Publications by authors named "Marijana Tadic"

300 Publications

Blood pressure variability correlates with right ventricular strain in women with gestational hypertension and preeclampsia.

J Hum Hypertens 2021 Jul 16. Epub 2021 Jul 16.

University Clinical Hospital Center "Dr. Dragisa Misovic-Dedinje", Clinic for Internal medicine, Cardiology Department, Belgrade, Serbia.

The aim of this study was to evaluate the short- and long-term blood pressure (BP) variability and right ventricular (RV) remodeling in women with gestational hypertension and preeclampsia, as well as their association. This cross-sectional study included 161 pregnant women (56 normotensive controls, 55 patients with gestational hypertension, and 50 patients with preeclampsia) after 20 weeks of gestation. All women underwent 24-h ambulatory BP monitoring and echocardiographic examination. Our findings showed that 24-h, daytime and nighttime systolic and diastolic BPs, as well as visit-to-visit systolic and diastolic BPs, were significantly higher in women with gestational hypertension and preeclampsia than in control group. Parameters of short- and long-term BP variability gradually increased from controls, throughout women with preeclampsia, to those with gestational hypertension. RV diameter, E/e' and PAP were significantly higher in women with gestational hypertension and preeclampsia than in controls. Global and free wall RV longitudinal strains, as well as corresponding endo- and epicardial strains, gradually reduced from controls to women with preeclampsia. Parameters of short- and long-term BP variability were independently associated with global and free wall RV longitudinal strain. In conclusion, short- and long-term BP variability was higher in women with pregnancy-induced hypertensive disorders. RV diastolic function and mechanics were deteriorated in these women comparing with controls. A significant association between BP variability and RV longitudinal strain underlines the importance of determination of short- and long-term BP variability during pregnancy.
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http://dx.doi.org/10.1038/s41371-021-00580-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284030PMC
July 2021

Functional tricuspid regurgitation, related right heart remodeling, and available treatment options: good news for patients with heart failure?

Heart Fail Rev 2021 Jul 15. Epub 2021 Jul 15.

Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081, Ulm, Germany.

Significant functional tricuspid regurgitation (FTR) represents a poor prognostic factor independent of right ventricular (RV) function. It is usually the consequence of left-sided cardiac diseases that induce RV dilatation and dysfunction, but it can also resulted from right atrial (RA) enlargement and consequent tricuspid annular dilatation. FTR is very frequent among patients with heart failure, particularly in those with reduced LVEF and concomitant functional mitral regurgitation. The development of three-dimensional echocardiography enabled detailed assessment of tricuspid valve anatomy, subvavlular apparatus, and RA and RV changes, as well as accurate evaluation of FTR etiology. Due to high in-hospital mortality risk in patients who were operatively treated for isolated FTR, it has been treated only medically for a long time. Percutaneous approach considers mainly transcatheter tricuspid valve repair (edge-to-edge and annuloplasty) and represents a very attractive option for the high-risk patients. Studies that investigated the effects of different devices showed excellent feasibility and safety, followed by significant reduction in FTR grade, improvement in functional capacity and NYHA class, quality of life, and reduction in hospitalization due to heart failure. Some investigations also reported a decreased mortality in FTR patients. Nevertheless, the results of these investigations should be interpreted with cautious due to the small number of participants and relatively short follow-up. The aim of this review was to summarize the existing data about the clinical importance of FTR and FTR-induced right heart remodeling and currently existing therapeutic approaches for treatment of FTR.
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http://dx.doi.org/10.1007/s10741-021-10141-6DOI Listing
July 2021

The Predictive Value of Right Ventricular Longitudinal Strain in Pulmonary Hypertension, Heart Failure, and Valvular Diseases.

Front Cardiovasc Med 2021 17;8:698158. Epub 2021 Jun 17.

Klinik für Innere Medizin II, Universitätsklinikum Ulm, Ulm, Germany.

Right ventricular (RV) systolic function has an important role in the prediction of adverse outcomes, including mortality, in a wide range of cardiovascular (CV) conditions. Because of complex RV geometry and load dependency of the RV functional parameters, conventional echocardiographic parameters such as RV fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE), have limited prognostic power in a large number of patients. RV longitudinal strain overcame the majority of these limitations, as it is angle-independent, less load-dependent, highly reproducible, and measure regional myocardial deformation. It has a high predictive value in patients with pulmonary hypertension, heart failure, congenital heart disease, ischemic heart disease, pulmonary embolism, cardiomyopathies, and valvular disease. It enables detection of subclinical RV damage even when conventional parameters of RV systolic function are in the normal range. Even though cardiac magnetic resonance-derived RV longitudinal strain showed excellent predictive value, echocardiography-derived RV strain remains the method of choice for evaluation of RV mechanics primarily due to high availability. Despite a constantly growing body of evidence that support RV longitudinal strain evaluation in the majority of CV patients, its assessment has not become the part of the routine echocardiographic examination in the majority of echocardiographic laboratories. The aim of this clinical review was to summarize the current data about the predictive value of RV longitudinal strain in patients with pulmonary hypertension, heart failure and valvular heart diseases.
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http://dx.doi.org/10.3389/fcvm.2021.698158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8247437PMC
June 2021

