Publications by authors named "Giovanni de Simone"

278 Publications

Determinants of aortic root dilatation over time in patients with essential hypertension: The Campania Salute Network.

Eur J Prev Cardiol 2020 Jun 12. Epub 2020 Jun 12.

Background: Determinants of changes of aortic root dimension over time are not well defined.

Design: We investigated whether specific phenotype and treatment exist predicting changes in aortic root dimension in hypertensive patients from the Campania Salute Network.

Methods: N = 4856 participants (age 53 ± 11 years, 44% women) were included. At first and last available echocardiograms, we measured aortic root and a z-score of aortic root (AOz) was generated as the difference between measured and predicted aortic root, derived from a healthy reference population. Aortic root dilatation (ARD) was defined as AOz >75th percentile of distribution.

Results: At baseline, 3642 patients (75%) exhibited normal aortic root, and 1214 (25%) ARD. After a follow-up of 6.1 years (interquartile range 3.0-8.8 years), 366 (11%) patients with initial normal aortic root exhibited ARD, whereas 457(38%) with initial ARD exhibited normal aortic root. At multivariate analysis patients with incident ARD were most likely to be women, obese, with left ventricular hypertrophy, lower systolic but higher diastolic blood pressure and stroke volume index at baseline, and higher average value of diastolic blood pressure during follow-up (p < 0.05); whereas patients normalizing their ARD were non-obese women with lower baseline systolic blood pressure, stroke volume index, average diastolic blood pressure during follow-up and longer follow-up time (p < 0.05). Anti-renin-angiotensin system (anti-RAS) was associated with 45% greater probability to normalize aortic root dimension.

Conclusions: Volume (stroke volume index) and pressure loads (diastolic blood pressure) influence aortic root dimension over time. Aortic root normalization, reflecting a more favourable haemodynamic load, is predictable in non-obese women with lower diastolic blood pressure, taking more anti-RAS therapy. This suggest that sex elicits a different response in aortic walls to pathological stimuli.
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http://dx.doi.org/10.1177/2047487320931630DOI Listing
June 2020

The Global Ambulatory Blood Pressure Monitoring (ABPM) in Heart Failure with Preserved Ejection Fraction (HFpEF) Registry. Rationale, design and objectives.

J Hum Hypertens 2020 Nov 25. Epub 2020 Nov 25.

Servicios y Tecnología Cardiovascular de Guatemala. Cardiosolutions, Guatemala City, Guatemala.

Hypertension is a major risk factor for the development of heart failure with preserved ejection fraction (HFPEF) and blood pressure (BP) in itself is an important marker of prognosis. The association of BP levels, and hemodynamic parameters, measured by ambulatory blood pressure monitoring (ABPM), with outcomes, in patients with HFPEF is largely unknown. Patients with HFPEF have a substantial burden of co-morbidities and frailty. In addition there are marked geographic differences in HFPEF around the world. How these difference influence the association between BP and outcomes in HFPEF are unknown. The Global Ambulatory Blood Pressure Monitoring (ABPM) in Heart Failure with Preserved Ejection Fraction (HFpEF) Registry aims to assess the relevance of BP parameters, measured by ABPM, on the outcome of HFPEF patients worldwide. Additionally, the influence of other relevant factors such as frailty and co-morbidities will be assessed. Stable HFPEF patients with a previous hospitalization, will be included. Patients should be clinically and hemodynamically stable for at least 4 weeks before study inclusion. Specific data related to HF, biochemical markers, ECG and echocardiography will be collected. An ABPM and geriatric and frailty evaluation will be performed and the association with morbidity and mortality assessed. Follow up will be at least one year.
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http://dx.doi.org/10.1038/s41371-020-00446-8DOI Listing
November 2020

Predictors and prognostic role of low myocardial mechano-energetic efficiency in chronic inflammatory arthritis.

J Hypertens 2021 Jan;39(1):53-61

Division of Rheumatology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona.

Objective: To assess the variables associated with the status of low myocardial mechano-energetic efficiency (MEE) [the ratio between myocardial left ventricular (LV) work and magnitude of myocardial oxygen consumption] and whether low-MEE is a prognosticator of adverse cardiovascular outcome in patients with chronic inflammatory arthritis.

Methods: A total of 432 outpatients with established chronic inflammatory arthritis without overt cardiac disease were recruited from March 2014-March 2016; 216 participants were used as comparison group. Low-MEE status was a priori identified by standard echocardiography at rest as less than 0.32 ml/s per g (5th percentile of MEE calculated in 145 healthy individuals). The pre-specified primary end-point of the study was a composite of cardiovascular death/hospitalization. Follow-up ended September 2019.

Results: MEE was significantly lower in chronic inflammatory arthritis patients than controls (0.35 ± 0.11 vs. 0.45 ± 0.10 ml/s per g; P < 0.001). Low-MEE was detected in 164 patients (38%). Independent predictors of low-MEE were older age, higher SBP, diabetes mellitus, LV concentric geometry and lower LV systolic function. During a follow-up of 36 (21-48) months, a primary end-point occurred in 37 patients (8.6%): 22/164 patients with low-MEE (13.4%) and 15/268 (5.6%) without low-MEE (P = 0.004). Low-MEE predicted primary end-points in multivariate Cox regression analysis [heart rate 2.23 (confidence interval 1.13-4.38), P = 0.02] together with older age, lower renal function and higher LV mass.

