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Acampa M, Lazzerini PE, Cartocci A, Iadanza E, Cevenini G, Domenichelli C, Accioli R, Salvini V, Guideri F, Tassi R, Martini G. The Impact of Sex and Arterial Stiffness Interactions on the Outcome after an Acute Ischemic Stroke: A Retrospective Cohort Study. J Clin Med 2024; 13:4095. [PMID: 39064135 PMCID: PMC11278401 DOI: 10.3390/jcm13144095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/18/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Background/Objectives: Arterial stiffness (AS) is an independent predictor of cardiovascular events and is associated with a poor prognosis. While AS may represent a novel therapeutic target, recent evidence shows that it is sexually dimorphic. The aim of this study was to evaluate relative sex differences in arterial stiffness and their possible impact on the outcome of acute ischemic stroke. Methods: We retrospectively evaluated a cohort of adult patients with the following inclusion criteria: acute ischemic stroke, which occurred within 24 h from the onset of symptoms, confirmed through neuroimaging examinations, additional evaluations including extracranial and transcranial arterial ultrasound examinations, transthoracic echocardiography, a 12-lead resting ECG, and continuous 24 h in-hospital blood pressure monitoring. Based on the 24 h blood pressure monitoring, the following parameters were evaluated: systolic blood pressure, diastolic blood pressure, mean blood pressure, pulse pressure, and arterial stiffness index (ASI). The modified Rankin scale (mRS) was assessed at 90 days to evaluate the 3-month clinical outcome, defining an unfavorable outcome as an mRS score ≥ 3. To assess the factors associated with unfavorable outcomes, a stepwise logistic regression model was performed on the total sample size, and the analyses were replicated after stratifying by sex. Results: A total of 334 patients (176 males, 158 females) were included in the analysis. There was a significant sex-dependent impact of ASI on the 90-day unfavorable Rankin score (mRS score ≥ 3) as only men had a reduced likelihood of favorable outcomes with increasing arterial stiffness (OR:1.54, 95% CI: 1.06-2.23; P-interaction = 0.023). Conclusions: The influence of ASI on the 3-month functional outcome after acute ischemic stroke is at least in part sex-related, suggesting that, in males, higher ASI values are associated with a worse outcome.
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Affiliation(s)
- Maurizio Acampa
- Stroke Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (F.G.); (G.M.)
| | - Pietro Enea Lazzerini
- Electroimmunology Unit, Division of Internal Medicine and Geriatrics, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (P.E.L.); (R.A.); (V.S.)
| | - Alessandra Cartocci
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (A.C.); (E.I.); (G.C.)
| | - Ernesto Iadanza
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (A.C.); (E.I.); (G.C.)
| | - Gabriele Cevenini
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (A.C.); (E.I.); (G.C.)
| | - Carlo Domenichelli
- Stroke Unit, Department of Emergency-Urgency and Transplants, Azienda Ospedaliera Universitaria Senese, “Santa Maria alle Scotte” General Hospital, 53100 Siena, Italy; (C.D.); (R.T.)
| | - Riccardo Accioli
- Electroimmunology Unit, Division of Internal Medicine and Geriatrics, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (P.E.L.); (R.A.); (V.S.)
| | - Viola Salvini
- Electroimmunology Unit, Division of Internal Medicine and Geriatrics, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (P.E.L.); (R.A.); (V.S.)
| | - Francesca Guideri
- Stroke Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (F.G.); (G.M.)
| | - Rossana Tassi
- Stroke Unit, Department of Emergency-Urgency and Transplants, Azienda Ospedaliera Universitaria Senese, “Santa Maria alle Scotte” General Hospital, 53100 Siena, Italy; (C.D.); (R.T.)
| | - Giuseppe Martini
- Stroke Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (F.G.); (G.M.)