Omega-3 Fatty Acids and Coronary Artery Disease: More Questions Than Answers.

J Clin Med 2021 Jun 4;10(11). Epub 2021 Jun 4.

Department of Medicine and Surgery, University of Milano-Bicocca, Milan and Policlinico di Monza, 28100 Monza, Italy.

Studies show that patients with elevated triglycerides and well-controlled LDL levels under statin therapy still have a significant residual risk of cardiovascular (CV) events. Despite many attempts to reduce triglycerides with different hypolipidemic drugs, no therapeutic option has given satisfactory results so far. The initial enthusiasm that omega-3 fatty acids can effectively reduce triglycerides and CV risk was replaced with skepticism when the first large clinical trials failed to show any benefit in primary or secondary prevention. However, the latest studies succeeded in showing a positive effect of omega-3 fatty acids on CV outcome in patients with hypertriglyceridemia. The largest benefit was reported in secondary but not primary prevention. Interestingly, the reduction in triglycerides in some of these studies was disproportionately low to the relatively high CV risk reduction, which could indicate some other effects of omega-3 fatty acids that go well beyond hypotriglyceridemic action. This includes blood pressure reduction, antithrombotic effect, improvement of inflammatory status, endothelial function, and insulin resistance. Investigations also reported a significant and positive influence of omega-3 fatty acids on the composition and stabilization of coronary atherosclerotic plaques in patients with and without previous CV events. In addition to insufficiently known mechanisms of action and conflicting results about the effectiveness of omega-3 fatty acids, the safety problems, which include increased prevalence of atrial fibrillation and hemorrhage, were also reported. The aim of this clinical review was to summarize the current knowledge regarding the use of omega-3 fatty acids in CV patients, particularly those with coronary artery disease, and to present an overview of key clinical trial data.
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http://dx.doi.org/10.3390/jcm10112495DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8201167PMC
June 2021

Myocardial strain and left ventricular geometry: a meta- echocardiographic studies in systemic hypertension.

J Hypertens 2021 Jun 14. Epub 2021 Jun 14.

University Hospital 'Dr Dragisa Misovic - Dedinje' Department of Cardiology, Belgrade, Serbia Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.

Aim: Evidence on systolic dysfunction, as assessed by left ventricular (LV) mechanics, in hypertensive heart disease phenotyped by abnormal LV geometric patterns is still limited. Thus, we performed a systematic meta-analysis of 2D/3D speckle-tracking studies in order to provide an updated comprehensive information on this topic.

Methods: The PubMed, OVID-MEDLINE, and Cochrane library databases were analyzed to search for articles published from the inception up to 31 January 2021. Studies were identified by using MeSH terms and crossing the following search items: 'myocardial strain', 'left ventricular mechanics', 'speckle tracking echocardiography', 'systolic dysfunction', 'hypertensive heart disease', 'left ventricular hypertrophy', left ventricular remodeling", 'concentric hypertrophy', 'eccentric hypertrophy'.

Results: Overall, data of 267 normotensive controls and 712 hypertensive patients (234 normal geometry, 97 LV concentric remodeling, 176 eccentric LVH, and 205 concentric LVH) from eight studies were considered. Pooled ejection fraction was similar in normotensives and in the whole group of hypertensive patients: (SMD 0.037 ± 0.05, confidence interval (CI): 0.14/0.07, P = 0.51) as well as in hypertensive subgroups. LVMI, and E/e' gradually increased from hypertensive patients with normal geometry and concentric remodeling, to patients with eccentric and concentric LVH. LV global longitudinal strain (GLS) was lower in all hypertensive groups compared with normotensive controls, in particular, in the eccentric (SMD 1.14 ± 0.22, CI: 0.69/1.59, P < 0.0001) and concentric LVH group (SMD 1.37 ± 0.21, CI: 0.95/1.79, P < 0.0001). The meta-analysis restricted to hypertensive patients showed that GLS gradually deteriorated from hypertensive patients with normal LV geometry, across those with concentric remodeling, to participants with eccentric and concentric LVH (-19.5 ± 0.6 versus -18.8 ± 0.73 versus -17.6 ± 0.66 versus -16.5 ± 0.6%, P < 0.001 for trend). Statistical significance was reached when GLS of the concentric and eccentric LVH group but not the concentric remodeling was compared with the normal geometry one.