Conclusion: Low-MEE is detectable in more than one-third of patients with chronic inflammatory arthritis and is associated with traditional cardiovascular risk factors and abnormalities in LV geometry and systolic function. In these patients low-MEE is a powerful prognosticator of adverse cardiovascular events.
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http://dx.doi.org/10.1097/HJH.0000000000002587DOI Listing
January 2021

Leptin levels predict the development of left ventricular hypertrophy in a sample of adult men: the Olivetti Heart Study.

J Hypertens 2021 Apr;39(4):692-697

Department of Clinical Medicine and Surgery, ESH Excellence Center of Hypertension.

Objective: A higher leptin (LPT) is associated with a greater cardiometabolic risk. Some studies also showed a positive association between LPT and cardiovascular organ damage but no consistent data are available about a predictive role of LPT on cardiac remodelling. Hence, the aim of this study was to evaluate the potential role of LPT on the incidence of left ventricular hypertrophy (LVH) in a sample of adult men.

Methods: The study population was made up of 439 individuals (age: 51 years) without LVH at baseline, participating in The Olivetti Heart Study. The ECG criteria were adopted to exclude LVH at baseline and echocardiogram criteria for diagnosis of LVH at follow-up were considered.

Results: At baseline, LPT was significantly and positively correlated with BMI, waist circumference, ECG indices, SBP and DBP but not with age and renal function. At the end of the 8-year follow-up period, there was an incidence of 23% in LVH by echocardiography. Individuals who developed LVH had higher baseline age, LPT, BMI, waist circumference, blood pressure and ECG indices (P < 0.05). Furthermore, those that had LPT above the median had greater risk to develop LVH (odds ratio: 1.7; P < 0.05). This association was also confirmed after adjustment for main confounders, among which changes in blood pressure and anthropometric indices.

Conclusion: The results of this study suggest a predictive role of circulating LPT levels on cardiac remodelling expressed by echocardiographic LVH, independently of body weight and blood pressure changes over the years.
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http://dx.doi.org/10.1097/HJH.0000000000002687DOI Listing
April 2021

Finding the right time for anti-inflammatory therapy in COVID-19.

Int J Infect Dis 2020 12 1;101:247-248. Epub 2020 Oct 1.

Department of Advanced Biomedical Science, Federico II University of Naples, Naples, Italy.

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http://dx.doi.org/10.1016/j.ijid.2020.09.1454DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7528747PMC
December 2020

Erectile dysfunction and arterial hypertension: Still looking for a scapegoat.

Eur J Intern Med 2020 11 16;81:22-23. Epub 2020 Sep 16.

Hypertension Research Center & Department of Advanced Biomedical Sciences, Federico II University Hospital, via S.Pansini 5, bld 1, 80131, Naples, Italy.

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http://dx.doi.org/10.1016/j.ejim.2020.09.004DOI Listing
November 2020

Elevated blood pressure, cardiometabolic risk and target organ damage in youth with overweight and obesity.

Nutr Metab Cardiovasc Dis 2020 09 1;30(10):1840-1847. Epub 2020 Jun 1.

Department of Movement Sciences and Wellbeing, University of Naples Parthenope, Naples, Italy. Electronic address:

Background And Aim: To compare cardiometabolic risk profile and preclinical signs of target organ damage in youth with normal and elevated blood pressure (BP), according to the American Academy of Pediatrics (AAP) guidelines.

Methods And Results: This cross-sectional multicenter study included 2739 youth (5-17 year-old; 170 normal-weight, 610 overweight and 1959 with obesity) defined non hypertensive by the AAP guidelines. Anthropometric, biochemical and liver ultrasound data were available in the whole population; carotid artery ultrasound and echocardiographic assessments were available respectively in 427 and 264 youth. Elevated BP was defined as BP ≥ 90th to <95th percentile for age, gender and height in children or BP ≥ 120/80 to <130/80 in adolescents. The overall prevalence of elevated BP was 18.3%, and significantly increased from normal-weight to obese youth. Young people with elevated BP showed higher levels of body mass index (BMI), insulin resistance and a higher prevalence of liver steatosis (45% vs 36%, p < 0.0001) than normotensive youth, whilst they did not differ for the other cardiometabolic risk factors, neither for carotid intima media thickness or left ventricular mass. Compared with normotensive youth, individuals with elevated BP had an odds ratio (95%Cl) of 3.60 (2.00-6.46) for overweight/obesity, 1.46 (1.19-1.78) for insulin-resistance and 1.45 (1.19-1.77) for liver steatosis, controlling for centers, age and prepubertal stage. The odds for insulin resistance and liver steatosis persisted elevated after correction for BMI-SDS.

Conclusion: Compared to normotensive youth, elevated BP is associated with increased BMI, insulin resistance and liver steatosis, without significant target organ damage.
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http://dx.doi.org/10.1016/j.numecd.2020.05.024DOI Listing
September 2020

Very low reporting rate of connective tissue diseases among coronavirus disease 2019 (Covid-19) patients and the renin-angiotensin system - An overlooked association?

