Determinants and impact of masked hypertension in offspring of patients with diabetes: relation with coronary flow and cardiac function.

OBJECTIVE: We aimed to evaluate the prevalence, determinants and clinical impact of masked hypertension in offspring of patients with diabetes. Masked hypertension was defined according to guidelines as daytime ambulatory blood pressure monitoring "ABPM" ≥135/85 mmHg and clinic BP <140/90 mmHg. METHODS: 100 nondiabetic offspring of patients with diabetes and 60 offspring of healthy people were enrolled; 24-h ABPM was applied to evaluate mean 24-h systolic/diastolic blood pressure "BP", daytime, nighttime and night dipping readings. Left ventricular parameters and coronary flow reserve of the left anterior descending artery (induced by adenosine 0.14 mg/kg/min) was calculated in all offspring. RESULTS: 29% of offspring of patients with diabetes had masked hypertension compared to only 3.3% offspring in healthy people (p < 0.001). Compared with those without masked hypertension, offspring with masked hypertension had a significantly reduced coronary flow reserve (p < 0.001), significantly higher E/e' (p < 0.01), [a surrogate marker of left ventricular filling pressure], more microalbuminuria (p < 0.01), and higher values of high-sensitive C-reactive protein "CRP" (p < 0.001). Multivariate regression analysis showed that, fasting blood glucose, and high-sensitive CRP, were independently associated with masked hypertension, whilst daytime systolic BP and non-dipping systolic BP were the strongest predictors for masked hypertension. Logistic regression analysis revealed that masked hypertension was independently associated with reduced coronary flow reserve (p < 0.0001) and diastolic dysfunction (p < 0.001). CONCLUSION: Masked hypertension is prevalent in offspring of patients with diabetes and significantly associated with reduced coronary flow reserve and left ventricular diastolic dysfunction. These findings suggest that offspring of patients with diabetes constitute a high risk group and deserve close follow up, mainly with the use of ABPM.

Ventricular dyssynchrony as a marker of latent carditis in children with acute rheumatic fever: A tissue Doppler imaging.

OBJECTIVE: We aimed to investigate the hypothesis that the presence of left ventricular (LV) dyssynchrony in children with acute rheumatic fever (ARF) children may be a predictor of latent rheumatic carditis. METHODS: Eighty-nine children with ARF and 45 healthy control children were included the study. LV dyssynchrony was investigated by color-coded tissue Doppler imaging. RESULTS: LV dyssynchrony parameters including Ts-SD-12, Ts-12, Ts-SD-6, and Ts-6 were found to be prolonged in children with ARF than in controls (P < .001). We found that 45.2% in children with ARF without carditis had LV dyssynchrony (Ts-SD-12 ≥ 34.4 ms), while 63.4% in children with ARF with carditis had LV dyssynchrony. Follow-up analysis demonstrated that children with arthritis and without dyssynchrony had no adverse events (recurrent rheumatic activity, development of valvular diseases; heart failure and atrial fibrillation), while those with LV dyssynchrony had events rate of 40.9% (P < .001). Likewise, children with carditis had event rates of 63.4%. Ts-SD-12 was found to be correlated with hs-CRP (r = .63; P < .001). Receiver-operating characteristic (ROC) curve analysis showed that a Ts-SD-12 ≥ 36.5 was the optimal cutoff value in predicting unfavorable outcome in patients with ARF, with a sensitivity of 95% and specificity of 82%. CONCLUSIONS: We found that children with ARF without any evidence of carditis had a significant LV systolic dyssynchrony spite of normal EF. LV dyssynchrony in those children had a significant event rates on follow-up. These results highlighted the incremental value of LV dyssynchrony as a marker of subclinical carditis in children with ARF.

Atrial dyssynchrony and left atrial stiffness are risk markers for cryptogenic stroke in patients with patent foramen ovale.

OBJECTIVE: The clinical and echocardiographic parameters associated with the risk predictors of cryptogenic stroke (CS) in patients with patent foramen ovale (PFO) still diverse and with a great debate. We hypothesized that left atrial stiffness (LASt) and atrial dyssynchrony may increase the risk of CS in patients with PFO. METHODS: A total of 129 consecutive patients presented without clinical reasoning of stroke were recruited. Transesophageal echocardiographic assessment was performed to investigate the presence of PFO. PFO was identified in 52% (group I) and absent in 48% (group II). Utilizing speckle-tracking imaging LASt and atrial dyssynchrony was evaluated among patients with PFO (group I) vs those without PFO (group II). RESULTS: LASt was significantly increased in group I patients compared with group II (P < .001). Likewise patients with PFO had a significant LA dyssynchrony compared with those in group II (P < .001). Interatrial dyssynchrony and left atrial dyssynchrony were correlated with LASt (r = .47 and 0.51, respectively; P < .001). Cardiac arrhythmias were significantly encountered in group I patients (at presentation and with Holter monitoring) P < .001. Besides significantly increase in atrial dyssynchrony and in LASt in patients with arrhythmias compared with those without (P < .001). ROC analysis revealed that LASt index ≥ 0.61 and LA dyssynchrony ≥ 23.5 predicts cardiac arrhythmias in CS patients with PFO with (AUC: 0.85 and 0.87, respectively, P < .001). CONCLUSION: In conclusion, we demonstrated that LASt and atrial dyssynchrony might be risk markers of cryptogenic stroke in patients with PFO.