Conclusion: The present meta-analysis confirms that GLS performs better than ejection fraction in identifying systolic dysfunction in the hypertension setting. More importantly, it suggests that this occurs in patients with altered LV structure and geometry, such as LVH.
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http://dx.doi.org/10.1097/HJH.0000000000002911DOI Listing
June 2021

The interactions between antihypertensive drugs and novel anticancer therapy.

J Hypertens 2021 Jul;39(7):1303-1305

Clinica Medica, University of Milan-Bicocca, Milan, Italy.

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http://dx.doi.org/10.1097/HJH.0000000000002806DOI Listing
July 2021

The Prognostic Importance of Right Ventricular Longitudinal Strain in Patients with Cardiomyopathies, Connective Tissue Diseases, Coronary Artery Disease, and Congenital Heart Diseases.

Diagnostics (Basel) 2021 May 26;11(6). Epub 2021 May 26.

Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany.

Right ventricular (RV) systolic function represents an important independent predictor of adverse outcomes in many cardiovascular (CV) diseases. However, conventional parameters of RV systolic function (tricuspid annular plane excursion (TAPSE), RV myocardial performance index (MPI), and fractional area change (FAC)) are not always able to detect subtle changes in RV function. New evidence indicates a significantly higher predictive value of RV longitudinal strain (LS) over conventional parameters. RVLS showed higher sensitivity and specificity in the detection of RV dysfunction in the absence of RV dilatation, apparent wall motion abnormalities, and reduced global RV systolic function. Additionally, RVLS represents a significant and independent predictor of adverse outcomes in patients with dilated cardiomyopathy (CMP), hypertrophic CMP, arrhythmogenic RV CMP, and amyloidosis, but also in patients with connective tissue diseases and patients with coronary artery disease. Due to its availability, echocardiography remains the main imaging tool for RVLS assessment, but cardiac magnetic resonance (CMR) also represents an important additional imaging tool in RVLG assessment. The findings from the large studies support the routine evaluation of RVLS in the majority of CV patients, but this has still not been adopted in daily clinical practice. This clinical review aims to summarize the significance and predictive value of RVLS in patients with different types of cardiomyopathies, tissue connective diseases, and coronary artery disease.
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http://dx.doi.org/10.3390/diagnostics11060954DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8228710PMC
May 2021

In-hospital outcome in COVID-19 patients: Did we learn something?

Kardiol Pol 2021 Jun 1. Epub 2021 Jun 1.

Department of Medicine and Surgery, University of Milano-Bicocca, and Milano Istituto Auxologico Italiano, IRCCS, Milano, Italy.

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http://dx.doi.org/10.33963/KP.a2021.0027DOI Listing
June 2021

Myocardial strain in hypertension: a meta-analysis of two-dimensional speckle tracking echocardiographic studies.

J Hypertens 2021 May 28. Epub 2021 May 28.

University Hospital 'Dr Dragisa Misovic - Dedinje' Department of Cardiology, Belgrade, Serbia Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.

Aim: Available evidence on systolic dysfunction in systemic hypertension, as assessed by left ventricular (LV) mechanics, is still based on single studies. Thus, we performed a systematic meta-analysis of two-dimensional speckle-tracking studies in order to provide an updated comprehensive information on this issue.

Methods: The PubMed, OVID-MEDLINE, and Cochrane library databases were analyzed to search English language articles published from the inception up to 31 December 2020. Studies were identified by using MeSH terms and crossing the following search items: 'myocardial strain', 'left ventricular mechanics', 'speckle tracking echocardiography', 'systolic dysfunction', 'hypertensive heart disease', 'systemic hypertension', 'essential hypertension'.

Results: Data from 4276 individuals (2089 normotensive controls and 2187 mostly uncomplicated hypertensive patients) were included. Left ventricular (LV) mass index, relative wall thickness, left atrial volume index and E/e' ratio were significantly higher in hypertensive patients than in normotensive controls. LV ejection fraction did not differ in the two pooled groups (SMD -0.048 ± 0.054, 95% CI -0.20 to 0.10, P = 0.30), whereas LV global longitudinal strain (GLS) was significantly impaired in the hypertensive group (SMD: 1.07 ± 0. 15, 95% CI 0.77-1.36, P < 0.0001). Similar findings were obtained in a sub-analysis restricted to 15 studies in which mean age was similar in cases and controls (SMD 1.21 ± 0.23, 95% CI 0.76-1.67, P = 0.002).

