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Journal of Clinical Hypertension... Dec 2019Hypertension-mediated organ damage (HMOD) is frequently observed in hypertensive patients at different cardiovascular (CV) risk profile. This may have both diagnostic... (Review)
Review
Hypertension-mediated organ damage (HMOD) is frequently observed in hypertensive patients at different cardiovascular (CV) risk profile. This may have both diagnostic and therapeutic implications for the choice of the most appropriate therapies. Among different markers of HMOD, the most frequent functional and structural adaptations can be observed at cardiac level, including left ventricular hypertrophy (LVH), diastolic dysfunction, aortic root dilatation, and left atrial enlargement. In particular, LVH was shown to be a strong and independent risk factor for major CV events, namely myocardial infarction, stroke, congestive heart failure, CV death. Thus, early identification of LVH is a key element for preventing CV events in hypertension. Although echocardiographic assessment of LVH represents the gold standard technique, this is not cost-effective and cannot be adopted in routine clinical practice of hypertension. On the other hand, electrocardiographic (ECG) assessment of HMOD relative to the heart is a simple, reproducible, widely available and cost-effective method to assess the presence of LVH, and could be preferred in large scale screening tests. Several new indicators have been proposed and tested in observational studies and clinical trials of hypertension, in order to improve the relatively low sensitivity of the conventional ECG criteria for LVH, despite high specificity. This article reviews the differences in the use of the main conventional and the new 12 lead ECG criteria of LVH for early assessment of asymptomatic, subclinical cardiac HMOD in a setting of clinical practice of hypertension.
Topics: Aorta; Cardiovascular Diseases; Cost-Benefit Analysis; Death; Dilatation, Pathologic; Early Diagnosis; Electrocardiography; Female; Heart; Heart Failure; Heart Failure, Diastolic; Humans; Hypertension; Hypertrophy, Left Ventricular; Male; Mass Screening; Myocardial Infarction; Narration; Practice Patterns, Physicians'; Risk Assessment; Risk Factors; Stroke
PubMed: 31693279
DOI: 10.1111/jch.13726 -
Indian Journal of Ophthalmology Dec 2020Keratoconus (KC) is a progressive ectatic corneal disorder. There are multiple topographic devices and their varied indices used for diagnosis, detecting progression,... (Review)
Review
Keratoconus (KC) is a progressive ectatic corneal disorder. There are multiple topographic devices and their varied indices used for diagnosis, detecting progression, and deciding management. It is important to understand the repeatablility, intra- test variabililty, and comparability amongst various topographic devices. The Scheimpflug camera-based devices, such as the Pentacam (Oculus, Wetzlar, Germany), Galilei (Ziemer, Biel, Switzerland), and Sirius (Costruzione Strumenti Oftalmici, Florence, Italy) are known to assist in the detection of early keratoconus and subclinical keratoconus. This article reviews the various Scheimpflug camera-based devices in depth, addressing their different indices, diagnostic accuracy, repeatability, and agreement and identifying the strongest parameter of each device. It will guide the practicing clinician by giving practical tips for decision making in the diagnosis and management of keratoconus.
Topics: Cornea; Corneal Topography; Dilatation, Pathologic; Face; Humans; Keratoconus; Reproducibility of Results
PubMed: 33229649
DOI: 10.4103/ijo.IJO_2111_20 -
Indian Journal of Ophthalmology Dec 2020Recent advances in the diagnosis and treatment of ectatic corneal disease have mandated a more modern staging system. The new Belin ABCD keratoconus staging system...
Recent advances in the diagnosis and treatment of ectatic corneal disease have mandated a more modern staging system. The new Belin ABCD keratoconus staging system incorporates anterior and posterior curvature centered on the thinnest point of the cornea, thinnest pachymetry values and distance visual acuity in grades from 0-4. By including posterior curvature and thickness measurements based on the thinnest point, as opposed to apical, the new staging system better reflects anatomical changes seen in keratoconus and other ectatic diseases.
Topics: Cornea; Corneal Pachymetry; Corneal Topography; Dilatation, Pathologic; Humans; Keratoconus; Visual Acuity
PubMed: 33229658
DOI: 10.4103/ijo.IJO_2078_20 -
Alzheimer's & Dementia : the Journal of... May 2019We tested the hypothesis that brain arterial dilatation increases the risk of Alzheimer's dementia (AD).