Eur J Intern Med 2020 10 12;80:106-107. Epub 2020 Jun 12.

Centro Interdipartimentale di Ricerca sull'Ipertensione Arteriosa e le Patologie Associate (CIRIAPA), Dipartimento di Scienze Biomediche Avanzate, Università Federico II, Napoli, Italy.

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http://dx.doi.org/10.1016/j.ejim.2020.06.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7290229PMC
October 2020

Primum non nocere.

J Hum Hypertens 2020 09 16;34(8):547-550. Epub 2020 Jun 16.

Hypertension Research Center and Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.

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http://dx.doi.org/10.1038/s41371-020-0366-9DOI Listing
September 2020

Determinants of aortic root dilatation over time in patients with essential hypertension: The Campania Salute Network.

Eur J Prev Cardiol 2020 Jun 12:2047487320931630. Epub 2020 Jun 12.

Hypertension Research Center and Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy.

Background: Determinants of changes of aortic root dimension over time are not well defined.

Design: We investigated whether specific phenotype and treatment exist predicting changes in aortic root dimension in hypertensive patients from the Campania Salute Network.

Methods:  = 4856 participants (age 53 ± 11 years, 44% women) were included. At first and last available echocardiograms, we measured aortic root and a -score of aortic root (AOz) was generated as the difference between measured and predicted aortic root, derived from a healthy reference population. Aortic root dilatation (ARD) was defined as AOz >75th percentile of distribution.

Results: At baseline, 3642 patients (75%) exhibited normal aortic root, and 1214 (25%) ARD. After a follow-up of 6.1 years (interquartile range 3.0-8.8 years), 366 (11%) patients with initial normal aortic root exhibited ARD, whereas 457(38%) with initial ARD exhibited normal aortic root. At multivariate analysis patients with incident ARD were most likely to be women, obese, with left ventricular hypertrophy, lower systolic but higher diastolic blood pressure and stroke volume index at baseline, and higher average value of diastolic blood pressure during follow-up ( < 0.05); whereas patients normalizing their ARD were non-obese women with lower baseline systolic blood pressure, stroke volume index, average diastolic blood pressure during follow-up and longer follow-up time ( < 0.05). Anti-renin-angiotensin system (anti-RAS) was associated with 45% greater probability to normalize aortic root dimension.

Conclusions: Volume (stroke volume index) and pressure loads (diastolic blood pressure) influence aortic root dimension over time. Aortic root normalization, reflecting a more favourable haemodynamic load, is predictable in non-obese women with lower diastolic blood pressure, taking more anti-RAS therapy. This suggest that sex elicits a different response in aortic walls to pathological stimuli.
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http://dx.doi.org/10.1177/2047487320931630DOI Listing
June 2020

COVID-19: Timing is Important.

Eur J Intern Med 2020 07 13;77:134-135. Epub 2020 Apr 13.

Hypertension Research Center, Department of Advanced Biomedical Sciences, Federico II University Hospital, via S.Pansini 5, bld 1, 80131 Naples, Italy.

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http://dx.doi.org/10.1016/j.ejim.2020.04.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152892PMC
July 2020

Management of patients with combined arterial hypertension and aortic valve stenosis: a consensus document from the Council on Hypertension and Council on Valvular Heart Disease of the European Society of Cardiology, the European Association of Cardiovascular Imaging (EACVI), the European Association of Percutaneous Cardiovascular Interventions (EAPCI).

Eur Heart J Cardiovasc Pharmacother 2020 Apr 30. Epub 2020 Apr 30.

Department of Clinical Science, University of Bergen, Bergen (NORWAY).

Aortic valve stenosis (AS) is the third most common cardiovascular disease. The prevalence of both AS and arterial hypertension increases with age, and the conditions therefore often co-exist. Co-existence of AS and arterial hypertension is associated with higher global left ventricular (LV) pressure overload, more abnormal LV geometry and function, and more adverse cardiovascular outcome. Arterial hypertension may also influence grading of AS, leading to underestimation of the true AS severity. Current guidelines suggest re-assessing patients once arterial hypertension is controlled. Management of arterial hypertension in AS has historically been associated with prudence and concerns, mainly related to potential adverse consequences of drug-induced peripheral vasodilatation combined with reduced stroke volume due to the fixed LV outflow obstruction. Current evidence suggests that patients should be treated with antihypertensive drugs blocking the renin-angiotensin aldosterone system, adding further drug classes when required, to achieve similar target blood pressure values as in hypertensive patients without AS. The introduction of trans-catheter aortic valve implantation has revolutionized the management of patients with AS, but requires proper blood pressure management during and following valve replacement. The purpose of this document is to review the recent evidence and provide practical expert advice on management of hypertension in patients with AS.
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http://dx.doi.org/10.1093/ehjcvp/pvaa040DOI Listing
April 2020

Speculation is not evidence: antihypertensive therapy and COVID-19.

Eur Heart J Cardiovasc Pharmacother 2020 07;6(3):133-134

Hypertension Research Center, Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy.

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http://dx.doi.org/10.1093/ehjcvp/pvaa021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7184342PMC
July 2020

Characteristics and Outcomes of Patients Presenting With Hypertensive Urgency in the Office Setting: The Campania Salute Network.