Conclusion: The present meta-analysis suggests that GLS assessment unmasks systolic dysfunction undetected by conventional ejection fraction in the uncomplicated hypertension setting and that this parameter should be incorporated into routine work-up aimed to identify hypertension-mediated cardiac damage.
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http://dx.doi.org/10.1097/HJH.0000000000002898DOI Listing
May 2021

The influence of left ventricular geometry on myocardial work in essential hypertension.

J Hum Hypertens 2021 May 5. Epub 2021 May 5.

Department of Cardiology, University Hospital "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia.

We sought to investigate echocardiography-derived myocardial work in hypertensive patients with different left ventricular (LV) geometric patterns. This cross-sectional study included 211 hypertensive patients (74 with normal LV geometry, 53 with concentric remodeling, 46 with eccentric LV hypertrophy (LVH) and 38 with concentric LVH) who underwent complete two-dimensional echocardiographic examination including two-dimensional speckle-tracking echocardiography. Pressure-strain curve was used to determine parameters of myocardial work. Our findings showed that multidirectional LV strain was lower in patients with eccentric and concentric LVH than in those with normal LV geometry and concentric remodeling. Global myocardial work index and global constructive work were higher in patients with eccentric and concentric LVH than in those with normal LV geometry and concentric remodeling. Global wasted work and global efficacy work were similar between groups with different LV geometry. E/e' and LV mass index were associated with global myocardial work index and global constructive work independently of clinical and echocardiographic parameters. In conclusion, myocardial work was higher in patients with eccentric and concentric LVH than in patients with normal LV geometry and concentric remodeling. Increased blood pressure in patients with concentric LVH in comparison with other LV geometric patterns has significant impact on the final result. LV geometry has significant impact on myocardial work in hypertensive patients.
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http://dx.doi.org/10.1038/s41371-021-00543-2DOI Listing
May 2021

Characteristics of the 24-hour ambulatory blood pressure monitoring in a COVID-19 survivor.

Future Cardiol 2021 Apr 20. Epub 2021 Apr 20.

Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.

COVID-19 infection primarily causes severe pneumonia complicated by acute respiratory distress syndrome and multiorgan failure requiring a ventilator support. We present a case of a 55-year-old male, admitted with COVID-19. He was obese but had no other medical conditions. His blood pressure was measured by his general physician on several occasions in the past, all values being normal (<140/90 mmHg). He developed multiorgan failure, requiring vasopressor and ventilator support for 17 days. A prone positioning improved the arterial oxygenation, and reduced the need for supplemental oxygen. After recovery, he showed persistently elevated blood pressure and sinus tachycardia both in clinic and out-of-clinic. The activation of the renin-angiotensin-aldosterone and sympathetic systems, volume-overload, hyperreninemia and cytokine storm might have contributed to the exaggerated cardiovascular response.
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http://dx.doi.org/10.2217/fca-2020-0235DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8056747PMC
April 2021

New antidiabetic therapy and HFpEF: light at the end of tunnel?

Heart Fail Rev 2021 Apr 11. Epub 2021 Apr 11.

Clinica Medica, University of Milan-Bicocca, Milan, Italy.

New antidiabetic therapy that includes sodium-glucose co-transporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 receptor (GLP-1R) agonists, and dipeptidyl peptidase 4 (DPP-4) inhibitors showed significant benefit on cardiovascular outcomes in patients with and without type 2 diabetes mellitus, and this was particularly confirmed for SGLT2 inhibitors in subjects with heart failure (HF) with reduced ejection fraction (HFrEF). Their role on patients with HF with preserved ejection fraction (HFpEF) is still not elucidated, but encouraging results coming from the clinical studies indicate their beneficial role. The role of GLP-1R agonists and particularly DPP-4 inhibitors is less clear and debatable. Findings from the meta-analyses are sending positive message about the use of GLP-1R agonists in HFrEF therapy and revealed the improvement of left ventricular (LV) diastolic function in HFpEF. Nevertheless, the relevant medical societies still consider their effect as neutral or insufficiently investigated in HF patients. The impact of DPP-4 inhibitors in HF is the most controversial due to conflicting data that range from negative impact and increased risk of hospitalization due to HF, throughout neutral effect, to beneficial influence on LV diastolic dysfunction. However, this is a very heterogeneous group of medications and some professional societies made clear discrepancy between saxagliptin that might increase risk of HF hospitalization and those DPP-4 inhibitors that have no effect on hospitalization. The aim of this review is to summarize current clinical evidence about the effect of new antidiabetic medications on LV diastolic function and their potential benefits in HFpEF patients.
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http://dx.doi.org/10.1007/s10741-021-10106-9DOI Listing
April 2021

Association between myocardial work and functional capacity in patients with arterial hypertension: an echocardiographic study.