INTRODUCTION
We tested the hypothesis that brain arterial dilatation increases the risk of Alzheimer's dementia (AD).
METHODS
We studied dementia-free participants in the Washington Heights-Inwood Columbia Aging Project who had a brain MRI and post-MRI dementia adjudication. We measured the axial T2-proton density diameters of the intracranial carotids and basilar diameters and used Cox models to obtain AD hazard ratios and 95% intervals.
RESULTS
Of 953 participants (mean age 77 ± 7 y, women 64%, 71% nonwhite) followed on average for 3 ± 3 years, 76 (8%) developed AD. In a model adjusted for demographics, vascular risks, apolipoprotein E (APOE)-ε4, and white matter hyperintensities, larger carotid diameters increased the risk of AD, defined categorically as ≥ 90th percentile (HR 4.34, 1.70-11.11) or continuously (HR 1.44 per SD, 1.07-1.94).
DISCUSSION
Understanding the pathophysiology of the association between AD and brain arterial dilatation may reveal new clues to the vascular contributions to AD.
Topics: Aged; Alzheimer Disease; Brain; Carotid Arteries; Cerebral Arteries; Dilatation, Pathologic; Female; Humans; Longitudinal Studies; Magnetic Resonance Imaging; Male; Risk Factors
PubMed: 30827874
DOI: 10.1016/j.jalz.2018.12.018 -
Eye (London, England) Jan 2021Early identification of keratoconus is imperative for preventing iatrogenic corneal ectasia and allowing for early corneal collagen cross-linking treatments to... (Review)
Review
OBJECTIVES
Early identification of keratoconus is imperative for preventing iatrogenic corneal ectasia and allowing for early corneal collagen cross-linking treatments to potentially halt progression and decrease transplant burden. However, early diagnosis of keratoconus is currently a diagnostic challenge as there is no uniform screening criteria. We performed a review of the current literature to assess imaging modalities that can be used to help identify subclinical keratoconus.
METHODS
A Pubmed database search was conducted. We included primary and empirical studies for evaluating different modalities of screening for subclinical keratoconus.
RESULTS
A combination of multiple imaging tools, including corneal topography, tomography, Scheimpflug imaging, anterior segment optical coherence tomography, and in vivo confocal microscopy will allow for enhanced determination of subclinical keratoconus. In patients who are diagnostically borderline using a single screening criteria, use of additional imaging techniques can assist in diagnosis. Modalities that show promise but need further research include polarization-sensitive optical coherence tomography, Brillouin microscopy, and atomic force microscopy.
CONCLUSIONS
Recognition of early keratoconus can reduce risk of post-refractive ectasia and reduce transplantation burden. Though there are no current uniform screening criterion, multiple imaging modalities have shown promise in assisting with the early detection of keratoconus.
Topics: Cornea; Corneal Topography; Dilatation, Pathologic; Humans; Keratoconus; Tomography, Optical Coherence
PubMed: 32678352
DOI: 10.1038/s41433-020-1039-1 -
BMC Pediatrics May 2024Patients with Turner syndrome (TS) face an increased risk of developing aortic dilatation (AD), but diagnosing AD in children presents greater complexity compared to...
BACKGROUND
Patients with Turner syndrome (TS) face an increased risk of developing aortic dilatation (AD), but diagnosing AD in children presents greater complexity compared to adults. This study aimed to investigate the application of various assessment indicators of AD in Chinese children and adolescents with TS.
METHODS
This study included TS patients admitted to Shenzhen Children's Hospital from 2017 to 2022. Cardiovascular lesions were diagnosed by experienced radiologists. Patients without structural heart disease were divided into different body surface area groups, then the Chinese TS population Z-score (CHTSZ-score) of the ascending aorta was calculated and compared with other indicators such as aortic size index (ASI), ratio of the ascending to descending aortic diameter (A/D ratio), and TSZ-score (Quezada's method).
