 12/2011; 29(12):2462-8. · 4.02 Impact Factor
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ABSTRACT: The purpose of this study was to investigate the association of autonomic nervous system dysregulation with blood pressure variability. Among the 2370 participants in the X-CELLENT study, 577 patients (59.0±10.2 years) were randomly selected to participate in an ancillary ambulatory blood-pressure monitoring study. We proposed a novel autonomic nervous system regulation index termed dSBP/dHR, which was defined as the steepness of the slope of the relationship between the 24-h systolic blood pressure (SBP) and the heart rate (HR) for each participant. Within-subjects s.d. of SBP, weighted for the time interval between consecutive validated readings from 24-h ambulatory blood pressure monitoring, was used to evaluate blood pressure variability. When dSBP/dHR was divided into tertiles, we observed a progressive increase from tertile 1 to tertile 3 in the daytime SBP, a progressive decrease in nighttime SBP, and consequently a progressive increase in the day-night SBP gradient (P<0.001). The s.d. of both daytime and nighttime SBPs were consistently and significantly increased from tertile 1 to tertile 3 (P<0.01). Both before and after adjustment for age, gender and 24-h mean blood pressure, all of these increasing and decreasing trends reached statistical significance (P<0.01). Furthermore, in our sensitivity analysis, when men and women were considered separately, the findings remained unaltered. In summary, autonomic nervous system dysfunction was associated with a heightened day-night SBP gradient and more variable SBP over 24 h in patients with essential hypertension.
Hypertension Research 12/2011; 35(4):399-403. · 2.58 Impact Factor
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ABSTRACT: To investigate the effect of different antihypertensive agents on blood pressure (BP) variability (BPV) and the underlying mechanism, we analyzed the ambulatory BP monitoring data of 577 patients before and after 3-month antihypertensive treatment, in the Natrilix SR Versus Candesartan and Amlodipine in the Reduction of Systolic Blood Pressure in Hypertensive Patients (X-CELLENT) Study, a multicenter, multinational, randomized, double-blind, placebo-controlled study with 4 parallel treatment arms (placebo, candesartan, indapamide sustained release, and amlodipine). Within-subject mean and SD of 24-hour BP, weighted by time interval between consecutive readings, were calculated in 3 time frames (daytime, nighttime, and 24 hours) to evaluate BP and BPV. The mean 24-hour heart rate (HR) and HR variability were calculated with the same algorithms. We found that the 3 antihypertensive drugs had a similar BP-lowering effect (P<0.001 for all), but amlodipine (P<0.007) and indapamide sustained release (P<0.04) were the only agents associated with a significantly decreased BPV after 3-month treatment. On the other hand, the major determinants of BPV at baseline were age, mean BP, and the corresponding HR variability. However, the reduction in BPV by amlodipine was significantly associated with the reduction in BP (P<0.006) and the reduction in HR variability (P<0.02), whereas the corresponding reduction by indapamide sustained release was only associated with the reduction in HR variability at night (P=0.004). In summary, 3-month amlodipine or indapamide sustained release treatment was associated with a significant reduction in BPV, and the mechanism of those reductions was possibly attributable to lowering BP or ameliorating the autonomic nervous system regulation or both. The combination of the 2 agents might help to optimize such properties.
Hypertension 08/2011; 58(2):155-60. · 6.21 Impact Factor
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ABSTRACT: Aortic stiffness (pulse wave velocity, PWV) and pressure wave reflections (augmentation index, AI) are two interrelated markers of mortality. Their potential synergistic effect on mortality has never been studied. We sought to investigate the association as well as the combined effect of PWV and AI on mortality in a cohort (PROTEGER Study) of very old (>70 years, mean age ( ± s.d.): 85.4 ± 7.4 years). Aortic PWV and pressure wave AI were assessed by pulse wave analysis; carotid structure and cardiac function were analyzed by ultrasound. The analysis was performed in 259 patients who had all the data available. Neither PWV nor AI was, in separate, predictors of mortality (log-rank test: P=0.278 and P=0.433, respectively, Kaplan-Meier analysis). No linear association was found between PWV and AI (P=0.278). To investigate the possible synergistic effect of PWV and AI on mortality, the population was analyzed according to the tertiles of PWV and AI. Subjects with combined high PWV (third tertile) and moderate-to-high AI (second and third tertiles) had lower survival compared with the rest of the population (Kaplan-Meier survival curve, log-rank test: P=0.030). Cox regression analysis showed that this effect was independent from age, gender, blood pressure, cardiac/carotid parameters and other confounders, except creatinine and insulin resistance. The present study provides further insight on the pathophysiological association between large artery stiffness and pressure wave reflections, suggesting that when both are elevated they may increase the mortality in the elderly.
