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Belhadjer Z, Ladouceur M, Soulat G, Legendre A, Gencer U, Dietenbeck T, Iserin L, Houyel L, Bonnet D, Mousseaux E. Increased aortic pressures and pulsatile afterload components promote concentric left ventricular remodeling in adults with transposition of the great arteries and arterial switch operation. Int J Cardiol 2024; 405:131969. [PMID: 38490269 DOI: 10.1016/j.ijcard.2024.131969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 12/12/2023] [Accepted: 03/12/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Functional abnormalities of the ascending aorta (AA) have been mainly reported in young patients who underwent arterial switch operation (ASO) for transposition of the great arteries (TGA). OBJECTIVES To compare systolic, diastolic brachial and central blood pressures (bSBP, bDBP, cSBP, cDBP), aortic biomechanical parameters, and left ventricular (LV) afterload criteria in adult ASO patients with healthy controls and to assess their relationships with LV remodeling and aortic size. MATERIALS AND METHODS Forty-one prospectively enrolled patients (16.8 to 35.8 years) and 41 age- and sex-matched healthy volunteers underwent cardiac MRI to assess LV remodeling with simultaneous brachial BP estimation. After MRI, carotid-femoral tonometry was performed to measure pulse wave velocity (cfPWV), cSBP and cDBP for further calculation of pulse pressure (cPP), AA distensibility (AAD), and AA and LV elastance (AAE, LVE). RESULTS bSBP, bDBP, cSBP,cDBP and cPP were all significantly higher in ASO group than in controls: cSBP (116.5 ± 13.8 vs 106.1 ± 12.0, p < 0.001), cDBP (72.5 ± 6.9 vs 67.1 ± 9.4, p = 0.002), cPP (44.0 ± 12.1 vs 39.1 ± 8.9, p = 0.003) and not related to aortic size. AAD were decreased in ASO patients vs controls (4.70 ± 2.72 vs 6.69 ± 2.16, p < 0.001). LV mass was correlated with bSBP, cSBP, cPP (ρ = 0.48; p < 0.001), while concentric LV remodeling was correlated with AAE (ρ = 0.60, p < 0.001) and LVE (ρ = 0.32, p = 0.04), but not with distensibility. CONCLUSION Even without reaching arterial hypertension, aortic sBP and PP are increased in the adult TGA population after ASO, altering the pulsatile components of afterload and contributing to LV concentric remodeling.
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Affiliation(s)
- Zahra Belhadjer
- Assistance Publique Hôpitaux de Paris, France; Hôpital Européen Georges Pompidou, Paris, France; Hôpital Necker, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, F-75015 Paris, France
| | - Magalie Ladouceur
- Assistance Publique Hôpitaux de Paris, France; Hôpital Européen Georges Pompidou, Paris, France; Hôpital Necker, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, F-75015 Paris, France; Université Paris Cité, Paris, France; PARCC, INSERM UMR970, Paris, France
| | - Gilles Soulat
- Assistance Publique Hôpitaux de Paris, France; Hôpital Européen Georges Pompidou, Paris, France; Université Paris Cité, Paris, France; PARCC, INSERM UMR970, Paris, France
| | - Antoine Legendre
- Assistance Publique Hôpitaux de Paris, France; Hôpital Européen Georges Pompidou, Paris, France; Hôpital Necker, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, F-75015 Paris, France
| | - Umit Gencer
- Assistance Publique Hôpitaux de Paris, France; Hôpital Européen Georges Pompidou, Paris, France; PARCC, INSERM UMR970, Paris, France
| | - Thomas Dietenbeck
- SorbonneUniversite, CNRS, INSERM, Laboratoire d'Imagerie Biomedicale, LIB, Paris, France
| | - Laurence Iserin
- Assistance Publique Hôpitaux de Paris, France; Hôpital Européen Georges Pompidou, Paris, France; Hôpital Necker, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, F-75015 Paris, France
| | - Lucile Houyel
- Assistance Publique Hôpitaux de Paris, France; Hôpital Necker, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, F-75015 Paris, France
| | - Damien Bonnet
- Assistance Publique Hôpitaux de Paris, France; Hôpital Necker, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, F-75015 Paris, France; Université Paris Cité, Paris, France
| | - Elie Mousseaux
- Assistance Publique Hôpitaux de Paris, France; Hôpital Européen Georges Pompidou, Paris, France; Université Paris Cité, Paris, France; PARCC, INSERM UMR970, Paris, France.