Am J Hypertens 2020 04;33(5):414-421

Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy.

Background: Hypertensive urgencies (HypUrg) are defined as severe elevation in blood pressure (BP) without acute target organ damage. In the office setting, treated asymptomatic patients, with severe BP elevation meeting criteria for urgency are often seen. We evaluate incident Cardiovascular (CV) events (n = 311) during follow-up (FU) in patients with HypUrg at first outpatient visit.

Methods: HypUrg was defined by systolic BP ≥180 mm Hg and/or diastolic BP ≥110 mm Hg. Patients were >18 years old, with available ultrasound data, without prevalent CV disease, and no more than stage III Chronic Kidney Disease. BP control was defined as the average BP during FU <140/90 mm Hg.

Results: Four hundred and sixty-nine of 6,929 patients presented with HypUrg at first visit. Patients with HypUrg were more likely to be women, obese and diabetic and with higher prevalence of left ventricle (LV) hypertrophy and carotid plaque (all P <  0.05). During FU patients with HypUrg had 5-fold higher risk of uncontrolled BP (95% confidence interval (CI) 4.1-6.8, P < 0.0001). In Cox regression presenting with HypUrg was not associated with increased CV risk after adjusting for significant covariates, including age, sex, BP control, LV hypertrophy, and carotid plaque (hazard ratio (HR) 1.42, 95% CI (0.96-2.11), P = 0.08).

Conclusions: Patients with HypUrg have worst CV risk profile, reduced probability of BP control during FU and greater prevalence of target organ damage, but the excess CV event risk appears to be mediated through BP control, non-BP cardio-vascular disease risk factors, and demographic attributes.

Clinicaltrials.gov Identifier: NCT02211365.
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http://dx.doi.org/10.1093/ajh/hpaa003DOI Listing
April 2020

Peripartum management of hypertension: a position paper of the ESC Council on Hypertension and the European Society of Hypertension.

Eur Heart J Cardiovasc Pharmacother 2020 11;6(6):384-393

Department of Advanced Biomedical Sciences, Hypertension Research Center, Federico II University, Naples, Italy.

Hypertensive disorders are the most common medical complications in the peripartum period associated with a substantial increase in morbidity and mortality. Hypertension in the peripartum period may be due to the continuation of pre-existing or gestational hypertension, de novo development of pre-eclampsia or it may be also induced by some drugs used for analgesia or suppression of postpartum haemorrhage. Women with severe hypertension and hypertensive emergencies are at high risk of life-threatening complications, therefore, despite the lack of evidence-based data, based on expert opinion, antihypertensive treatment is recommended. Labetalol intravenously and methyldopa orally are then the two most frequently used drugs. Short-acting oral nifedipine is suggested to be used only if other drugs or iv access are not available. Induction of labour is associated with improved maternal outcome and should be advised for women with gestational hypertension or mild pre-eclampsia at 37 weeks' gestation. This position paper provides the first interdisciplinary approach to the management of hypertension in the peripartum period based on the best available evidence and expert consensus.
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http://dx.doi.org/10.1093/ehjcvp/pvz082DOI Listing
November 2020

Echocardiography in Low-Risk Hypertensive Patients.

J Am Heart Assoc 2019 12 16;8(24):e013497. Epub 2019 Dec 16.

Department of Medicine University of Perugia Italy.

Background It is debated whether echocardiography should be part of the diagnostic workup in all hypertensive patients. We identified some factors potentially associated with left ventricular hypertrophy (LVH) at echocardiography in untreated hypertensive patients. Methods and Results We studied 2150 patients without LVH at ECG. All patients underwent standard 12-lead ECG and echocardiography. Mean age was 48.7 years, and mean office blood pressure was 154/97 mm Hg. Prevalence of echocardiographic LVH (LV mass >47.0 g/m in women and >50.0 g/m in men) was 37.1%. We developed a nomogram based on 7 items (age, smoking, body mass index, office systolic and diastolic blood pressure, Cornell voltage, and chronic kidney disease) on the basis of a multivariable logistic regression analysis. We internally validated the model by bootstrap recalibration and obtained a calibration curve to assess agreement in the validation data set. Probability of LVH at echocardiography ranged from <10% (score, ≤100 points) to >90% (score, ≥180 points). Proportion of patients with LVH progressively increased with the total score (χ=444.8; <0.001). Prevalence of LVH was <2% and 90% at the lower 5th and upper 95th percentile of its distribution, respectively. Conclusions We developed and validated a novel score to assess the probability of LVH at echocardiography in hypertensive patients without LVH at ECG. The score may guide the appropriateness of echocardiographic study in low-risk hypertensive patients. Echocardiography appears most appropriate for score values >136 in men and >124 in women.
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http://dx.doi.org/10.1161/JAHA.119.013497DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6951057PMC
December 2019

Impact of estimated left atrial volume on prognosis in patients with asymptomatic mild to moderate aortic valve stenosis.

Int J Cardiol 2019 12 3;297:121-125. Epub 2019 Oct 3.

Department of Clinical Science, University of Bergen, Bergen, Norway.