Hypertension Research 04/2011; 34(7):803-8. · 2.58 Impact Factor
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ABSTRACT: Cytochrome (CYP) 4F2 isoform is a key metabolizing enzyme for the renal 20-hydroxyeicosatetraenoic acid (20-HETE), which, as an endogenous vasoconstrictor, may influence properties of the peripheral muscular arteries and arterioles. We, therefore, investigated the CYP4F2 polymorphisms in relation to arterial wave reflections, as measured by augmentation indexes (AIx) in Chinese.
We performed arterial measurements by SphygmoCor and genotyped three CYP4F2 polymorphisms (V433M, rs3093089, and rs3093098) by PCR-restriction fragment length polymorphism in 1421 participants enrolled in the JingNing Population study. A replication study for the V433M polymorphism was performed in 924 Chinese recruited from a workplace setting. Urinary 20-HETE concentration was determined by ELISA in a randomly selected subsample of 318 JingNing individuals.
In spite of the fact that genetic associations were not significant (P ≥ 0.12) in all JingNing participants, there was significant (Pint ≤ 0.02) interaction of the V433M polymorphism with sex and pulse rate in relation to peripheral and central AIx. M433 allele carriers, compared with V433V homozygotes, had significantly greater peripheral (+5.0%, P = 0.0002) and central AIx (+3.2%, P = 0.001) in 693 men. The corresponding values were +2.7% (P = 0.04) and +1.9% (P = 0.04) in 490 individuals of the top tertile of pulse rate (≥ 76 beats/min), and were +4.0% (P = 0.02) and +3.3% (P = 0.02) in 315 replication participants with a pulse rate at least 76 beats/min. Urinary 20-HETE concentration was significantly higher (P = 0.002) in M433M (2.06 ng/ml) and V433M (1.13 ng/ml) individuals than in V433V homozygotes (0.98 ng/ml).
The CYP4F2 V433M polymorphism is associated with the size of arterial wave reflections in male Chinese, or individuals with a faster pulse rate.
Journal of hypertension 03/2011; 29(3):501-8. · 4.02 Impact Factor
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ABSTRACT: Recent studies indicated that central SBP could be estimated by radial late-SBP (rSBP2) with a small disparity. However, most of these studies were conducted by SphygmoCor with a transfer function. The agreement between rSBP2 and central SBP was also tested in several invasive studies, but with inconsistent results. The objective of the present study was, therefore, to investigate whether rSBP2, from commercially available noninvasive devices, could practically indicate central SBP in current clinical care.
We assessed carotid SPB (cSBP) and aortic SBP (aSBP) and rSBP2 by two broadly used tonometry-based devices, SphygmoCor and PulsePen, in 106 patients (57.5±14.1 years) from our cardiovascular department.
In SphygmoCor and PulsePen, rSBP2 correlated well with aSBP and cSBP (R>0.80, P<0.001), but significantly underestimated them with a discrepancy ranging from 1.2±5.1 to 13.9±10.9 mmHg. The slopes of regression line in the correlation plots between the PulsePen rSBP2 and cSBPs from SphygmoCor and PulsePen were 0.91 and 0.99, respectively, and did not significantly differ from 1.
PulsePen rSBP2 underestimated cSBP with a systematical but clinically substantial discrepancy, whereas SphygmoCor rSBP2 underestimated aSBP and cSBP with a nonsystematical but much smaller disparity. From a practical point of view, neither of these noninvasive devices can be applied for the precise estimation of central SBP with rSBP2 in clinical practice.
Journal of hypertension 01/2011; 29(4):676-81. · 4.02 Impact Factor
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ABSTRACT: Left ventricular diastolic dysfunction (LVDD) was reported as a significant predictor of mortality, mainly in patients with heart failure. However, prospective data are scarce in the hospitalized elderly population.
We studied the association of severe LVDD, defined by conventional echocardiographic parameters, with cardiovascular and all-cause mortality in a population of 331 hospitalized elderly patients with a history of cardiovascular disease (mean age +/- SD, 87 +/- 7 years). After a mean follow-up of 378 days, 110 deaths occurred.
Compared with left ventricular systolic dysfunction (LVSD), subjects with severe diastolic dysfunction had a similar prevalence (12% vs 10%) and similar cardiovascular and all-cause mortality (18% vs 19%, 49% vs 50%). Both cardiovascular and all-cause mortality increased progressively and significantly with increasing number of diagnostic criteria of LVDD (P = .035, P = .013) and reached 48.7% for all-cause mortality when at least 2 criteria were met. In addition to cardiovascular risk factors and LVSD, severe LVDD provided incremental and independent prognostic information of all-cause mortality with increased chi(2) value of Cox regression model (48.1 vs 43.5, P = .022).
