Stefania L. MAGDA, Raluca I. MINCU, Maria FLORESCU, Andrea O. CIOBANU, Gabriela F UDREA, Mircea CINTEZA and Dragos VINEREANU

ABSTRACT

Background and purpose: Rheumatoid arthritis (RA) causes frequently cardiovascular complications, probably determined by early atherosclerosis in connection to chronic systemic inflammation. Purpose of our study was to assess subclinical cardiac and vascular dysfunction, and to evaluate the mechanisms of ventriculo-arterial interaction, in patients with correctly treated RA vs. normal subjects.
Methods: We evaluated 46 subjects (55±10 years, 2 men): 29 patients with seropositive treated RA (mean duration of 11±9 years), without documented cardiovascular or pulmonary disease, and 17 control subjects, matched for age, sex, and distribution of conventional major risk factors. All RA patients were under long-term treatment (more than 6 months) with Methotrexat + Sulfasalasine (22 patients) or Methotrexat + Sulfasalasine + Infliximab (7 patients). We determined biomarkers of inflammation (P-selectin, interleukines 1, 6, 10, 18, seric amiloid A, α-TNF, γ-interferon, C-reactive protein, anti-oxidated LDL antibodies), myocardial fibrosis (β-crosslaps) and ventricular overload (BNP). We assessed the parameters of cardiac function by standard and tissue Doppler echocardiography, intima-media thickness and arterial stiffness by “e-tracking” and “wave intensity analysis” (at the level of the right carotid artery), endothelial function by flow mediated dilation (FMD), and carotid-femoral pulse wave velocity by the Complior method.
Results: Biological parameters of inflammation, markers of myocardial fibrosis and of ventricular overload were not different between the 2 study groups. Also, parameters of subclinical cardiac and vascular function were similar between the two groups. RA patients had subclinical RV dysfunction, correlated to the duration of the disease. They also tended to have higher values of systolic pulmonary artery pressure than normals.
Conclusion: Correctly treated patients with RA, with controlled systemic inflammation, have normal LV, endothelial and arterial function. However, in the absence of documented pulmonary disease, they do have subclinical RV dysfunction, correlated with the duration of disease. This suggests an intrinsic RV myocardial involvement but, since pulmonary artery pressure was also higher, a secondary mechanism might be also involved.

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Leonida GHERASIM, Andrea O. CIOBANU, Carmen Lucia GHERGHINESCU, Raluca DULGHERU, Stefania MAGDA, Ruxandra DRAGOI GALRINHO, Maria FLORESCU, Suzana GUBERNA, Mircea CINTEZA and Dragos VINEREANU

ABSTRACT

Background: Blood pressure variability (BPV) was proved as a cardiovascular risk factor. One of its mechanisms is related to arterial stiffness and ventriculo-arterial coupling; however its impact on subclinical cardiovascular dysfunction has not been evaluated yet.

Objectives: To assess the relationship between BPV on 24 hours, and subclinical left ventricle (LV), renal, and vascular dysfunction in diabetic and hypertensive patients. Material and methods: We studied 56 patients (57±9 years, 29 men) with mild-to-moderate hypertension and type 2 diabetes, no cardiovascular disease, normal ejection fraction and normal renal function. 24 hours ambulatory blood pressure monitoring (ABPM) was used to assess BPV, daytime (d) and night time (n), by: 1. mean (M); 2. standard deviation of mean (SD); 3. variance (Vr); 4. coefficient of variation (CV); 5. day/night variation: reverse dippers, non-dippers, dippers and extreme dippers; conventional and 2D speckle tracking echo to assess LV function; myocardial deformation was measured as global longitudinal strain (GLS). Endothelial (flow mediated dilation, FMD) and arterial function (intima media-thickness, IMT; pulse wave velocity, PWV), microalbuminuria were tested.

Outcomes: Daytime BPV correlates inversely with subclinical myocardial function evaluated through GLS. Daytime systolic BPV correlates positively with IMT (all rho > 0.30, all p < 0.05). Also, there is a significantly inverse correlation between mean BP and GLS. We found a direct correlation between mean BP, but not BPV, and microalbuminuria (all rho > - 0.30 and all p < 0.05). We found no correlation between BPV and FMD, PWV. There were no differences for GLS, microalbuminuria and FMD between dipper groups.

Conclusions: In diabetic patients with mild-to-moderate hypertension, increased daytime blood pressure variability correlates with subclinical left ventricular dysfunction and arterial function (IMT), while microalbuminuria correlates with elevated blood pressure, but not with blood pressure variability.

Keywords: blood pressure variability, ventricular dysfunction, diabetes, hypertension

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Mircea CINTEZA, Bogdan PANA, Emil COCHINO, Maria FLORESCU, Andrei MARGULESCU, Anca FLORIAN and Dragos VINEREANU

Background. Cardiovascular disease (CVD) – including Coronary Artery Disease, Stroke, or Peripheral Arterial Disease – is the leading cause of mortality in Romania. Several risk factors (obesity – OB, smoking – SM, hypertension – HT, diabetes mellitus – DM, or hypercholesterolemia – Hchol) are associated with the development of CVD and their prevalence may vary by region of the country. However, there are few estimates of CVD risk factors burden or of its control status in Romania.

Aims. 1) to evaluate the prevalence of CVD and its risk factors in a general practitioners population among different regions in Romania and 2) to assess the status of control of CVD risk factors in this population.

Design. A cross-sectional study was conducted among an 8 EURO-regions in Romania (Bucharest, Muntenia, Oltenia, Banat, Crisana, Transilvania, Moldova and Dobrogea) between April and June 2006. From 17,330 questionnaires, 3,124 eligible individuals aged between 18 – 85 year old, 61 % female, were randomly selected to create a representative sample to respect age, gender and regional population distribution.

Methods. The following were standardly assessed: weight and height for calculation of body mass index, smoking status, arterial pressure, blood sample for measuring basal glucose and total cholesterol, history of angina and medical history questionnaire.

Results. The global prevalence of major CV risk factors (95% CI) was: HT – 39.1%, known DM – 11.8%, Hchol 31.4%, and SM – 21.7%. The general prevalence of the obesity was 26.3%, while the presence of other risk factors significantly increased the prevalence of OB (43% in diabetics vs 24% in nondiabetics, p<0.05). There was not significant difference of the CV risk factors prevalence among the EUROregions, except Banat, where the prevalence of OB and HT was higher (38.3%, respectively 42.7%) and Muntenia, where the prevalence of diabetes was higher (22.6%). The presence of history of angina and stroke was significantly increased in diabetics when compared with non-diabetics (34.2% vs 11.5%, p<0.05 and 9.3% vs 2.5%, p<0.05). Despite the treatment, adequate control of blood pressure, blood glucose or total cholesterol was present in only 22.3% of patients with HT, 19.6% of patients with DM, and 39% of those with Hchol.

Conclusions. 1. General prevalence of CVD and its risk factors in Romania is high and there are no important differences in risk factors among the 8 EURO-regions. 2. Effective risk factors control among the general practitioners population is still poor.

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