Background: The prognostic impact of increased left atrial (LA) volume in mild-to-moderate aortic valve stenosis (AS) is unclear. We investigated the association of estimated LA volume with prognosis in a large prospective study of patients with asymptomatic mild-to-moderate AS.

Methods: The association of estimated LA volume with major cardiovascular events (MACE, combined cardiovascular death, heart failure hospitalization and non-hemorrhagic stroke) was assessed in 1534 patients with initially mild-to moderate asymptomatic AS, participating in the Simvastatin Ezetimibe in Aortic Stenosis study for a median of 4.3 years. LA volume was estimated from LA diameter applying a validated nonlinear equation and indexed to body height in meters squared (eLAVI). An enlarged eLAVI was identified by using sex-specific cut-offs (>19 ml/height in men and >17 ml/height in women).

Results: Patients with enlarged eLAVI were older, more obese, and had higher systolic blood pressure and left ventricular (LV) mass index (all p < 0.001). During follow-up, incident MACE occurred in 137 patients, more often in patients with enlarged eLAVI (20% vs. 7.7%, p < 0.001). Using aortic valve replacement as a competing risk event, enlarged eLAVI at baseline predicted increased hazard rate (HR) of MACE (HR 2.21 [95% confidence interval 1.37-3.55], p = 0.001) independent of significant associations with presence of LV hypertrophy, older age, higher peak aortic jet velocity, serum creatinine and lower LV ejection fraction and stroke volume.

Conclusions: Presence of enlarged eLAVI was independently associated with increased risk of MACE in patients with mild-to moderate asymptomatic AS.
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http://dx.doi.org/10.1016/j.ijcard.2019.10.004DOI Listing
December 2019

Left Ventricular Mass in Hypertrophic Cardiomyopathy Assessed by 2D-Echocardiography: Validation with Magnetic Resonance Imaging.

J Cardiovasc Transl Res 2020 04 5;13(2):238-244. Epub 2019 Sep 5.

Department of Advanced Biomedical Sciences, University Federico II of Naples, Via S Pansini, I-80131, Naples, Italy.

We aim to validate echocardiographic left ventricular (LV) mass (echoLVM) in sixty-one patients with hypertrophic cardiomyopathy (HCM), using cardiac magnetic resonance measures (cmrLVM) as gold standard. cmrLVM was calculated using LV short-axis images, from base to apex, whereas echoLVM by LV epicardial minus LV endocardial volumes in 4 and 2 chamber views, using Simpson disk summation; trabeculae and papillary muscle were excluded in both cmrLVM and echoLVM. cmrLVM and echoLVM were not different by paired t test (145 ± 66 vs 147 ± 61; p = 0.240), and their correlation was good (r = 0.977; p < 0.0001). Intraclass correlation demonstrated reliability of echoLVM with cmrLVM (ρ = 0.987; Cls = 0.978-0.992; p < 0.0001). LV end-diastolic volume was higher by CMR than that by echo (137 ± 33 vs 85 ± 28 mL, p < 0.0001), resulting in a lower mass/volume ratio (1.1 ± 0.4 vs 1.8 ± 0.8, p < 0.0001). EchoLVM may be determined in patients with HCM. However, mass/volume ratio is higher by echocardiography than that by CMR.
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http://dx.doi.org/10.1007/s12265-019-09911-3DOI Listing
April 2020

The American Academy of Pediatrics hypertension guidelines identify obese youth at high cardiovascular risk among individuals non-hypertensive by the European Society of Hypertension guidelines.

Eur J Prev Cardiol 2020 01 6;27(1):8-15. Epub 2019 Aug 6.

Department of Movement and Wellbeing Sciences, University of Naples Parthenope, Naples, Italy.

Background: Two different systems for the screening and diagnosis of hypertension (HTN) in children currently coexist, namely, the guidelines of the 2017 American Academy of Pediatrics (AAP) and the 2016 European Society for Hypertension (ESH). The two systems differ in the lowered cut-offs proposed by the AAP versus ESH.

Objectives: We evaluated whether the reclassification of hypertension by the AAP guidelines in young people who were defined non-hypertensive by the ESH criteria would classify differently overweight/obese youth in relation to their cardiovascular risk profile.

Methods: A sample of 2929 overweight/obese young people (6-16 years) defined non-hypertensive by ESH (ESH) was analysed. Echocardiographic data were available in 438 youth.

Results: Using the AAP criteria, 327/2929 (11%) young people were categorized as hypertensive (ESH/AAP). These youth were older, exhibited higher body mass index, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), triglycerides, total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) ratio, blood pressure, left ventricular mass index and lower HDL-C ( <0.025-0.0001) compared with ESH/AAP. The ESH/AAP group showed a higher proportion of insulin resistance (i.e. HOMA-IR ≥3.9 in boys and 4.2 in girls) 35% . 25% ( <0.0001), high TC/HDL-C ratio (≥3.8 mg/dl) 35% . 26% ( = 0.001) and left ventricular hypertrophy (left ventricular mass index ≥45 g/h) 67% . 45% ( = 0.008) as compared with ESH/AAP.