Severe LVDD, diagnosed by conventional echocardiography, has similar prevalence and prognosis as LVSD and provides incremental prognostic value, which highlights the clinical significance of routine evaluation of LVDD in risk assessment strategies of the hospitalized elderly.
American heart journal 09/2010; 160(3):471-8. · 4.65 Impact Factor
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ABSTRACT: To investigate the association of overall mortality with the presence and extent of cardiovascular calcifications.
We investigated the association of cardiac (mitral annulus, aortic valve) and arterial calcifications (abdominal aorta, carotid and femoral arteries) by ultrasonography, with all-cause mortality in a population of 331 high-risk elderly subjects (86.8 ± 6.9 years). After a mean follow-up of 378 days, 110 deaths occurred.
A simple calcification score, defined by the presence of cardiac and arterial calcifications, was significantly associated with all-cause mortality (HR=1.47, 95% CI: 1.08-1.99), independent of low plasma albumin, increased plasma glucose and creatinine, as well as low diastolic blood pressure. Moreover, arterial calcifications showed negligible prognostic value with a high prevalence >89%, while cardiac calcifications significantly predicted overall mortality (HR=1.92, 95% CI: 1.28-2.87) at a prevalence of 36%. In another Cox regression, mitral annular calcification was proved to be a significant predictor of total mortality (HR=1.61, 95% CI: 1.02-2.54).
The independent association between the extent of calcification and all-cause mortality is consistently significant in this frail elderly population. Arterial calcification presents a very high prevalence but a low predictive value, whereas in cardiac calcification, prevalence is lower but predictive value is much higher.
Atherosclerosis 09/2010; 213(2):622-6. · 3.79 Impact Factor
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ABSTRACT: This study aimed to evaluate the accuracy of the automated Health & Life oscillometric wrist blood pressure monitor HL168JD for home blood pressure monitoring according to the European Society of Hypertension International Protocol.
Systolic and diastolic blood pressures were sequentially measured in 33 adult Chinese using the mercury sphygmomanometer (two observers) and the HL168JD device (one supervisor). Ninety-nine pairs of comparisons were obtained from 15 participants in phase 1 and further 18 participants in phase 2 of the validation study. Data analysis was performed using the ESHIP Analyzer program.
The HL168JD device successfully passed phase 1 of the validation study with a number of absolute differences between device and observers within 5, 10, and 15 mmHg for at least 33/45, 41/45, and 45/45 measurements, respectively. The device also achieved the targets for phase 2.1, with 71/99, 90/99, and 98/99 differences within 5, 10, and 15 mmHg, respectively, for systolic blood pressure, and with 73/99, 89/99, and 99/99 within 5, 10, and 15 mmHg, respectively, for diastolic blood pressure. In phase 2.2, 27 and 26 participants had at least 2 of the 3 device-observers differences within 5 mmHg for systolic and diastolic blood pressure, respectively.
The Health & Life wrist blood pressure monitor HL168JD can be recommended for home use in adults.
Blood pressure monitoring 07/2009; 14(3):125-7. · 1.62 Impact Factor
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ABSTRACT: This study aimed to evaluate the accuracy of the automated oscillometric upper arm blood pressure monitor LD-578 (HONSUN Group, Shanghai, China) for home blood pressure monitoring according to the International Protocol.
Systolic and diastolic blood pressures were sequentially measured in 33 adult Chinese using a mercury sphygmomanometer (two observers) and the LD-578 device (one supervisor). Ninety-nine pairs of comparisons were obtained from 15 participants in phase 1 and a further 18 participants in phase 2 of the validation study. Data analysis was performed using the ESHIP Analyzer.
The LD-578 device successfully passed phase 1 of the validation study with a number of absolute differences between device and observers within 5, 10, and 15 mmHg for at least 32 of 45, 41 of 45, and 45 of 45 measurements (required 25, 35, and 40), respectively. The device also achieved the targets for phase 2.1, with 67 of 99, 90 of 99, and 98 of 99 differences within 5, 10, and 15 mmHg, respectively, for systolic blood pressure, and with 69 of 99, 95 of 99, and 98 of 99 within 5, 10, and 15 mmHg, respectively, for diastolic blood pressure. In phase 2.2, 24 participants had at least two of the three device-observers differences within 5 mmHg (required >or=22) for systolic and diastolic blood pressure.
The HONSUN upper arm blood pressure monitor LD-578 can be recommended for home use in adults.
Blood pressure monitoring 07/2009; 14(3):128-31. · 1.62 Impact Factor