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Candemir M, Kızıltunç E, Nurkoç SG, Cihan B, Şahinarslan A. Predictors of length of hospital stay and in-hospital adverse events in patients with acute decompensated heart failure: in-hospital 24-hour blood pressure monitoring data. Hellenic J Cardiol 2024:S1109-9666(24)00132-5. [PMID: 38925251 DOI: 10.1016/j.hjc.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/12/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE Neurohumoral alterations in heart failure (HF) affect blood pressure variability (BPV) and vascular compliance, but little is known about this subject among patients admitted to the hospital with decompensated HF. This study sought to investigate in-hospital 24-h blood pressure monitoring (BPM)-derived BPV parameters and vascular compliance in patients with decompensated HF and explore the association of these parameters with hospitalization length and in-hospital adverse events. METHODS A 24-h BPM was applied during the first 6 h of admission to the hospital in patients with decompensated HF. Circadian patterns were determined by the study patients. Average real variability (ARV), pulse pressure index (PPI), pulse stiffening ratio (PSR), and ambulatory arterial stiffness index (AASI) values were calculated from in hospital 24-h BPM recordings. Admission and discharge N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, length of hospitalization, and in-hospital adverse events were recorded. RESULTS A total of 167 patients with decompensated HF were included in the study. The dipper group exhibited a greater NT-proBNP decrease with the treatment than the non-dipper group and reverse dipper group. Hospitalization length was shorter in the dipper group than in the non-dipper and reverse dipper groups. Although ARV, AASI, and PSR were independently associated with the length of hospitalization, ARV, AASI, and PPI were independently associated with in-hospital adverse events. CONCLUSION The post-admission in hospital 24-h BPM-derived parameters (dipper pattern, ARV, PPI, PSR, and AASI) of patients admitted to hospital with decompensated HF provide important prognostic information and predict the length of hospital stay.
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Affiliation(s)
- Mustafa Candemir
- Gazi University, Faculty of Medicine, Department of Cardiology, Ankara 06560, Turkey.
| | - Emrullah Kızıltunç
- Gazi University, Faculty of Medicine, Department of Cardiology, Ankara 06560, Turkey
| | | | - Burcu Cihan
- Gazi University, Faculty of Medicine, Department of Cardiology, Ankara 06560, Turkey
| | - Asife Şahinarslan
- Gazi University, Faculty of Medicine, Department of Cardiology, Ankara 06560, Turkey
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Boos CJ, Hein A, Wardill T, Diamondali S, Wai S, O'Kane P, Khattab A. The relationship between ambulatory arterial stiffness index and incident atrial fibrillation. Clin Cardiol 2024; 47:e24299. [PMID: 38873860 PMCID: PMC11177039 DOI: 10.1002/clc.24299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 05/03/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND The ambulatory arterial stiffness index (AASI) is an indirect measure of blood pressure variability and arterial stiffness which are atrial fibrillation (AF) risk factors. The relationship between AASI and AF development has not been previously investigated and was the primary aim of this study. METHODS This was an observational cohort study of adults (aged 18-85 years) in sinus rhythm, who underwent 24-h ambulatory blood pressure monitoring (ABPM) for the diagnosis of hypertension or its control. RESULTS Eight hundred and twenty-one patients (49% men) aged 58.7 ± 15.3 years were followed up for a median of 4.0 years (3317 patient-years). In total, 75 patients (9.1%) developed ≥1 AF episode during follow-up. The mean AASI was 0.46 ± 0.17 (median 0.46). AASI values (0.52 ± 0.16 vs. 0.45 ± 0.17; p < .001) and the proportion of AASI values above the median (65.3% vs. 48.4%; p = .005) were greater among the patients who developed AF versus those that did not respectively. AASI significantly correlated with age (r = .49; 95% confidence interval: 0.44-0.54: p < .001). On Kaplan-Meier analysis, higher baseline AASI by median, tertiles, and quartiles were all significantly associated with AF development (X2: 10.13; p < .001). On Cox regression analyses, both a 1-standard deviation increase and AASI > median were independent predictors of AF, but this relationship was no longer significant when age was included in the model. CONCLUSIONS AASI is an independent predictor of AF development. However, this relationship becomes insignificant after adjustment for age which is higher correlated with AASI.