Conclusions: The reclassification of hypertension by the AAP guidelines in young people overweight/obese defined non-hypertensive by the ESH criteria identified a significant number of individuals with high blood pressure and abnormal cardiovascular risk. Our data support the need of a revision of the ESH criteria.
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http://dx.doi.org/10.1177/2047487319868326DOI Listing
January 2020

Severity of Coronary Atherosclerosis and Risk of Diabetes Mellitus.

J Clin Med 2019 Jul 21;8(7). Epub 2019 Jul 21.

Department of Advanced Biomedical Sciences, University of Naples Federico II, 80100 Napoli, Italy.

Background: Cardio-vascular target organ damage predicts the onset of type 2 diabetes mellitus (DM) in hypertensive patients. Whether an increased incidence of DM is also in relation to the severity of coronary atherosclerosis is unknown.

Objective: We evaluated the onset of DM in relation to the extent and severity of coronary atherosclerosis, using the SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score (SS), in patients with stable angina or acute coronary syndromes, referred for coronary angiography (CA).

Methods: Non-diabetic patients that underwent CA for the first time were included, and the SS was computed. Predictors of DM onset in low, medium, and high SSs were investigated.

Results: Five hundred and seventy patients were included, and the mean SS was 6.3 ± 7.6. During a median follow-up of 79 months (interquartile range (IQR): 67-94), 74 patients (13%) developed DM. The risk of DM onset was significantly higher in the patients with a medium or high SS (hazard ratio (HR)-95% confidence interval (CI): 16 (4-61), < 0.0001; and 30 (9-105), < 0.0001, vs low SS, respectively), even after adjustment for obesity, history of hypertension, impaired fasting glucose, and cardiovascular therapy.

Conclusions: The severity and extent of the coronary atherosclerosis, evaluated by the SS, is a strong and independent predictor of the development of DM in patients, referred to CA.
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http://dx.doi.org/10.3390/jcm8071069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6678313PMC
July 2019

Depressed Myocardial Energetic Efficiency Increases Risk of Incident Heart Failure: The Strong Heart Study.

J Clin Med 2019 Jul 17;8(7). Epub 2019 Jul 17.

Hypertension Research Center, University Federico II of Naples, I-80131 Naples, Italy.

An estimation of myocardial mechano-energetic efficiency (MEE) per unit of left ventricular (LV) mass (MEEi) can significantly predict composite cardiovascular (CV) events in treated hypertensive patients with normal ejection fraction (EF), after adjustment for LV hypertrophy (LVH). We have tested whether MEEi predicts incident heart failure (HF), after adjustment for LVH, in the population-based cohort of a "Strong Heart Study" (SHS) with normal EF. We included 1,912 SHS participants (age 59 ± 8 years; 64% women) with preserved EF (≥50%) and without prevalent CV disease. MEE was estimated as the ratio of stroke work to the "double product" of heart rate times systolic blood pressure. MEEi was calculated as MEE/LV mass, and analyzed in quartiles. During a follow-up study of 9.2 ± 2.3 years, 126 participants developed HF (7%). HF was preceded by acute myocardial infarction (AMI) in 94 participants. A Kaplan-Meier plot, in quartiles of MEEi, demonstrated significant differences, substantially due to the deviation of the lowest quartile ( < 0.0001). Using AMI as a competing risk event, sequential models of Cox regression for incident HF (including significant confounders), demonstrated that low MEEi predicted incident HF not due to AMI ( = 0.026), after adjustment for significant effect of age, LVH, prolonged LV relaxation, diabetes, and smoking habits with negligible effects for sex, hypertension, antihypertensive therapy, obesity, and hyperlipemia. Low LV mechano-energetic efficiency per unit of LVM, is a predictor of incident, non-AMI related, HF in subjects with initially normal EF.
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http://dx.doi.org/10.3390/jcm8071044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6678469PMC
July 2019

Achievement of target SBP without attention to decrease in DBP can increase cardiovascular morbidity in treated arterial hypertension: the Campania Salute Network.

J Hypertens 2019 09;37(9):1889-1897

Hypertension Research Center.

Objectives: Results of the SPRINT study have influenced recent guidelines on arterial hypertension, in the identification of target SBP, but scarce attention has been paid to the consequences on DBP. However, there is evidence that reducing DBP too much can be harmful.

Methods: We analyzed outcome in 4005 treated hypertensive patients (22% obesity, 8% diabetes and 21% current smoking habit) with target attended office SBP less than 140 mmHg, in relation to quintiles of DBP, cardiovascular risk profile and target organ damage (LV hypertrophy, carotid plaque and left atrial dilatation). Composite fatal and nonfatal cardiovascular event was the outcome variable in this analysis (stroke and myocardial infarction, sudden cardiac death, heart failure requiring hospitalization, transient ischemic attack, myocardial revascularization, de novo angina, carotid stenting and atrial fibrillation).

Results: Lower DBP was associated with greater proportion of women and diabetes, older age, decline in kidney function and greater values of LV mass index and left atrial volume and greater prevalence of carotid plaque (all 0.04 < P < 0.0001). The lowest quintile of DBP (74.1 ± 3.7 mmHg) was associated with 1.49 higher hazard of composite cardiovascular events, independently of significant effect of older age, female sex, LV hypertrophy and borderline effect of left atrial dilatation (0.04 < P < 0.001).