Blood Press 2021 06 26;30(3):188-195. Epub 2021 Mar 26.

Department of Cardiology, University Hospital 'Dr. Dragisa Misovic - Dedinje', Belgrade, Serbia.

Purpose: The aim of this study was to examine myocardial performance using pressure-strain loops in hypertensive patients with different level of blood pressure control.

Material And Methods: This cross-sectional study included 204 subjects (45 controls, 70 patients with well-controlled hypertension, 58 patients with uncontrolled hypertension and 31 patients with resistant hypertension) who underwent complete two-dimensional echocardiographic examination including two-dimensional speckle-tracking echocardiography. Pressure-strain curve was used to determine global myocardial work, constructive work, wasted work and work efficiency in all study participants.

Results: Left ventricular (LV) longitudinal strain gradually reduced from controls throughout well-controlled hypertensive patients, to patients with uncontrolled and resistant hypertension. Global myocardial work was higher in patients with uncontrolled and resistant hypertension than in controls and well-controlled hypertension. Constructive work was also higher in all hypertensive patients than in controls. Global wasted work and work efficiency were similar between different groups. Global myocardial work index was associated with peak oxygen consumption independently of sex, age, body mass index (BMI), LV structural and functional parameters in all hypertensive participants.

Conclusions: Myocardial work was significantly deteriorated in patients with uncontrolled and resistant arterial hypertension compared to controls and well-controlled hypertensive patients. Global myocardial work was associated with functional capacity independent of clinical and echocardiographic parameters.
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http://dx.doi.org/10.1080/08037051.2021.1902267DOI Listing
June 2021

Looking at the best indexing method of left atrial volume in the hypertensive setting.

Hypertens Res 2021 Jun 11;44(6):722-724. Epub 2021 Mar 11.

University Hospital "Dr. Dragisa Misovic - Dedinje" Department of Cardiology, Belgrade, Serbia.

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http://dx.doi.org/10.1038/s41440-021-00642-0DOI Listing
June 2021

Coronavirus disease 2019 and cardiovascular complications: focused clinical review.

J Hypertens 2021 07;39(7):1282-1292

University of Milano-Bicocca, Milano and Policlinico di Monza, Monza, Italy.

The coronavirus disease 2019 (COVID-19) may cause not only an acute respiratory distress syndrome (ARDS) but also multiple organ damage and failure requiring intensive care and leading to death. Male sex, advanced age, chronic lung disease, chronic kidney disease and cardiovascular disease, such as hypertension, diabetes and obesity have been identified as risk factors for the COVID-19 severity. Presumably, as these three cardiovascular risk factors are associated with a high prevalence of multiorgan damage. In the present focused clinical review, we will discuss the cardiovascular complications of COVID-19 including acute cardiovascular syndrome (acute cardiac injury/COVID cardiomyopathy, thromboembolic complications and arrhythmias) and post-COVID-19 sequelae. Preliminary data shows that the cause of acute cardiovascular syndrome may be multifactorial and involve direct viral invasion of the heart and vascular system, as well as through the immune and inflammation-mediated systemic cytokine storm. COVID-19 survivors may also show persistently elevated blood pressure and sinus tachycardia at rest. Furthermore, poor diabetic control, persistent renal damage and cerebral sequelae, such as persistent cognitive and neuropsychiatric alterations are also frequently reported. A particular attention should be paid towards cardiovascular protection in COVID-19 patients who develop acute cardiovascular syndromes during hospitalization, and/or permanent/semipermanent sequelae after recovery from COVID-19. These conditions may require careful clinical assessment, treatment and close follow-up to avoid short-term and long-term complications.
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http://dx.doi.org/10.1097/HJH.0000000000002819DOI Listing
July 2021

Hypertension and COVID-19: Ongoing Controversies.

Front Cardiovasc Med 2021 17;8:639222. Epub 2021 Feb 17.

Department of Cardiology, University of Milan-Bicocca, Milan, Italy.

