Volume 2 Issue 1
Research Article: Management of Therapy Resistant Hypertension Guided by Non-Invasive Hemodynamic Measurements; an Observational Study
Rainer Szulcek1, Robert Szulcek2 and Peter Lanzer3*
Objective: Management of patients with therapy resistant hypertension is largely guided by empiricism and remains challenging. The study was designed to guide the medical therapy by thorax impedance derived hemodynamics in real-life out-patient office settings.
Methods: Fifty patients, 22 females, 61.8 ± 8.0 years of age and 28 males, 63.0 ± 12.0 years of age with confirmed therapy resistant hypertension were studied at baseline and 6 and 12 months follow-up. In each patient office and ambulatory 24 hours blood pressure measurements were taken at each data point. Antihypertensive medication was adjusted based on the outcome of hemodynamic measurements utilizing the HOTMAN-System® thoracic impedance. Specifically, the hemodynamic modulators Volume Status (VS), Vasotonus (VT) and Left Stroke Work Index (LSWI) were measured.
Results: At six months follow-up office and 24 hours ambulatory blood pressure measurements in patients' cohort significant reduction of systolic and diastolic pressures from baseline 170.3 ± 20.7/ 90.2 ± 13.3 mmHg to 149.26 ± 18.5/ 82.3 ± 13.2 mmHg (p < 0.0001/ p < 0.0015) and 144.4 ± 18.2/ 82.8 ± 12.6 mmHg to 130.1 ± 15.5/ 76.0 ± 12.8 mmHg (p < 0.0001 and p < 0.0006), respectively, was noted. On twelve months follow-up the positive effect was largely maintained but no further blood pressure reduction was achieved. Among the hemodynamic modulators hypervolumic state has been the most frequent (87.8%) and the most prominent (136. 0 ± 134.1%) factor. At six months follow-up volume state reduction to 73.7% ± 26.4% (p = 0.002) was achieved.
Conclusions: In patients with therapy resistant hypertension hemodynamically- guided blood pressure management may represent complementary approach to the current empiricism- guided approach to improve blood pressure control.
Cite this Article: Szulcek R, Szulcek R, Lanzer P. Management of Therapy Resistant Hypertension Guided by Non-Invasive Hemodynamic Measurements; an Observational Study. Int J Clin Cardiol Res. 2018;2(1): 022-026
Published: 05 March 2018
Research Article: Gender Effects on Direct vs Indirect Blood Pressure Measurements at Rest and During Biking
Moran S. Sashiv1*, Ehud Goldhammer2, David Ben-Sira3 and Michael S. Sagiv3
Purpose: This study tested gender effect on the systolic and diastolic Blood Pressures (BP) measured simultaneously by intra - arterial catheter and auscultation methods at rest, during two submaximal aerobic exercises and at peak bicycle exercise.
Methods: Comparisons were made between females and males: 18 males and 18 females age 23.6 ± 2.0 and 24.0 ± 2.0 years respectively, with work capacity of 14.5 ± 1.2 for males and 12.8 METs for females were recruited.
Results: At all conditions, heart rate were significantly (p < 0.05) higher in the females compared to the males group. At rest, correlations coefficients between direct and indirect BP measurements were high in female and males (0.91 and 0.92 respectively) for systolic BP and satisfactory for the diastolic BP (0.83 and 0.83 respectively). During exercises, at 60% and 70% efforts, correlations coefficients between direct and indirect BP measurements were high in females and males for systolic BP (0.92 and 0.90 respectively) and reasonable for the diastolic BP. At peak exercise no differences between males and females were noted in means achieved for systolic BP and diastolic BP.
Conclusions: The validity of an auscultation method in females and males at rest, submaximal aerobic exercise and peak aerobic exercises, are reliable for systolic BP, while auscultatory diastolic BP readings at rest and submaximal satisfactory. The significant higher rise in systolic BP in males compared to females reflects gender differences in levels of sympathetic and parasympathetic drive.
Keywords: Aerobic exercise; Auscultation; Intra - arterial blood pressure; Systolic blood pressure; Diastolic blood pressure.
Cite this Article: Sashiv MS, Goldhammer E, Sira DB, Sagiv MS. Gender Effects on Direct vs Indirect Blood Pressure Measurements at Rest and During Biking. Int J Clin Cardiol Res. 2018;2(1): 017-021.
