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- Morales Salinas, Alberto, et al.
(författare)
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Clinical Perspective on Antihypertensive Drug Treatment in Adults With Grade 1 Hypertension and Low-to-Moderate Cardiovascular Risk : An International Expert Consultation
- 2017
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Ingår i: Current problems in cardiology. - : Elsevier. - 0146-2806 .- 1535-6280. ; 42:7, s. 198-225
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Forskningsöversikt (refereegranskat)abstract
- Hypertension is a leading risk factor for disease burden globally. An unresolved question is whether grade 1 hypertension (140-159/90-99 mm Hg) with low (cardiovascular mortality < 1% at 10 years) to moderate (cardiovascular mortality ≥ 1% and <5% at 10 years) absolute total cardiovascular risk (CVR) should be treated with antihypertensive agents. A virtual international consultation process was undertaken to summarize the opinions of select experts. After holistic analysis of all epidemiological, clinical, psychosocial, and public health elements, this consultation process reached the following consensus in hypertensive adults aged < 80 years: (1) The question of whether drug treatment in grade 1 should be preceded by a period of some weeks or months during which only lifestyle measures are recommended cannot be evidence based, but the consensus opinion is to have a period of lifestyle alone reserved only to patients with grade 1 "isolated" hypertension (grade 1 uncomplicated hypertension with low absolute total CVR, and without other major CVR factors and risk modifiers). (2) The initiation of antihypertensive drug therapy in grade 1 hypertension with moderate absolute total CVR should not be delayed. (3) Men ≥ 55 years and women ≥ 60 years with uncomplicated grade 1 hypertension should automatically be classified within the moderate absolute total CVR category, even in the absence of other major CVR factors and risk modifiers. (4) Statins should be considered along with blood-pressure lowering therapy, irrespective of cholesterol levels, in patients with grade 1 hypertensive with moderate CVR.
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- Quintana, Miguel, et al.
(författare)
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Cardiac incoordination induced by left bundle branch block : its relation with left ventricular systolic function in patients with and without cardiomyopathy
- 2008
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Ingår i: Cardiovascular Ultrasound. - : Springer Science and Business Media LLC. - 1476-7120. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Although left bundle branch block (LBBB) alters the electrical activation of the heart, it is unknown how it might change the process of myocardial coordination (MC) and how it may affect the left ventricular (LV) systolic function. The present study assessed the effects of LBBB on MC in patients with LBBB with and without dilated (DCMP) or ischemic cardiomyopathy (ICMP). METHODS: Tissue Doppler echocardiography (TDE) was performed in 86 individuals: 21 with isolated LBBB, 26 patients with DCMP + LBBB, 19 patients with ICMP + LBBB and in 20 healthy individuals (Controls). MC was assessed analyzing the myocardial velocity profiles obtained from six basal segments of the LV using TDE. The LV systolic function was assessed by standard two-dimensional echocardiography and by TDE. RESULTS: Severe alterations in MC were observed in subjects with LBBB as compared with controls (P < 0.01 for all comparisons); these derangements were even worse in patients with DCMP and ICMP (P < 0.001 for comparisons with Controls and P < 0.01 for comparison with individuals with isolated LBBB). Some parameters of MC differed significantly between DCMP and ICMP (P < 0.01). A good or very good correlation coefficient was found between variables of MC and variables of LV systolic function. CONCLUSION: LBBB induces severe derangement in the process of MC that are more pronounced in patients with cardiomyopathies and that significantly correlates with the LV systolic function. The assessment of MC may help in the evaluation of the etiology of dilated cardiomyopathy.
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- Vraka, Aikaterini, et al.
(författare)
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Alternative Time-Domain P-wave Analysis for Precise Information on Substrate Alteration after Pulmonary Vein Isolation for Atrial Fibrillation
- 2021
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Ingår i: 2021 9th E-Health and Bioengineering Conference, EHB 2021. - 9781665440004
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Konferensbidrag (refereegranskat)abstract
- While P-wave duration (PWD) is primarily employed to observe the atrial substrate alterations after pulmonary vein isolation (PVI) on atrial fibrillation (AF) patients, the acquired information corresponds to the entire atria. Left (LA) and right atrium (RA), though, may be differently affected by PVI, implying the need for different after-PVI handling. In order to clarify this assumption, five-minute lead II recordings from 29 paroxysmal AF patients undergoing first-ever PVI were recruited before and after PVI. PWD was analyzed integrally and in parts, with the first part (PWD1) from the onset to the peak corresponding to RA and the second part (PWD2) to LA depolarization. Time from P-wave onset or offset to the R peak were also calculated (Pon - R and Poff - R, respectively). Normalization (N) to mitigate heart-rate effect was applied. Results before and after PVI were compared with Mann-Whitney U-test (MWU). Median values and variations due to PVI were calculated for all features and compared between PWD and the remaining features via Pearson correlation. After PVI, PWD (-9.84%, p = 0.0085, N: - 17.96%, p = 0.0442) and PWD2 (-22.03%, p = 0.0250, N: - 27.77%, p = 0.0268) were significantly decreased. PWD1 did not shorten significantly (up to -8.96%, p > 0.05 at either cases). PWD - PWD1 (ρ > 74.5%, p < 0.0001) showed higher correlation than PWD - PWD2 (ρ > 41.9%, p < 0.0001) in before and after PVI analysis but not for PVI-related variation (ρPWD-PWD1 = 54.0%, p = 0.0114 and ρPWD-PWD2 = 61.4%, p = 0.0031). While RA depolarization time is more in line with PWD analysis, the effect of PVI in PWD is more coherent with LA's findings. Additionally, PWD shortening is only observed in the LA. Therefore, LA is crucial for the assessment of the atrial substrate alteration after PVI and its analysis should be considered by future studies.
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- Vraka, Aikaterini, et al.
(författare)
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The P-Wave Time-Domain Significant Features to Evaluate Substrate Modification After Catheter Ablation of Paroxysmal Atrial Fibrillation
- 2022
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Ingår i: 2022 Computing in Cardiology, CinC 2022. - 2325-887X .- 2325-8861. - 9798350300970 ; 2022-September
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Konferensbidrag (refereegranskat)abstract
- The outcome of catheter ablation (CA) of atrial fibrillation (AF) is vastly analyzed by the entire P-wave duration (PWD). However, the first and second P-wave parts, corresponding to right (RA) and left atrial (LA) wavefront propagation, may be unequally modified. Five-minute lead II recordings before and after the first-ever CA of 40 parox-ysmal AF patients were analyzed and P-wave features were calculated: PWDon-off of the entire P-wave and each P-wave part (RA:PWDon-peak, LA:PWDpeak-off) and the time from P-wave onset or offset to the R-peak (PWDon-R and PWDoff-R, respectively). Heart-rate (HR) adjustment (HRA) mitigated the HR fluctuations. Prelpost-CA comparison was performed with Mann-Whitney U-test and median values were calculated. Pearson's correlation was calculated between PWD and the remaining features. The effect of CA with (Δ: -17.96%) or without HRA (Δ: -9.84%) was significant at the entire PWDon-off and at the PWDpeak-off(HRA:Δ: -27.77%, no HRA: Δ: -22.03%). PWDon-off showed a stronger correlation with RA than LA(ρmax=0.805 vs ρmax=0.541). P-wave features corresponding to RA are more strongly related to the entire P-wave. Nevertheless, only the P-wave part associated with LA is significantly affected by CA. That being so, studies are encouraged to incorporate part-time P-wave analysis.
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