RESULTS
A total of 115 TS patients were included, with an average age of 10.0 ± 3.7 years. The incidences of the three most serious cardiovascular complications were 9.6% (AD), 10.4% (coarctation of the aorta, CoA), and 7.0% (bicuspid aortic valve, BAV), respectively. The proportion of developing AD in TS patients aged ≥ 10 years was higher than that in those < 10 years old (16.6% vs. 1.8%, P = 0.009), and the proportion of patients with CoA or BAV who additionally exhibited AD was higher than those without these conditions (31.6% vs. 5.2%, P < 0.001). The ASI, A/D ratio, TSZ-score, and CHTSZ-score of the 11 patients with AD were 2.27 ± 0.40 cm/m, 1.90 ± 0.37, 1.28 ± 1.08, and 3.07 ± 2.20, respectively. Among the AD patients, only 3 cases had a TSZ-score ≥ 2, and 2 cases had a TSZ-score ≥ 1. However, based on the assessment using the CHTSZ-score, 6 patients scored ≥ 2, and 5 patients scored ≥ 1. In contrast, the TSZ-score generally underestimated the aortic Z-scores in Chinese children with TS compared to the CHTSZ-score.
CONCLUSIONS
The applicability of ASI and A/D ratio to children with TS is questionable, and racial differences can affect the assessment of TSZ-score in the Chinese population. Therefore, establishing the CHTSZ-score specifically tailored for Chinese children and adolescents is of paramount importance.
Topics: Humans; Turner Syndrome; Child; Adolescent; Female; China; Dilatation, Pathologic; Male; Retrospective Studies; Aorta; Aortic Coarctation; Bicuspid Aortic Valve Disease; Child, Preschool; Incidence; East Asian People
PubMed: 38720245
DOI: 10.1186/s12887-024-04783-2 -
Revista Da Associacao Medica Brasileira... Jun 2021The predictive value of the fibrinogen-to-albumin ratio has been evidenced in coronary artery disease. Available data demonstrated that inflammation and oxidative stress...
OBJECTIVE
The predictive value of the fibrinogen-to-albumin ratio has been evidenced in coronary artery disease. Available data demonstrated that inflammation and oxidative stress are the relevant mechanisms of ascending aortic aneurysm formation and dilatation. The fibrinogen-to-albumin ratio reflects oxidative stress and inflammation. This study investigated the correlation between fibrinogen-to-albumin ratio and ascending aortic aneurysm.
METHODS
A total of 250 consecutive patients with ascending aortic aneurysm and 250 consecutive patients with normal ascending aortic diameter were included in the study using comprehensive transthoracic echocardiography. All data and fibrinogen-to-albumin ratio were compared between two groups.
RESULTS
The fibrinogen-to-albumin ratio levels were significantly higher in ascending aortic aneurysm group compared with normal ascending aortic diameter group (p<0.001). Also, there was significantly positive correlation between the diameter of the ascending aorta and the fibrinogen-to-albumin ratio (p<0.001).
CONCLUSION
Fibrinogen-to-albumin ratio is associated with ascending aortic aneurysm and may serve as blood marker for identifying high-risk patients.
Topics: Albumins; Aorta; Aortic Aneurysm; Dilatation, Pathologic; Fibrinogen; Humans
PubMed: 34709332
DOI: 10.1590/1806-9282.20210198 -
Clinical & Experimental Optometry May 2021
Topics: Contact Lenses; Corneal Diseases; Dilatation, Pathologic; Humans; Stevens-Johnson Syndrome
PubMed: 33689647
DOI: 10.1080/08164622.2021.1878835 -
European Review For Medical and... Mar 2023Bicuspid aortic valve (BAV) is the most common congenital heart defect. Ascending aorta dilatation is related to BAV- and hypertension (HTN)-associated aortopathy. The...
Endotrophin and matrix metalloproteinase-2 levels in bicuspid aortic valve and hypertension associated aortopathy and their relationship with strain parameters of the ascending aorta.
OBJECTIVE
Bicuspid aortic valve (BAV) is the most common congenital heart defect. Ascending aorta dilatation is related to BAV- and hypertension (HTN)-associated aortopathy. The aim of this study was to investigate aortic elasticity, as well as aortic deformation of the ascending aorta, using strain imaging, and to evaluate the possible relationship of biomarkers, such as endotrophin and matrix metalloproteinase-2 (MMP-2), with ascending aorta dilatation in patients with BAV- or HTN-associated aortopathy.