Coronavirus disease 2019 (COVID-19) has become a worldwide pandemic responsible for millions of deaths around the world. Hypertension has been identified as one of the most common comorbidities and risk factors for severity and adverse outcome in these patients. Recent investigations have raised the question whether hypertension represents a predictor of outcome in COVID-19 patients independently of other common comorbidities such as diabetes, obesity, other cardiovascular diseases, chronic kidney, liver, and pulmonary diseases. However, the impact of chronic and newly diagnosed hypertension in COVID-19 patients has been insufficiently investigated. The same is true for the relationship between blood pressure levels and outcomes in COVID-19 patients. It seems that the long discussion about the impact of angiotensin-converting enzyme inhibitors (ACEI) and blockers of angiotensin I receptors (ARB) on severity and outcome in COVID-19 is approaching an end because the large number of original studies and meta-analyses discarded the initial findings about higher prevalence of ACEI/ARB use in patients with unfavorable outcomes. Nevertheless, there are many controversies in the relationship between hypertension and COVID-19. The aim of this review article is to provide a clinical overview of the currently available evidence regarding the predictive value of hypertension, the effect of blood pressure levels, the impact of previously known and newly diagnosed hypertension, and the effect of antihypertensive therapy on the severity and outcomes in COVID-19 patients.
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http://dx.doi.org/10.3389/fcvm.2021.639222DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7925389PMC
February 2021

Reverse dipping and subclinical cardiac organ damage: a meta-analysis of echocardiographic studies.

J Hypertens 2021 Aug;39(8):1505-1512

Department of Medicine and Surgery, University of Milano-Bicocca.

Aim: Available evidence on the association between reverse dipping pattern and subclinical cardiac damage is scanty. We performed a systematic meta-analysis of echocardiographic studies in order to provide an updated and comprehensive information on this issue.

Methods: The PubMed, OVID-MEDLINE, and Cochrane library databases were analyzed to search English-language articles published from January from the inception up to 31 July 2020. Studies were identified by using MeSH terms and crossing the following search items: 'reverse dipping', 'nondipping', 'inverted dipping', 'ambulatory blood pressure', 'cardiac damage', 'hypertensive heart disease', 'left ventricular mass', 'left ventricular hypertrophy', and 'echocardiography'.

Results: Data from 14 studies including 1429 patients with reverse dipping, 2584 dippers and 3508 nondippers were considered. Left ventricular (LV) mass index and relative wall thickness were greater in reverse dippers than in dippers (SMD: 0.40 ± 0.04 g/m2, P < 0.0001; 0.31 ± 0.07, P < 0.0001) and nondippers (SMD: 0.25 ± 0.04 g/m2, P < 0.0001; 0.21 ± 0.07, P = 0.004). The reverse dipping group had an increased risk of LV hypertrophy compared with dipping (OR = 1.85, CI 1.47-2.32, P < 0.0001) and nondipping group (OR = 1.45, CI 1.19-1.78, P < 0.0001). A significant progressive reduction in the E/A ratio, paralleled by an increase in left atrium diameter occurred from dippers, to nondippers and reverse dippers.

Conclusion: The present meta-analysis provides a novel piece of information about the unfavourable association between the reverse dipping pattern and subclinical cardiac alterations and suggests that the detection of this blood pressure phenotype may identify individuals at increased risk for subclinical organ damage.
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http://dx.doi.org/10.1097/HJH.0000000000002836DOI Listing
August 2021

Extreme dipping and target organ damage: is there any relationship?

J Hum Hypertens 2021 Feb 23. Epub 2021 Feb 23.

University of Milan-Bicocca, Milan, Italy.

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http://dx.doi.org/10.1038/s41371-021-00501-yDOI Listing
February 2021

Blood pressure variability and target organ damage regression in hypertension.

J Clin Hypertens (Greenwich) 2021 06 4;23(6):1159-1161. Epub 2021 Feb 4.

University Clinical Hospital Centre "Dragisa Misovic", Belgrade, Serbia.

The study by Triantafyllidi et al. supports the view that regression of subclinical cardiac damage requires an effective 24-hour blood pressure (BP) control along with a reduction in BP variability and suggests that the assessment of BPV and its modifications during the course of therapy may be an useful approach in predicting the beneficial effects of treatment on cardiac structure. However, some aspects and limitations of this study require caution in drawing firm conclusions. So, further investigation is needed to determine if reduction of BPV is actually associated with a regression in cardiac and extracardiac organ damage to identify which which classes of antihypertensive drugs are most effective in reducing BPV, and to elucidate whether those treatments provide additional clinical benefit, independent of the conventional BP targets.
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http://dx.doi.org/10.1111/jch.14208DOI Listing
June 2021

The prevalence and Covariates of Stroke in Khyber Pakhtunkhwa; From a European Perspective.

Pak J Med Sci 2021 Jan-Feb;37(1):1-3

Jukka Putaala MD, PhD. Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

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http://dx.doi.org/10.12669/pjms.37.1.3815DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7794126PMC
January 2021

The influence of diabetes and hypertension on outcome in COVID-19 patients: Do we mix apples and oranges?