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Mulligan LJ, Thrash J, Mitrev L, Folk D, Exarchakis A, Ewert D, Hill JC. Evaluation of vascular aging on measures of cardiac function and mechanical efficiency: insights from in-silico modeling. Front Cardiovasc Med 2024; 11:1351484. [PMID: 38601041 PMCID: PMC11004371 DOI: 10.3389/fcvm.2024.1351484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/23/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction This study evaluated the hypothesis that vascular aging (VA) reduces ventricular contractile function and mechanical efficiency (ME) using the left ventricular pressure-volume (PV) construct. Methods A previously published in-silico computational model (CM) was modified to evaluate the hypothesis in two phases. In phase I, the CM included five settings of aortic compliance (CA) from normal to stiff, studied at a heart rate of 80 bpm, and phase II included the normal to stiff CA settings evaluated at 60, 100, and 140 bpm. The PV construct provided steady-state and transient data through a simulated vena caval occlusion (VCO). The steady-state data included left ventricular volumes (EDV and ESV), stroke work (SW), and VCO provided the PV area (PVA) data in addition to the three measures of contractile state (CS): end-systolic pressure-volume relationship (ESPVR), dP/dtmax-EDV and preload recruitable stroke work (PRSW). Finally, ME was calculated with the SW/PVA parameter. Results In phase I, EDV and ESV increased, as did SW and PVA. The impact on the CS parameters demonstrated a small decrease in ESPVR, no change in dP/dtmax-EDV, and a large increase in PRSW. ME decreased from 71.5 to 60.8%, respectively. In phase II, at the normal and stiff CA settings, across the heart rates studied, EDV and ESV decreased, ESPVR and dP/dtmax-EDV increased and PRSW decreased. ME decreased from 76.4 to 62.6% at the normal CA and 65.8 to 53.2% at the stiff CA. Discussion The CM generated new insights regarding how the VA process impacts the contractile state of the myocardium and ME.
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Affiliation(s)
- Lawrence J. Mulligan
- Department of Anesthesiology, Cooper University Hospital, Camden, NJ, United States
- Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Julian Thrash
- Department of Electrical and Computer Engineering, North Dakota State University, Fargo, ND, United States
| | - Ludmil Mitrev
- Department of Anesthesiology, Cooper University Hospital, Camden, NJ, United States
- Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Douglas Folk
- Department of Integrated Engineering, Minnesota State UniversityMankato, MN, United States
| | - Alyssa Exarchakis
- Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Daniel Ewert
- Department of Biomedical Engineering, University of North Dakota, Grand Forks, ND, United States
| | - Jeffrey C. Hill
- Department of Diagnostic Medical Sonography, School of Medical Imaging and Therapeutics, Massachusetts College of Pharmacy and Health Sciences University, Worcester, MA, United States
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Ding CCA, Dokos S, Bakir AA, Zamberi NJ, Liew YM, Chan BT, Md Sari NA, Avolio A, Lim E. Simulating impaired left ventricular-arterial coupling in aging and disease: a systematic review. Biomed Eng Online 2024; 23:24. [PMID: 38388416 PMCID: PMC10885508 DOI: 10.1186/s12938-024-01206-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 01/11/2024] [Indexed: 02/24/2024] Open
Abstract
Aortic stenosis, hypertension, and left ventricular hypertrophy often coexist in the elderly, causing a detrimental mismatch in coupling between the heart and vasculature known as ventricular-vascular (VA) coupling. Impaired left VA coupling, a critical aspect of cardiovascular dysfunction in aging and disease, poses significant challenges for optimal cardiovascular performance. This systematic review aims to assess the impact of simulating and studying this coupling through computational models. By conducting a comprehensive analysis of 34 relevant articles obtained from esteemed databases such as Web of Science, Scopus, and PubMed until July 14, 2022, we explore various modeling techniques and simulation approaches employed to unravel the complex mechanisms underlying this impairment. Our review highlights the essential role of computational models in providing detailed insights beyond clinical observations, enabling a deeper understanding of the cardiovascular system. By elucidating the existing models of the heart (3D, 2D, and 0D), cardiac valves, and blood vessels (3D, 1D, and 0D), as well as discussing mechanical boundary conditions, model parameterization and validation, coupling approaches, computer resources and diverse applications, we establish a comprehensive overview of the field. The descriptions as well as the pros and cons on the choices of different dimensionality in heart, valve, and circulation are provided. Crucially, we emphasize the significance of evaluating heart-vessel interaction in pathological conditions and propose future research directions, such as the development of fully coupled personalized multidimensional models, integration of deep learning techniques, and comprehensive assessment of confounding effects on biomarkers.