Conclusion: Increased risk associated with aggressive reduction of DBP should be balanced with the advantage of reducing aggressively SBP to predict the net benefit of antihypertensive treatment, especially in the oldest old individuals.
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http://dx.doi.org/10.1097/HJH.0000000000002128DOI Listing
September 2019

CHADS-VASc score and left atrial volume dilatation synergistically predict incident atrial fibrillation in hypertension: an observational study from the Campania Salute Network registry.

Sci Rep 2019 05 27;9(1):7888. Epub 2019 May 27.

Hypertension Research Center, University of Naples, Federico II, Naples, Italy.

Arterial hypertension is a leading risk factor for developing atrial fibrillation. CHADS-VASc score can help to decide if patients with atrial fibrillation need anticoagulation. Whether CHADS-VASc may predicts incident atrial fibrillation and how it interacts with left atrial dilatation is unknown. We tested this hypothesis in a large registry of treated hypertensive patients. From 12154 hypertensive patients we excluded those with prevalent atrial fibrillation (n 51), without follow-up (n 3496), or carotid ultrasound (n 1891), and low ejection fraction (i.e. <50%, n 119). A CHADS-VASc score ≥3 was compared with CHADS-VASc score ≤2. Incident symptomatic or occasionally detected atrial fibrillation was the end-point of the present analysis. At baseline, 956 (15%) patients exhibited high CHADS-VASc; they were older, most likely to be women, obese and diabetic, with lower glomerular filtration rate, and higher prevalence of left ventricular hypertrophy, left-atrial dilatation and carotid plaque (all p < 0.005). Prevalent Stroke/TIA was found only in the subgroup with high CHADS-VASc. During follow-up (median = 54 months) atrial fibrillation was identified in 121 patients, 2.57-fold more often in patients with high CHADS-VASc (95% Cl 1.71-4.86 p < 0.0001). In multivariable Cox analysis, CHADS-VASc increased incidence of atrial fibrillation by 3-fold, independently of significant effect of left-atrial dilatation (both p < 0.0001) and other markers of organ damage. Incident AF is more than doubled in hypertensive patients with CHADS-VASc ≥3. Coexisting CHADS-VASc score >3 and LA dilatation identify high risk subjects potentially needing more aggressive management to prevent AF and associated cerebrovascular ischemic events.
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http://dx.doi.org/10.1038/s41598-019-44214-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6536498PMC
May 2019

Prognostic impact of increased pulse pressure/stroke index in a registry of hypertensive patients: the Campania Salute Network.

Blood Press 2019 08 9;28(4):268-275. Epub 2019 May 9.

a Hypertension Research Center, Federico II University , Naples , Italy.

Increased arterial stiffness is associated with advanced arteriosclerosis, abnormal left ventricular (LV) geometry and function. Whether increased arterial stiffness is associated with incident cardiovascular (CV) event (MACE), independent of other markers of target organ damage needs to be clarified. We selected hypertensive participants of the Campania Salute Network free of prevalent CV disease, with available echocardiogram and carotid ultrasound, ejection fraction ≥50%, and ≤ stage III Chronic Kidney Disease ( = 6907). Median follow-up was 63 months. End-point was incident MACE (fatal and non-fatal stroke and myocardial infarction, sudden cardiac death, carotid stenting and heart failure requiring hospitalization). Arterial stiffness was assessed from ratio of brachial pulse pressure/stroke index (i.e. normalized for body height in meter to 2.04 power) (PP/SVi). High PP/SVi ( = 980) was defined as >95th sex-specific percentile of the normal distribution from a reference normal population (>2.63/>2.82 mmHg/ml in men and women, respectively). Patients with high PP/SVi were more likely to be women, older, diabetic, with higher systolic blood pressure (BP) and heart rate, more LV concentric geometry, left atrial dilatation and more carotid plaque (all  < .01). At given increase in SVi, patients with high PP/SVi exhibited two-fold increase in PP compared to normal PP/SVi. In Cox regression, patients with high PP/SVi had 63% increased hazard of MACE [95% CI (1.02-2.59)  = .04], independently of significant effect of older age, male sex, carotid plaque and less frequent anti-RAS therapy. In treated hypertensive patients, high PP/SVi predicted increased rate of MACE, independent of common confounders.
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http://dx.doi.org/10.1080/08037051.2019.1612705DOI Listing
August 2019

Myocardial mechano-energetic efficiency and insulin resistance in non-diabetic members of the Strong Heart Study cohort.

Cardiovasc Diabetol 2019 04 30;18(1):56. Epub 2019 Apr 30.

Weill Cornell Med, New York, NY, USA.

Background: Myocardial energetic efficiency (MEE), is a strong predictor of CV events in hypertensive patient and is reduced in patients with diabetes and metabolic syndrome. We hypothesized that severity of insulin resistance (by HOMA-IR) negatively influences MEE in participants from the Strong Heart Study (SHS).