J Clin Hypertens (Greenwich) 2021 02 25;23(2):235-237. Epub 2020 Dec 25.

University of Milan-Bicocca, Milan, Italy.

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http://dx.doi.org/10.1111/jch.14145DOI Listing
February 2021

Targeting persistent normal left ventricular geometry in the general population: a 25-year follow-up study.

J Hypertens 2021 May;39(5):952-960

Department of Medicine and Surgery, University of Milano-Bicocca.

Aim: Findings regarding the extent of persistence over time of normal left ventricular (LV) geometry, a reference healthy echocardiographic phenotype, in the community are scanty. We sought to assess this issue in members of the general population enrolled in the Pressioni Arteriose Monitorate e Loro Associazioni study.

Methods: The study included 433 participants who attended the second and third survey of the Pressioni Arteriose Monitorate e Loro Associazioni study performed after 10 and 25 years from the initial evaluation. Data collection included medical history, anthropometric parameters, office, home, ambulatory blood pressure, routine blood examinations and echocardiography.

Results: During 25-year follow-up 167 participants showed persistently normal LV mass (LVM) and LV geometry pattern, whereas 266 participants exhibited LV hypertrophy or LV concentric remodelling at any point during study. Compared with participants developing, maintaining or regressing from LV hypertrophy and LV concentric remodelling those with a persistently normal LVM index and geometry were younger (-8 years) and more frequently female (63 vs. 45%), exhibited baseline (and follow-up) lower office and out-of-office blood pressure, BMI, serum creatinine, fasting blood glucose total serum cholesterol and rate of antihypertensive treatment. In multivariate regression analysis age [odds ratio (OR): 0.93, confidence interval (CI): 0.91-0.96, P < 0.0001] BMI (OR: 0.90, CI: 0.83-0.97, P = 0.008), office SBP (OR: 0.97, CI: 0.95-0.99, P = 0.005) and fasting blood glucose (OR: 0.96, CI: 0.93-0.99, P = 0.007) were independently associated with persistent normal LVM index and geometry.

Conclusion: The current long-term longitudinal study suggests that persistence of normal LV geometry is associated with normal/optimal SBP, BMI and blood glucose. Thus, a closer control of these risk factors in midlife may increase the likelihood of maintaining normal ventricular geometry and, in turn, reduce the burden of subclinical cardiac organ damage and related complications in advanced age.
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http://dx.doi.org/10.1097/HJH.0000000000002746DOI Listing
May 2021

Left atrial stiffness: a novel marker of hypertension-mediated organ damage on the horizon?

Hypertens Res 2021 03 1;44(3):365-367. Epub 2020 Dec 1.

Department of Cardiology, University Hospital "Dr. Dragisa Misovic-Dedinje", Belgrade, Serbia.

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http://dx.doi.org/10.1038/s41440-020-00582-1DOI Listing
March 2021

The value of multimodality imaging in hypertensive heart disease.

J Hypertens 2021 May;39(5):1040-1043

Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.

Hypertensive heart disease (HHD) includes left ventricular (LV) functional and structural remodeling. For a long time, this involved only LV diastolic dysfunction and LV hypertrophy. However, development of imaging technique enabled more detailed insights into LV mechanics. Its impairment seems to be the first step in the cascade of HHD. Tissue characterization, obtained by cardiac magnetic resonance, opened a completely new chapter in the assessment of HHD. We report a case of a 47-year-old man who was referred to our department for a newly detected heart failure. CT angiography excluded relevant coronary disease and cardiac magnetic resonance revealed focuses of fibrosis in interventricular septum, in addition severely dilated LV with severely reduced ejection fraction. Considering the fact that the patient had longstanding uncontrolled arterial hypertension and that other causes of cardiac remodeling and dysfunction were excluded, we hypothesized that the multimodality imaging approach enabled prompt diagnosis of HHD.
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http://dx.doi.org/10.1097/HJH.0000000000002726DOI Listing
May 2021

How to unmask masked hypertension: the role of office aortic blood pressure.

Hypertens Res 2021 02 5;44(2):256-258. Epub 2020 Nov 5.

Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy.

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http://dx.doi.org/10.1038/s41440-020-00573-2DOI Listing
February 2021

Right ventricular infarction: can we still use old tricks?

Minerva Cardioangiol 2020 Nov 4. Epub 2020 Nov 4.

Division of Cardiology, S. Maria Goretti Hospital, Latina, Italy.