Published: 26 February 2018
Letter to Editor: Modified Parameter of 2D Echocardiographic Wilkins Score for Assessment of Rheumatic Mitral Valve Stenosis
Wassam EL Din Hadad EL Shafey*
The Mitral Valve (MV) is the most commonly and severely affected (65% - 70% of patients) by rheumatic process by stenosis and/or regurgitation . Percutaneous Balloon Mitral Valvuloplasty (BMV) was introduced in 1984 by Inoue et al . For the treatment of selected patients with mitral stenosis. BMV is a minimally invasive, nonsurgical procedure that has been established in several clinical studies to be a safe and effective therapeutic modality in selected patients with Mitral Stenosis (MS)  and is equivalent to or even better than surgical commissurotomy . Unfavourable results of BMV are largely due to unfavourable morphology of the valve apparatus, particularly leaflets calcification and subvalvular apparatus involvement. A mitral valve score has been proposed about two decades ago, based on morphologic assessment of mitral valve apparatus by two-dimensional (2D) echocardiography to predict successful balloon dilation of the mitral valve. Several other scores have been developed in the following years in order to more successfully predict balloon dilatation outcome [5,6]. As regard the subjective nature of the Wilkins score [5,6] for assessment of rheumatic Mitral valve stenosis by 2D echocardiography, I present a novel objective and quantitative echocardiographic parameter for precise selection of patient best treated by BMV in addition to Wilkins score, through measuring free 2D strain and strain rate of both papillary muscles of mitral valve.
Cite this Article: Hadad EL Shafey WED. Modified Parameter of 2D Echocardiographic Wilkins Score for Assessment of Rheumatic Mitral Valve Stenosis. Int J Clin Cardiol Res. 2018;2(1): 014-016.
Published: 22 February 2018
Research Article: Assessment of Predictors and Prevalence of Peripheral Artery Disease among Type 2 Diabetic Patients in Zaria, Northern Nigerian
Yakubu PD1*, Khanna NN2, Bakari AG3, Garko SB2, Abubakar AB1, Adeiza MA, Iheonye HO2 and Danbauchi SS4
Background: The Ankle Brachial Index (ABI) is a simple, cheap, reliable, reproducible, highly sensitive and specific method used for the diagnosis of peripheral artery disease. It is defined as the ratio of the highest systolic blood pressure at the ankles divided by the higher of the systolic blood pressure at the arms.
Objective: To assess the predictors and prevalence of Peripheral Artery Disease (PAD) among type 2 diabetic patients in northern Nigeria.
Methodology: We conducted a descriptive cross sectional study among two hundred type 2 diabetic subjects comprising 82 (41%) males, 118 (59%) females and 100 age and gender matched non-diabetic, non-hypertensive, non-obese, non-cigarette smoker controls in Zaria, northern Nigeria. The mean ages of the diabetic subjects and the controls were 52.71 (± 10.60) and 52.10 (± 9.88) years respectively.
Results: The PAD among the type 2 diabetes subjects was 29% which was statistically significantly higher than the 13% in the controls (P = 0.00, OR = 2.76). Independent predictors of PAD after adjusting for confounders were intermittent claudication (AOR = 3.197), CI = 0.123-0.519), poor nails growth (AOR = 2.492, CI = 0.123-0.519) diminished/absent pedal pulses (AOR = 6.499, CI = 0.150-0.505), two hours postprandial glucose > 8.0 mmol/L (AOR = 2.512, CI = 0.032-0.264), HbA1c = 7.0% (AOR = 2.589, CI = 0.064-0.477).
Conclusion: There is high (29%) PAD among type 2 diabetic patients in northern Nigeria. The routine use of ABI will be a very significant way for early diagnosis which may result in early treatment in order to prevent complications.
Keywords: Diabetic; Peripheral Artery Disease; Predictors And Prevalence; Zaria
Cite this Article: akubu PD, Khanna NN, Bakari AG, Garko SB, Abubakar AB, et al. Assessment of Predictors and Prevalence of Peripheral Artery Disease among Type 2 Diabetic Patients in Zaria, Northern Nigeria. Int J Clin Cardiol Res. 2018;2(1): 008-013.
Published: 12 February 2018
Mark I.M. Noble*
As the electron is the sub-atomic particle embodying electrical energy, it can hardly be possible for cardiac electrophysiology not to involve electrons. This problem was approached by a focus on the changes in electric charge throughout the cardiac ventricular cycle. Depolarisation involved a rapid net loss of diastolic total negative charge. This loss of negative charge upon depolarisation was attributed to outflow of electrons in excess of sodium ion (Na+) ingress through sodium channels. Depolarisation was followed by a period of net total positive charge during the calcium transient attributed to calcium ion (Ca2+) release to cause contraction, and subsequent Ca2+ uptake by the sarcoplasmic reticulum. Repolarisation as a result of potassium ion (K+) outflow was found to cause intracellular K+ depletion not compatible with a steady state. Repolarisation was attributed to electron generation during oxidative phosphorylation by mitochondria. A one way process of electron generation and subsequent loss and dissipation as heat is postulated. .
Cite this Article: Mark I.M.Noble. A Re-Appraisement of Key Aspects of Ventricular Excitation and Contraction. Int J Clin Cardiol Res. 2018;2(1): 001-007.
Published: 04 January 2018
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