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Affiliation(s)
- Corina Cheng Ai Ding
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Socrates Dokos
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Azam Ahmad Bakir
- University of Southampton Malaysia Campus, 79200, Iskandar Puteri, Johor, Malaysia
| | - Nurul Jannah Zamberi
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Bee Ting Chan
- Department of Mechanical, Materials and Manufacturing Engineering, Faculty of Science and Engineering, University of Nottingham Malaysia, 43500, Selangor, Malaysia
| | - Nor Ashikin Md Sari
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Alberto Avolio
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, 2109, Australia
| | - Einly Lim
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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Bouazizi K, Zarai M, Noufaily A, Prigent M, Dietenbeck T, Bollache E, Nguyen T, Della Valle V, Blondiaux E, Clément K, Aron-Wisnewsky J, Andreelli F, Redheuil A, Kachenoura N. Associations of aortic stiffness and intra-aortic flow parameters with epicardial adipose tissue in patients with type-2 diabetes. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1106342. [PMID: 37304050 PMCID: PMC10250660 DOI: 10.3389/fcdhc.2023.1106342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/09/2023] [Indexed: 06/13/2023]
Abstract
Background It has been shown that increased aortic stiffness is related to type-2 diabetes (T2D) which is considered as a risk factor for cardiovascular disease. Among other risk factors is epicardial adipose tissue (EAT) which is increased in T2D and is a relevant biomarker of metabolic severity and adverse outcome. Purpose To assess aortic flow parameters in T2D patients as compared to healthy individuals and to evaluate their associations with EAT accumulation as an index of cardiometabolic severity in T2D patients. Materials and methods Thirty-six T2D patients as well as 29 healthy controls matched by age and sex were included in this study. Participants had cardiac and aortic MRI exams at 1.5 T. Imaging sequences included cine SSFP for left ventricle (LV) function and EAT assessment and aortic cine and phase-contrast imaging for strain and flow parameters quantification. Results In this study, we found LV phenotype to be characterized by concentric remodeling with decreased stroke volume index despite global LV mass within a normal range. EAT was increased in T2D patients compared to controls (p<0.0001). Moreover, EAT, a biomarker of metabolic severity, was negatively correlated to ascending aortic (AA) distensibility (p=0.048) and positively to the normalized backward flow volume (p=0.001). These relationships remained significant after further adjustment for age, sex and central mean blood pressure. In a multivariate model, presence/absence of T2D and AA normalized backward flow (BF) to forward flow (FF) volumes ratio are both significant and independent correlates of EAT. Conclusion In our study, aortic stiffness as depicted by an increased backward flow volume and decreased distensibility seems to be related to EAT volume in T2D patients. This observation should be confirmed in the future on a larger population while considering additional biomarkers specific to inflammation and using a longitudinal prospective study design.