PATIENTS AND METHODS
This prospective study included patients with ascending aorta dilatation with BAV (n = 33), or normal tricuspid aortic valve with HTN (n = 33), and 20 control subjects. The mean age of the total patients was 42.76 ± 10.4 years (67% male, 33% female). We calculated aortic elasticity parameters using the relevant formula by M-mode echocardiography and determined layer-specific longitudinal and transverse strains of the proximal aorta by speckle-tracking echocardiography. Blood samples of the participants were drawn for the analysis of endotrophin and MMP-2.
RESULTS
Aortic strain and aortic distensibility were significantly decreased, whereas the aortic stiffness index was significantly increased in patient groups with BAV or HTN compared to the control group (p < 0.001). Moreover, longitudinal strain of both the anterior and posterior aortic walls of the proximal aorta were significantly impaired in BAV and HTN patients (p < 0.001). Serum endotrophin levels were significantly reduced in the patient cohort compared to the controls (p = 0.001). Endotrophin was noted to be significantly positively correlated with aortic strain and aortic distensibility (r = 0.37, p = 0.001; r = 0.45, p < 0.001, respectively), whereas inversely associated with aortic stiffness index (r = -0.402, p < 0.001). Furthermore, endotrophin was the single independent predictor of ascending aorta dilatation (OR = 0.986, p < 0.001). A cut-off value of endotrophin ≤ 82.38 ng/mL predicted ascending aorta dilatation with a sensitivity of 80.3% and specificity of 78.5% (p < 0.0001).
CONCLUSIONS
The present study showed that aortic deformation parameters and elasticity are impaired in BAV and HTN patients, and strain imaging allows for a good analysis of ascending aorta deformation. Endotrophin could be a predictive biomarker of ascending aorta dilatation in BAV and HTN aortopathy.
Topics: Humans; Male; Female; Adult; Middle Aged; Bicuspid Aortic Valve Disease; Matrix Metalloproteinase 2; Heart Valve Diseases; Aorta, Thoracic; Prospective Studies; Aorta; Aortic Valve; Aortic Diseases; Biomarkers; Dilatation, Pathologic; Hypertension
PubMed: 37013755
DOI: 10.26355/eurrev_202303_31771 -
Revista Portuguesa de Cardiologia Jul 2018Intrinsic aortopathy can lead to dilatation late after tetralogy of Fallot (TOF) repair. Its extent and prevalence are not known. We aimed to assess aortic dimensions...
INTRODUCTION AND AIMS
Intrinsic aortopathy can lead to dilatation late after tetralogy of Fallot (TOF) repair. Its extent and prevalence are not known. We aimed to assess aortic dimensions and elasticity and to find predictors of aortic dilatation.
METHODS
A total of 126 adults were prospectively included after TOF repair and compared to 63 gender- and age-matched controls. Transthoracic echocardiography was used to assess aortic diameters at the level of the sinuses of Valsalva and ascending aorta and aortic dilatation was defined as z-score >+2. M-mode parameters of the ascending aorta were used to calculate strain, distensibility and stiffness index.
RESULTS
TOF patients (mean age 30±9 years; 52% male) had a complete repair at a median age of five (2-49) years; mean follow-up time since repair was 23±7 years. The prevalence of aortic dilatation at the sinuses of Valsalva and ascending aorta was 29% and 24%, respectively. Compared to controls, TOF patients had a higher ascending aorta z-score, lower strain (6.4% [0.0-61.5] vs. 15.2% [0.0-45.0], p<0.01) and higher stiffness index (7.3 [0.8-23.6] vs. 3.1 [0.9-14.1], p<0.01). On multivariate analysis male gender was strongly associated with sinuses of Valsalva dilatation (odds ratio 6.3, 95% confidence interval 1.5-26.3, p=0.01).
CONCLUSIONS
The prevalence of aortic dilatation late after TOF repair is significant, with a larger and stiffer ascending aorta. Male gender appears to influence aortic root dilatation. This aortopathy requires careful follow-up in order to prevent future complications.
Topics: Adult; Aortic Diseases; Dilatation, Pathologic; Female; Follow-Up Studies; Forecasting; Humans; Male; Postoperative Complications; Prospective Studies; Tetralogy of Fallot
PubMed: 30008310
DOI: 10.1016/j.repc.2017.10.014