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Affiliation(s)
- Christopher J. Boos
- Department of CardiologyUniversity Hospitals DorsetDorsetUK
- Faculty of Health & Social SciencesBournemouth UniversityBournemouthUK
| | - Aung Hein
- Faculty of Health & Social SciencesBournemouth UniversityBournemouthUK
| | - Tom Wardill
- Faculty of Health & Social SciencesBournemouth UniversityBournemouthUK
| | - Sadaf Diamondali
- Faculty of Health & Social SciencesBournemouth UniversityBournemouthUK
| | - Su Wai
- Department of CardiologyUniversity Hospitals DorsetDorsetUK
| | - Peter O'Kane
- Department of CardiologyUniversity Hospitals DorsetDorsetUK
| | - Ahmed Khattab
- Faculty of Health & Social SciencesBournemouth UniversityBournemouthUK
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Boos CJ, Hein A, Khattab A. Ambulatory arterial stiffness index, mortality, and adverse cardiovascular outcomes; Systematic review and meta-analysis. J Clin Hypertens (Greenwich) 2024; 26:89-101. [PMID: 38234206 PMCID: PMC10857461 DOI: 10.1111/jch.14755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/30/2023] [Accepted: 11/19/2023] [Indexed: 01/19/2024]
Abstract
The ambulatory arterial stiffness index (AASI) is a novel measure of both blood pressure (BP) variability and arterial stiffness. This systematic review and meta-analysis was designed to evaluate the strength of the association between AASI and mortality and major adverse cardiovascular events (MACE). PubMed, Scopus, CINAHL, Google Scholar. and the Cochrane library were searched for relevant studies to July 31, 2023. Two investigators independently extracted data. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of all included articles. The relationship between baseline AASI and outcomes were examined using relative risk (RR) ratios with 95% confidence intervals (CI) with RevMan web. Thirteen studies were included and representing 28 855 adult patients who were followed up from 2.2 to 15.2 years. A 1-standard deviation (1-SD) increase in AASI was associated with a significant increase in all-cause death (RR 1.12; 95% CI: 0.95-1.32), stroke (RR 1.25; 95% CI: 1.09-1.44), and MACE (RR 1.07; 95% CI: 1.01-1.13; [I2 = 32%]). Higher dichotomized AASI (above vs. below researcher defined cut-offs) was associated with a significant increase in all-cause mortality (RR 1.19; 95% CI: 1.06-1.32), cardiovascular death (RR 1.29; 95% CI: 1.14-1.46), stroke (RR 1.57; 95% CI: 1.33-1.85), and MACE (RR1.29; 95% CI: 1.16-1.44). There was a significant risk of bias in more than 50% of studies with no evidence of significant publication bias. Higher AASI is associated with an increased risk of all-cause and cardiovascular death, stroke, and MACE. Further high-quality studies are warranted to determine reproducible AASI cut-offs to enhance its clinical risk precision.
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Affiliation(s)
| | - Aung Hein
- Faculty of Health & Social SciencesBournemouth UniversityBournemouthUK
| | - Ahmed Khattab
- Faculty of Health & Social SciencesBournemouth UniversityBournemouthUK
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Lang X, Wang Q, Huang S, Feng D, Ding F, Wang W. Relations among perceived stress, fatigue, and sleepiness, and their effects on the ambulatory arterial stiffness index in medical staff: A cross-sectional study. Front Psychol 2022; 13:1010647. [PMID: 36389608 PMCID: PMC9652142 DOI: 10.3389/fpsyg.2022.1010647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/13/2022] [Indexed: 01/24/2023] Open
Abstract
Objective To explore the relations among perceived stress, fatigue, sleepiness, and the pathway of their effects on the ambulatory arterial stiffness index (AASI) among medical staff. Methods This cross-sectional study was conducted at a tertiary hospital in Wuhan, China. Perceived stress, fatigue, and sleepiness were measured using the perceived stress scale (PSS), Fatigue assessment scale (FAS), and Epworth Sleepiness Scale (ESS), respectively. AASI was obtained from 24-h ambulatory blood pressure monitoring. Path analysis was used to clarify the relations among the PSS, FAS, and ESS scores, and their relations to AASI values. Results A total of 153 participants were included herein. The PSS and FAS correlated with the ESS (r = 0.424, p < 0.001), and the PSS correlated with the FAS (r = 0.614, p < 0.001). In addition, the ESS correlated with the AASI (r = 0.225, p = 0.005). According to the path analysis results, the PSS and FAS had no direct effect on the AASI, but did have an indirect effect on this index (β = 0.059, 95% confidence interval [CI] = 0.017-0.128, p = 0.005; β = 0.059, 95%CI = 0.016-0.135, p = 0.006, respectively) by influencing the ESS (β = 0.263, β = 0.262, p = 0.004). Conclusion Sleepiness was a mediator of the effects of perceived stress and fatigue on AASI.
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Affiliation(s)
- Xiaorong Lang
- School of Nursing, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China,Tongji Hospital Affiliated with Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Quan Wang
- School of Nursing, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China,Tongji Hospital Affiliated with Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Sufang Huang
- Tongji Hospital Affiliated with Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China,*Correspondence: Sufang Huang,
| | - Danni Feng
- School of Nursing, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Fengfei Ding
- Department of Pharmacology, Fudan University Basic Medicine College, Shanghai, China
| | - Wei Wang
- Tongji Hospital Affiliated with Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
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