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Affiliation(s)
- Khaoula Bouazizi
- Laboratoire d’Imagerie Biomédicale (LIB), Sorbonne Université, Institut National de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Paris, France
- ICAN Imaging, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Mohamed Zarai
- ICAN Imaging, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Abdallah Noufaily
- Unité d’Imagerie Cardiovasculaire et Thoracique (ICT), Pitié-Salpêtrière Hospital, Paris, France
| | - Mikaël Prigent
- ICAN Imaging, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Thomas Dietenbeck
- Laboratoire d’Imagerie Biomédicale (LIB), Sorbonne Université, Institut National de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Paris, France
- ICAN Imaging, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Emilie Bollache
- Laboratoire d’Imagerie Biomédicale (LIB), Sorbonne Université, Institut National de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Paris, France
- ICAN Imaging, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Toan Nguyen
- Assistance Publique Hôpitaux de Paris, Radiology Department, Armand-Trousseau Hospital, Paris, France
| | - Valéria Della Valle
- Assistance Publique Hôpitaux de Paris, Radiology Department, Armand-Trousseau Hospital, Paris, France
| | - Eléonore Blondiaux
- Assistance Publique Hôpitaux de Paris, Radiology Department, Armand-Trousseau Hospital, Paris, France
| | - Karine Clément
- Sorbonne Université, INSERM, Nutrition and Obesities; approches systémiques (NutriOmique), Pitié-Salpêtrière Hospital, Nutrition Department, Paris, France
- Assistance Publique Hôpitaux de Paris, Nutrition Department, Centre de Recherche en Nutrition Humaine (CRNH) Ile-de-France, Pitié-Salpêtrière Hospital, Paris, France
| | - Judith Aron-Wisnewsky
- Sorbonne Université, INSERM, Nutrition and Obesities; approches systémiques (NutriOmique), Pitié-Salpêtrière Hospital, Nutrition Department, Paris, France
- Assistance Publique Hôpitaux de Paris, Nutrition Department, Centre de Recherche en Nutrition Humaine (CRNH) Ile-de-France, Pitié-Salpêtrière Hospital, Paris, France
| | - Fabrizio Andreelli
- ICAN Imaging, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
- Assistance Publique Hôpitaux de Paris, Diabetology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Alban Redheuil
- Laboratoire d’Imagerie Biomédicale (LIB), Sorbonne Université, Institut National de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Paris, France
- ICAN Imaging, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
- Unité d’Imagerie Cardiovasculaire et Thoracique (ICT), Pitié-Salpêtrière Hospital, Paris, France
| | - Nadjia Kachenoura
- Laboratoire d’Imagerie Biomédicale (LIB), Sorbonne Université, Institut National de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Paris, France
- ICAN Imaging, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
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Wang Y, Gong M. Evaluation of aortic biomechanics in patients with aortic disease via imaging: A review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:458-466. [PMID: 34669189 DOI: 10.1002/jcu.23087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/26/2021] [Accepted: 10/01/2021] [Indexed: 06/13/2023]
Abstract
As a bridge between the heart and the arteries, the aorta plays an important role in the cardiovascular system. The morbidity and mortality of aortic disease are extremely high, which is a serious threat to human life. The biomechanical abnormality of the aorta is an important factor of a series of pathological changes in the aortic wall. At present, there are many imaging methods to evaluate the biomechanics of the aorta, which will benefit to the early diagnosis and treatment of aortic disease. In this review, we describe the application of various imaging methods and parameters in aortic disease.
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Affiliation(s)
- Yanli Wang
- Department of Cardiovascular Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Min Gong
- Department of Cardiovascular Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
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Komoriyama H, Kamiya K, Nagai T, Oyama-Manabe N, Tsuneta S, Kobayashi Y, Kato Y, Sarashina M, Omote K, Konishi T, Sato T, Tsujinaga S, Iwano H, Shingu Y, Wakasa S, Anzai T. Blood flow dynamics with four-dimensional flow cardiovascular magnetic resonance in patients with aortic stenosis before and after transcatheter aortic valve replacement. J Cardiovasc Magn Reson 2021; 23:81. [PMID: 34176516 PMCID: PMC8237445 DOI: 10.1186/s12968-021-00771-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pre- and post-procedural hemodynamic changes which could affect adverse outcomes in aortic stenosis (AS) patients who undergo transcatheter aortic valve replacement (TAVR) have not been well investigated. Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) enables accurate analysis of blood flow dynamics such as flow velocity, flow pattern, wall shear stress (WSS), and energy loss (EL). We sought to examine the changes in blood flow dynamics of patients with severe AS who underwent TAVR. METHODS We examined 32 consecutive severe AS patients who underwent TAVR between May 2018 and June 2019 (17 men, 82 ± 5 years, median left ventricular ejection fraction 61%, 6 self-expanding valve), after excluding those without CMR because of a contraindication or inadequate imaging from the analyses. We analyzed blood flow patterns, WSS and EL in the ascending aorta (AAo), and those changes before and after TAVR using 4D flow CMR. RESULTS After TAVR, semi-quantified helical flow in the AAo was significantly decreased (1.4 ± 0.6 vs. 1.9 ± 0.8, P = 0.002), whereas vortical flow and eccentricity showed no significant changes. WSS along the ascending aortic circumference was significantly decreased in the left (P = 0.038) and left anterior (P = 0.033) wall at the basal level, right posterior (P = 0.011) and left (P = 0.010) wall at the middle level, and right (P = 0.012), left posterior (P = 0.019) and left anterior (P = 0.028) wall at the upper level. EL in the AAo was significantly decreased (15.6 [10.8-25.1 vs. 25.8 [18.6-36.2]] mW, P = 0.012). Furthermore, a significant negative correlation was observed between EL and effective orifice area index after TAVR (r = - 0.38, P = 0.034). CONCLUSIONS In severe AS patients undergoing TAVR, 4D flow CMR demonstrates that TAVR improves blood flow dynamics, especially when a larger effective orifice area index is obtained.