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http://dx.doi.org/10.23736/S0026-4725.20.05412-2DOI Listing
November 2020

The therapy with icosapent ethyl after the EVAPORATE trial: Between hope and skepticism.

J Clin Hypertens (Greenwich) 2020 12 21;22(12):2382-2384. Epub 2020 Oct 21.

University of Milan-Bicocca, Milan, Italy.

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http://dx.doi.org/10.1111/jch.14082DOI Listing
December 2020

Left ventricular mechanics in patients with hematological malignancies before initiation of chemo- and radiotherapy.

Int J Cardiovasc Imaging 2021 Mar 12;37(3):881-887. Epub 2020 Oct 12.

Department of Cardiology, Charité-University-Medicine Berlin, Campus Virchow Klinikum (CVK), Augustenburger Platz 1, 13353, Berlin, Germany.

Objective We sought to investigate left ventricular (LV) structure, function and mechanics in the patients with leukemia and lymphoma before initiation of chemotherapy, as well as the relationship between hematological malignancies and reduced LV longitudinal strain. Methods This retrospective investigation included 71 patients with leukemia and lymphoma before chemotherapy and 36 healthy controls. All participants underwent echocardiographic examination before initiation of chemotherapy and radiotherapy. Results LV global longitudinal strain (- 20.2 ± 1.7% vs. - 17.9 ± 3.0%, p < 0.001) was significantly lower in the patients with hematological malignancies than in controls. There was no difference in LV circumferential and radial strains between two observed groups. Subendocardial and subepicardial longitudinal strains were significantly lower in the patients with hematological malignancies (- 20.5 ± 3.6% vs. - 22.5 ± 3.8%, p = 0.001 for subendocardial strain; - 18.0 ± 1.5% vs. - 15.8 ± 2.6%, p < 0.001 for subepicardial strain). Hematological malignancies were associated with reduced global LV longitudinal strain (OR 21.0; 95%CI 2.04-215.0, p = 0.010) independently of age, gender, heart rate, body mass index, left ventricular ejection fraction, left ventricular mass index, and glucose level. Conclusions LV longitudinal strain was impaired in the patients with leukemia and lymphoma even before initiation of chemotherapy. Endocardial and epicardial LV layers are equally affected in the patients with hematological malignancies. Newly diagnosed hematological malignancies were related with reduced LV global longitudinal strain independently of common clinical and echocardiographic parameters.
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http://dx.doi.org/10.1007/s10554-020-02061-7DOI Listing
March 2021

Regression of left ventricular hypertrophy in primary aldosteronism after adrenalectomy: a meta-analysis of echocardiographic studies.

J Hypertens 2021 Apr;39(4):775-783

Department of Medicine and Surgery, University of Milano-Bicocca, Milano.

Aim: Available evidence on regression of left ventricular (LV) hypertrophy in patients with primary aldosteronism after unilateral adrenalectomy is scanty. We performed a systematic meta-analysis of echocardiographic studies to provide an updated and comprehensive information on this issue.

Methods: The PubMed, OVID-MEDLINE and Cochrane library databases were analyzed to search English-language articles published from 1 January 1990 up to 30 June 2020. Studies were identified by using MeSH terms and crossing the following search items: 'primary aldosteronism' 'Conn's syndrome' 'adrenalectomy', with 'cardiac damage', 'hypertensive heart disease' 'left ventricular mass', 'left ventricular hypertrophy', 'left ventricular hypertrophy regression', 'echocardiography'.

Results: A total of 629 hypertensive patients with primary aldosteronism (mean age 49 years, 45% men) were included in 14 studies. Baseline and postintervention pooled mean LV mass/BSA values were 134 ± 4 and 108 ± 3 g/m2 [standard means difference (SMD) -0.42 ± 0.05, confidence interval (CI) -0.52/-0.32, P < 0.0001]; corresponding values for LV mass/h2.7 were 56 ± 2 and 49 ± 1 g/h2.7 (SMD -0.45 ± 0.06, CI -0.52/-0.36, P < 0.0001). Adrenalectomy, followed by a marked decrease in blood pressure, was associated with a decrease in relative wall thickness (SMD -0.17 ± 0.06, CI -0.31/-0.03, P < 0.01) as well as in the number of antihypertensive drugs (SMD -0.45 ± 0.04, CI -0.50-0.32, P < 0.0001).

Conclusion: The present meta-analysis suggests that adrenalectomy in patients with primary aldosteronism exerts a beneficial effect on LV structure and geometry by reducing the burden of LV hypertrophy and LV concentric geometry.
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http://dx.doi.org/10.1097/HJH.0000000000002679DOI Listing
April 2021
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