Methods: We selected non-diabetic participants (n = 3128, 47 ± 17 years, 1807 women, 1447 obese, 870 hypertensive) free of cardiovascular (CV) disease, by merging two cohorts (Strong Heart Study and Strong Heart Family Study, age range 18-93). MEE was estimated as stroke work (SW = systolic blood pressure [SBP] × stroke volume [SV])/"double product" of SBP × heart rate (HR), as an estimate of O consumption, which can be simplified as SV/HR ratio and expressed in ml/sec. Due to the strong correlation, MEE was normalized by left ventricular (LV) mass (MEEi).

Results: Linear trend analyses showed that with increasing quartiles of HOMA-IR patients were older, more likely to be women, obese and hypertensive, with a trend toward a worse lipid profile (all p for trend < 0.001), progressive increase in LV mass index, stroke index and cardiac index and decline of wall mechanics (all p < 0.0001). In multivariable regression, after adjusting for confounders, and including a kinship coefficient to correct for relatedness, MEEi was negatively associated with HOMA-IR, independently of significant associations with age, sex, blood pressure, lipid profile and central obesity (all p < 0.0001).

Conclusions: Severity of insulin resistance has significant and independent negative impact on myocardial mechano-energetic efficiency in nondiabetic individual from a population study of American Indians. Trial registration number NCT00005134, Name of registry: Strong Heart Study, URL of registry: https://clinicaltrials.gov/ct2/show/NCT00005134 , Date of registration: May 25, 2000, Date of enrolment of the first participant to the trial: September 1988.
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http://dx.doi.org/10.1186/s12933-019-0862-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6492323PMC
April 2019

Impact of the 2017 Blood Pressure Guidelines by the American Academy of Pediatrics in overweight/obese youth.

J Hypertens 2019 04;37(4):732-738

Hypertension Research Center & Department of Translational Medical Sciences, Federico II University Naples, Naples, Italy.

Objectives: The aim of this study was to compare the impact of the European Society of Hypertension Guidelines 2016 (ESHG2016) and the American Academy of Pediatrics Guidelines 2017 (AAPG2017) on the screening of hypertension and classification of abnormal left ventricular geometry (ALVG) in overweight/obese youth.

Methods: This study included 6137 overweight/obese youth; 437 had echocardiographic assessment. Hypertension was defined using either ESHG2016 or AAPG2017. ALVG was defined using 95th percentile for age and sex of left ventricular mass index (LVMi) and/or relative wall thickness (RWT) more than 0.38 (juvenile cut-offs) according to ESHG2016 or LVMi more than 51 g/h and/or RWT more than 0.42 (adult cut-offs) according to AAPG2017.

Results: Prevalence of youth at a high risk of hypertension was 13% higher using AAPG2017 than ESHG2016. The increase was larger in overweight youth at least 13 years of age (+43%). Using the juvenile cut-offs for ALVG, youth at a high risk of hypertension by ESHG2016 had an odds ratio [95% confidence interval (95% CI)] of 3.03 (1.31-7.05) for left ventricular concentric remodelling (LVcr) and 2.53 (1.43-4.47) for concentric left ventricular hypertrophy (cLVH) as compared with youth with normal LVG. Similarly, in youth at a high risk of hypertension by AAPG2017, the odds ratio for LVcr was 3.28 (1.45-7.41, P < 0.001) and 3.02 (95% CI: 1.73-5.27, P < 0.001) for cLVH. Using the adult cut-offs, no significant difference in ALVG was found with both guidelines.

Conclusion: The prevalence of overweight/obese youth at a high risk of hypertension increased by 13% comparing AAPG2017 vs. ESHG2016. The juvenile cut-offs for ALVG were more effective than the adult criteria in intercepting individuals with a potentially higher cardiovascular risk.
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http://dx.doi.org/10.1097/HJH.0000000000001954DOI Listing
April 2019

Anterior vs lateral symmetric interstitial syndrome in the diagnosis of acute heart failure.

Int J Cardiol 2019 04 15;280:130-132. Epub 2019 Jan 15.

Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy.

Acute dyspnea due to acute heart failure (AHF) is one of the most common reasons for admission to the Emergency Department (ED). The importance of lung ultrasound (LUS) examination in the diagnostic workup of AHF has been widely established. Limited anterior LUS examination for the diagnosis of AHF is controversial. This study compares the accuracy of LUS examination limited to the anterior or lateral lung zones for the diagnosis of AHF and their accuracy among patients with different levels of hypoxemia according to PO/FiO ratio evaluation. We analyzed 170 patients admitted to the ED for acute dyspnea, who underwent multi-organ ultrasound examination of lung, heart and inferior vena cava for differential diagnosis. The thorax was examined following a simplified protocol that provides two scans at each side (anterior and lateral) to sample upper and lower lobes and the presence or the absence of interstitial syndrome (IS) was evaluated. The presence of anterior symmetric IS exhibited lower accuracy than lateral symmetric IS in the diagnosis of AHF in the whole population, but its diagnostic accuracy improves in sub-groups of patients with severe and critical hypoxemia.
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http://dx.doi.org/10.1016/j.ijcard.2019.01.013DOI Listing
April 2019

Are We Underestimating Prehypertension?

Hypertension 2019 03;73(3):541-542

From the Hypertension Research Center and Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy.

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http://dx.doi.org/10.1161/HYPERTENSIONAHA.118.12310DOI Listing
March 2019