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Affiliation(s)
- Hirokazu Komoriyama
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Kiwamu Kamiya
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Noriko Oyama-Manabe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Kita 14, Nishi 5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Satonori Tsuneta
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Kita 14, Nishi 5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Yuta Kobayashi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Yoshiya Kato
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Miwa Sarashina
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Kazunori Omote
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Takao Konishi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Takuma Sato
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Shingo Tsujinaga
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Hiroyuki Iwano
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Yasushige Shingu
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Satoru Wakasa
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
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Jordan J, Ricci F, Hoffmann F, Hamrefors V, Fedorowski A. Orthostatic Hypertension: Critical Appraisal of an Overlooked Condition. Hypertension 2020; 75:1151-1158. [PMID: 32223382 DOI: 10.1161/hypertensionaha.120.14340] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Orthostatic hypertension, which appears to be mediated through excess neurohumoral activation while standing, is a common blood pressure trait among patients with and without arterial hypertension. However, lack of consensus regarding the definition of orthostatic hypertension makes it difficult to assess the true prevalence of this condition. Orthostatic hypertension appears to predict the risk for progression to arterial hypertension in younger and risk of cardiovascular morbidity and mortality in older persons. Yet, the risk may differ between populations. Whether orthostatic hypertension indicates a generally increased risk of death, constitutes an intermediate variable in the causal pathway of cardiovascular risk factors, a simple measure of disease severity, or an independently acting mechanism is not known. Since both orthostatic hypotension and orthostatic hypertension herald increased risk of cardiovascular disease, it appears reasonable to screen the patients for abnormal orthostatic blood pressure responses using simple orthostatic testing. However, how presence of orthostatic hypertension may affect clinical management decisions such as the choice of antihypertensive drugs is currently difficult to ascertain. Clearly, this issue deserves more attention.
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Affiliation(s)
- Jens Jordan
- From the Institute of Aerospace Medicine, German Aerospace Center (DLR) and Chair of Aerospace Medicine (J.J., F.H.), University of Cologne, Germany.,University Hypertension Center (J.J., F.H.), University of Cologne, Germany
| | - Fabrizio Ricci
- Department of Clinical Sciences, Lund University, Malmö, Sweden (F.R., V.H., A.F.).,Department of Neuroscience, Imaging and Clinical Sciences, "G.d'Annunzio" University, Chieti-Pescara, Italy (F.R.)
| | - Fabian Hoffmann
- From the Institute of Aerospace Medicine, German Aerospace Center (DLR) and Chair of Aerospace Medicine (J.J., F.H.), University of Cologne, Germany.,University Hypertension Center (J.J., F.H.), University of Cologne, Germany
| | - Viktor Hamrefors
- Department of Clinical Sciences, Lund University, Malmö, Sweden (F.R., V.H., A.F.).,Department of Internal Medicine (V.H.), Skåne University Hospital, Malmö, Sweden
| | - Artur Fedorowski
- Department of Clinical Sciences, Lund University, Malmö, Sweden (F.R., V.H., A.F.).,Department of Cardiology (A.F.), Skåne University Hospital, Malmö, Sweden
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